Friday, January 25, 2008

HR101 - Flexible Spending Accounts (FSA)

If your employer offers an FSA program & you have any out-of-pocket costs, it would behoove you to learn more & enroll when you get the chance. 

This is a federally mandated, tax savings program & with the exception of medical spending limits, the rules are the same nationwide

I won't get into a lot of details now, but will answer any questions you have.

Here's some info on qualified & non-qualified expenses (please ignore the hypelinks as all the info is listed):

Qualified Expenses - FSA - Unreimbursed Medical
Medical - Qualified Expenses

Doctor's fees and co-pays that do qualify for reimbursement

Co-pays and other payments to doctors and healthcare providers qualify unless they are reimbursed by insurance:

  • Doctor office co-pays
  • Emergency room co-pays
  • Out-patient surgery co-pays
  • Inpatient admission co-pays
  • Office visits
  • Routine check ups
  • Routine physicals and other non-diagnostic services or treatments.
  • Psychologist and psychiatrist fees
  • Obstetrics and fertility
  • Chiropractor and podiatrist fees
  • Orthodontist and dentist fees
  • Periodontist and endodontist fees
  • Physician and Osteopath fees
  • Acupuncture fees
  • Eye exams
  • Christian Science practitioner's fees
  • Radiology
  • Surgical fees
  • Lab fees
  • Diagnostic fees
  • X-rays and MRI
  • Weight loss programs and fees pertaining to a specific disease
  • Reconstructive surgery in connection with birth defects, disease, or accident.

Doctor's fees that do not qualify for reimbursement

  • Cosmetic surgery and procedures unless it is for reconstruction due to disease, birth defect, or accident.
  • Dental bleaching
  • Marriage counseling
  • Weight loss programs for general health or appearance.
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.

Health improvement programs and supplies that do qualify for reimbursement

Health improvement programs that qualify unless they are reimbursed by insurance:

  • Physical and speech therapy
  • Weight-loss programs (for specific disease)
  • Quit-smoking programs, patches, and gums
  • Alcoholism and drug treatment
  • Special schooling for a disabled child
  • Body scans
  • Reconstructive surgery associated with birth defect, disease, or accident.
  • Home drug tests
  • Cholesterol tests and monitors
  • Home blood tests
  • Gastric bypass surgery

Health improvement programs and supplies that do not qualify for reimbursement

  • Weight-loss programs for general health or appearance.
  • Cosmetic surgery and procedures unless it is for reconstruction due to disease, birth defect, or accident.
  • Dental bleaching
  • Marriage counseling
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.

Health related expenses and equipment that do qualify for reimbursement

Generally, the following items require a doctor's prescription to qualify. These expenses qualify unless they are reimbursed by insurance.

  • Humidifiers and vaporizers
  • First aid bandages, gloves, and masks
  • Hot and cold compress packs and wraps
  • Oxygen
  • Pill boxes
  • Shower protection for casts, prostheses, etc.
  • Therapeutic support gloves
  • Elevated toilet seat
  • Thermometers
  • Special school for disabled child
  • Artificial limbs and braces
  • Arches and orthopedic shoes
  • Wigs for hair loss caused by disease
  • Shower bars and safety handles
  • Hearing devices and batteries
  • Crutches and canes
  • Wheelchairs, walkers, and shower chairs
  • Medical alert bracelet and fees
  • Bedpans and ring cushions
  • Travel to doctors or healthcare facilities
  • Ambulance expenses

Health related expenses and equipment that do not qualify for reimbursement

  • Expenses and equipment that are not medically necessary or are not prescribed by your health practitioner.
  • Weight-loss programs for general health or appearance.


Prescription - Qualified Expenses

Prescription and co-pays that do qualify for reimbursement

  • Prescription medications unless they are reimbursed by insurance.
  • Co-pays for prescription medications.

Prescription and co-pays that do not qualify for reimbursement

  • Prescriptions taken strictly for cosmetic purposes and are not for reconstruction due to disease, birth defect, or accident.
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.


Over-the-Counter Medicines - Qualified Expenses

Over-the-counter medicines that do qualify for reimbursement

Over-the-counter items qualify unless they are reimbursed by insurance.

Antiseptics

  • Antiseptic wash or ointment for cuts or scrapes
  • Antiseptic mouthwash
  • Benzocaine swabs
  • Boric Acid powder
  • First aid wipes
  • Hydrogen Peroxide
  • Iodine tincture
  • Rubbing Alcohol
  • Sublimed Sulfur powder

Cold, Flu, Asthma, and Allergy Medications

  • Allergy medications
  • Bronchodilator/expectorant tablets
  • Bronchial asthma Inhalers
  • Cold relief syrup, tablets, and drops
  • Cough syrup, tablets, and drops
  • Flu relief syrup, tables, and drops
  • Medicated chest rub
  • Nasal decongestant spray, drops, or inhaler
  • Nasal strips to improve congestion
  • Sinus and allergy nasal spray
  • Homeopathic sinus medications
  • Vapor patch cough suppressant

Diabetes

  • Diabetic lancets
  • Diabetic supplies
  • Diabetic test strips
  • Glucose meters
  • Glucose tablets
  • Syringes
  • Needles

Ear/Eye Care

  • Airplane ear protection
  • Ear drops for swimmers
  • Ear water-drying aid
  • Ear wax removal drops
  • Homeopathic earache tablets
  • Contact lens solution

Health Aids

  • Antifungal treatments
  • Denture adhesive
  • Diuretics and water pills
  • Hemorrhoid relief
  • Lice control
  • Medicated bandages
  • Motion sickness tablets
  • Respiratory stimulant ammonia
  • Sleeping aids

Pain Relief

 

  • Arthritis pain reliever
  • Bunion and blister treatments
  • Itch relief
  • Orajel
  • Pain relievers, aspirin and non-aspirin
  • Throat pain medications

Personal Test Kits

  • Cholesterol tests
  • Colorectal cancer screening tests
  • Home drug tests
  • Ovulation indicators
  • Pregnancy tests

Skin Care

  • Acne medications
  • Anti-itch lotion
  • Bunion and blister treatments
  • Cold sore and fever blister medications
  • Corn and callus removal medications
  • Diaper rash ointment
  • Eczema cream
  • Medicated bath products
  • Wart removal medications

Stomach Care

 

  • Acid reducing gum, liquid, and tablets
  • Anti-Diarrhea medications
  • Gas prevention tablets or drops
  • Ipecac syrup
  • Laxatives
  • Pinworm treatment
  • Upset stomach medications

Dual use items that require a letter from health  practitioner to qualify

  • Adhesive or elastic bandages
  • Blood pressure meter
  • Cold or hot compresses
  • Eye drops
  • Foot spa
  • Gauze and tape
  • Gloves and masks
  • Herbs
  • Let or arm braces
  • Massagers
  • Minerals
  • Multivitamins
  • Saline nose drops
  • Special supplements
  • Special teeth cleaning system
  • Thermometers
  • Vitamins
  • Incontinence supplies

Over-the-counter medicines that do not qualify for reimbursement

  • Aromatherapy
  • Baby bottles and cups
  • Baby oil
  • Baby wipes
  • Breast enhancement system
  • Cosmetics
  • Cotton swabs
  • Dental floss
  • Deodorants
  • Feminine care fragrances
  • Hair regrowth
  • Low "carb" foods
  • Low calorie foods
  • Oral care
  • Petroleum jelly
  • Shampoo and conditioner
  • Skin care
  • Spa salts
  • Sun tanning products
  • Tooth brushes
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.

 



Dental - Qualified Expenses

Dental services and supplies

Dental services and supplies qualify unless they are reimbursed by insurance:

  • Co-payments
  • Dental fillings, crowns, and bridges
  • Deductibles
  • Dentures
  • Diagnostic fees
  • Oral surgery
  • Orthodontist and dentist fees
  • Periodontist and endodontist fees
  • Prescribed medicines
  • Routine checkups
  • Dental sealants
  • Surgical fees
  • X-rays

Dental services and supplies that do not qualify

  • Cosmetic surgery and procedures unless it is for reconstruction due to disease, birth defect or accident.
  • Dental bleaching.
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.


Vision - Qualified Expenses

Vision services and supplies that do qualify for reimbursement

Vision services and supplies qualify unless they are reimbursed by insurance.

  • Vision co-pays
  • Office visits and routine eye exams
  • Prescribed sunglasses and eyeglasses
  • Contact lenses, solutions, and supplies
  • Corrective eye surgery
  • LASIK surgery
  • Cataract surgery
  • Optometrist fees
  • Physician and ophthalmologist fees
  • Surgical fees and x-rays

Vision services and supplies that do not qualify for reimbursement

  • Cosmetic surgery and procedures unless it is for reconstruction due to disease, birth defect, or accident.
  • Over-the-counter items, drugs, or medications that are not medically necessary, or are not prescribed by your physician or health practitioner.


Limitation on Qualified Expenses

Your plan may restrict the reimbursement of one or more of these items. Check with your plan administrator. The total amount of all qualified expenses paid may not exceed the maximum allowed under the plan. Please review your Summary Plan Description or contact your plan administrator for more information.

 

29 comments:

  1. Thanks for posting this. I was just thinking about this in light of the fact my son has been having really bad allergy attacks. I got him some Claritin (which in now available over-the-counter) using my flex spending debit card. He hadn't been prescribed it in writing, but I have told the doctor's in the past he's a really sneezy child and the ped. told me to give him Claritin. Will I have to turn in proof at the end of the year in writing? Meaning should I have the doctor write an actual prescription for it?

    ReplyDelete
  2. You betta tell somebody!
    *going to put in for my last $20 reimbursement*

    ReplyDelete
  3. Not at all. OTC allergy meds are covered. All you need to do it turn in the receipts for reimbursement.

    ReplyDelete
  4. OTC allergy meds are covered. When you turn it in depends on you & your reimbursement schedule. All they need is the receipt(s).

    ReplyDelete
  5. Well, I think I'm good then. I've been keeping up with all the receipts, but I gotta get hubby to keep up with his doctor co-pay receipts.

    ReplyDelete
  6. Damn. I didn't think about this when I was putting together my dental treatment plan... I could have recovered most of that grip I'm spending on my fangs (obviously excluding the whitening)...

    I'll have to keep this in mind before I visit an orthodontist about this gap!

    ReplyDelete
  7. If you prefer to sumbit a year-end claim, just get a statement of account from all of your providers, showing the recipient, dates of service & type of service. That will suffice.

    ReplyDelete
  8. Can I just say Silkee, your gap looks fabulous on you! My sister has one and I tell her she's simple gorgeous with it and she betta not get it closed. I know it's a personal thing and everyone has to do what's right for them and makes them comfortable. But certain ppl can get away with a gap toothed smile. My granny had one (God rest her soul) and it looked like you could fill two teeth in its place, but she still was a looker! Ya'll work your loveliness no matter the matter ;-)

    ReplyDelete
  9. Aww!!! Thank you!
    I really don't want to have it closed, I'm just worried that since I had my wisdom teeth out last year my fangs are going to spread east and west and I don't think we need anymore space between my fronts... LMAO... I was hanging out with my homegirls last weekend and we were discussing all manner of orthodontia; they were telling me that rather than correct what's already there, just apply some kind of anchor to stop them from moving further.

    I'm totally amenable to THAT! (besides, I'm not trying to spend the next couple of years with a whole bunch of WIRE in my mouf and pay a grip for the torture!

    ReplyDelete
  10. I hear ya...

    On another front, my boss just got her grill redone...she got her spaces closed as well as her gap. All done with those Invisiline braces. Her doc did a FANTASTIC job on her teeth. Nice and neat, and she's still got the appearance of a smaller gap. Although getting re-fitted for her tray every two weeks or so seemed so time-taxing to me. I don't think our dental plan covered the whole process either. She had to have put down some duckets for them.

    ReplyDelete
  11. Girl... Invisalign will have me ho-ing on three different corners in Baltimore for the next seven years... I have a weird tissue connection from the inside of my lip to my upper gum that precludes me just from going and getting braces and that being the end of it... but we'll see. The girl that was talking about the anchors to hold my teeth in their present position had braces for a year and a half, I think she was supposed to have worn them for three years, she was saying that she talked to some folks and that the Invisalign HURTS because you're forcing your teeth into those forms...

    Can you even REMOTELY imagine what my big fat butt would look like at my advanced age with some damn train tracks in my mouth? LAWRD!

    ReplyDelete
  12. LOLOL!!! Girl stop!!

    My aunt who is just shy of 50 just got the metal removed from her mouth! I hear the results look wonderful. She has the same aforementioned gap that my grandma had (I guess it's hereditary, huh?) and she waited THIS long to get her teeth fixed?!!...woooo...OK!!

    But I find it ironic that ppl with the largest gaps make the biggest, widest, prettiest, smiles of anyone I know! There's no shame in it...and if you got it flaunt it babe! It does make you, you! I used to have one but it closed on its own.

    If you watch top model, I was so impressed with cycle 5's winner...I think, Danielle. She flat out told the judges she wasn't correcting her gap because it was her signature thing. The judges harped on that girl that she finally cowered and got it done. But she told the dentist not to close it entirely. She still has a minimal gap with the final procedure and still looked cute.

    ReplyDelete
  13. This is the exact reason I got braces at age 27. Once those wisdom teeth were gone, I noticed shifting. I never had an issue with my gap until it appeared that if I didn't do something I'd be able to fit another tooth in there & that was unacceptable.

    ReplyDelete
  14. Oh I forgot to add, if you buy FSA items at Walgreens or Target, your receipt will indicate what you can claim, including CONDOMS!

    ReplyDelete
  15. Due to the tissue in my gums, mine didn't close completely either. I'm ok with it. Severe pinching would have occured & I endured enough pain for 1 month after I got them. I had that gap for damn near 30 years so it was a part of me. I was the same smiling face then as I am now.

    ReplyDelete
  16. I worked in employee benefits for six years and still never really understood this benefit. They call it a "reimbursement" program, but I think that's very misleading. It's not like you are getting free money. It's YOUR MONEY that they took from YOUR CHECK that is being reimbursed to you. I almost see people viewing this benefit like their tax refunds. The government saved some of your money for you so you're excited when you get it back. ???

    I do understand that by participating your taxes are reduced but I guess what I don't understand is by how much and is it worth all the extra work of collecting receipts, etc.

    ReplyDelete
  17. Here's an example I use for employees:

    You/your dependent needs $1000 worth of dental work; you have an upcoming surgery & a $500 deductible on your plan. That's $1500 you need, damn near upfront & you don't have in your wallet or the bank. You might possibly be able to charge it, but for a vast majority of working folks, that's not the case.

    You elect the $1500 in January when the plan is effective. The $1500 is taken from your pay, but over a 12-month period.

    You visit the dentist on Jan 20. You charge the $1000 to your Visa. You turn in that claim and that $1000 is reimbursed back to you (to pay your Visa bill OR pocket) BEFORE you have $1000 in your account. On the same token, you have surgery on Feb 1 & the hospital wants the $500 upfront. Same scenario above. These bills can be paid BEFORE it even comes out of your check.

    These days Flex plans offer debit card. That same $1500 election is pre-loaded onto your card for qualified uses at anytime during the plan years.

    Make sense?

    ReplyDelete
  18. I had it, but every purchase I made, including co-pays at a clinic or getting my eyeglasses, they kept asking for the blasted receipts! I am not one to be mailing stuff, never have been so needless to say I let it go after the first year! I heard now that only items that are covered by your FSA can be purchased with your card (meaning like an EBT card, only the items that are allowable will be charged) making the need to constantly turn in receipts unneccessary. Is that true?

    ReplyDelete
  19. I use mine faithfully. Mine comes with the complete amount I chos and I often use it for my meds and that first $100 deductible. Its a great benefit. Also, my company has it set up with Wal-mart where it can tell the items I use the card for so I don't have to send it anything. If I do have to send something in, I can fax it real quick, or in the case I misplaced the receipt I needed to turn in, I was able to turn in another medical expense to compensate for it. I recommend it to everyone. (But of course, everyone won't do it and dont' think about it until they are in a bind. My people, my people....)

    ReplyDelete
  20. oh, ok! Now THAT'S A BENEFIT! Thanks MO!!!!

    ReplyDelete
  21. Like any other claims process you must provide proof of the qualified expense. Keeping up with receipts can be a headache, so let me suggest this: keep an envelope in your purse for the receipts & store them in a file at work - daily. You won't lose them at home & they'll be in one place when & where you need them.

    The FSA debit card does make it easier, however if you visit a provider not in their system, receipts will still be required. IRS regs - no way around it.

    If you have more than $100 out of pocket cost per year, I'd suggest giving it another try.

    ReplyDelete
  22. You guys have great questions so keep 'em coming!

    Even tho I participate & promote the program at work, it's not right for everyone.

    If you don't see a doctor/dentist like you should (and shame on you), you don't take prescription drugs, wear glasses/contacts, etc. or have dependents with those needs, this might not be worth it for you.

    If the only health cost you have in a 12-month period is a bottle of Advil & a box of band-aids, this isn't worth the time.

    The plan is sooooo worth it for big ticket items like Lasik, orthodontia, designer eye-wear, deductibles, etc.

    Even non-prescription acne treatment products (Proactiv, Clearasil, etc.) & condoms are FSA eligible.

    ReplyDelete
  23. Heyyyyyyyy!!! I didn't know about the protopic!!! I gotta look at my FSA brochure again, or at least holla at the benefits person at the gig. This blog has been super helpful, MsRo!!!!

    ReplyDelete
  24. No problem sis! Let me know if you have any other questions about the program. If you and/or hubby can, do enroll at work, you will definitely see the difference on your Form 1040.

    ReplyDelete
  25. SHAMELESS PLUG - My company administers these type of programs so if your employer is interested but doesn't know where to start, definitely let me know!!

    ReplyDelete
  26. Exactly! With the OTC items that can now be claimed, it's hard not to use all of the money in your account. You can never have too many band-aids or cotton balls! :o)

    ReplyDelete
  27. I had a another question via private question that is worth sharing:

    Question: What if I quit or get fired & I used all the money before they take it from my check?

    Answer: You just got over! Honestly! The law prevents an employer from withholding any amount above the scheduled deduction from final pay. We've had people spend up to $3,000 in less than 2 months & then quit. It's the company's loss and there's nothing the employer can do about it.

    ReplyDelete
  28. I take full advantage of this program, and they make it easy with giving me a Visa card to charge directly to it.

    ReplyDelete