Health Flexible Spending Account
Although your FSA will be deducted through your payroll, you will have access to your entire Health FSA election on the first day of your period of coverage. This is due to the Uniform Coverage Rule.
Dependent Care Flexible Spending Account
On the other hand, the Dependent Care FSA is a pay-to-balance account. Therefore, you cannot be reimbursed until the funds have been contributed through your payroll deductions. If a claim is submitted for more than the available balance, the claim will remain in a pending status and funds will be released as they become available until the entire claim has been reimbursed or until your annual election has been met.
The FSA is a "Use-or-Lose" benefit:
- Only expenses incurred during your period of coverage can be reimbursed by the FSA. Expenses incurred before or after the period of coverage are not reimbursable. o An expense is considered “incurred” when you are provided with the care that gives rise to the expense, not when you are formally billed, or pay for the service.
- Unused dollars in the FSA at the end of the plan year cannot be carried over and will be forfeited to the plan sponsor.
- Your election is irrevocable. You cannot change or cancel your election during the plan year unless you have a qualifying “Change in Status,” and your adjusted election is consistent with such a change.
Example of the "Use-or-Lose" Rule
Sue plans to have eye surgery in June of 2017. During her open enrollment period, she elects $2,000.00 for the 2017 plan year. In May 2017, Sue learns that she cannot have the eye surgery as planned. As of April 30, 2017, she has incurred and has received reimbursement for expenses totaling $1,000.00. Sue would like to decrease her election due to the change in her expected healthcare cost for the year. This is not a qualifying “Change in Status” event; therefore, she cannot make this change. Sue’s election is irrevocable.
Throughout the remaining months of the plan year, Sue incurs additional expenses totaling $500.00. As of December 31, 2017, Sue has an unused election of $ 500.00. Consistent with the “Use-or-Lose” rule, Sue will forfeit her remaining election of $500.00 to her plan sponsor.
Your election in the FSA is irrevocable. You cannot make a change in your election after your period of coverage begins. If you experience a qualifying Change in Status, you may be permitted to change the election in your Health FSA or Dependent Care FSA. Your requested change must correspond to the event, and you must request the change within 30 days.
Qualifying Change in Status Events that apply to Health and Dependent Care FSAs may include:
- Change in your legal marital status - including the gain or loss of a spouse
- Change in the number of your dependents - including gain or loss of taxable dependents
- Change in your employment status or that of your spouse or dependents
- Commencement of employment that triggers eligibility
- Termination of employment that causes a loss of eligibility.
Qualifying Change in Status Events that apply to Dependent Care FSA only may include:
- Change in your dependent care provider
- Change in your dependent care needs
- Change in the cost of dependent care
- If the dependent care provider is a relative, an increase in fees is not a qualifying Change in Status event.
If you have any questions regarding Change in Status events, please contact the Nyhart Flex Department or your employer prior to making a change.
According to the IRS Guidelines, all claims submitted through the Flexible Spending Account must be substantiated to verify the eligibility of the expense. All expenses must be substantiated by information from an independent third party. The third-party information must describe the following:
- Service provider – including name and address
- Date of service
- Type of service
- Patient responsibility
- Patient Name
If the expense was submitted to insurance for payment, you will need to submit an Explanation of Benefits (EOB) to establish the amount that was not paid by the insurance plan. If the expense was not submitted to insurance, you will need to submit itemized bills from the provider. If the expense was a prescription, submit the tag from the RX bag or a pharmacy summary. Please be aware that cancelled checks alone are not sufficient documentation to verify an expense. Keep the original receipts for your records and send copies to Nyhart.
For most medical expenses, proof of payment is not required. For orthodontia expenses; however, you must include documentation to indicate when payment was made along with the above information.
If over-the-counter products were purchased, you will need to submit a copy of the receipt clearly indicating the name of the OTC products purchased. If the claim is submitted for OTC medicines, you must include the prescription from your physician.
Dependent Care Expenses
In addition to the above requirements, Dependent Care FSA claims require additional information including:
- Name and age of dependent
- Provider information including name, address, Federal Tax ID, or Social Security Number
- Proof of payment
Health Flexible Spending Account
You may only be reimbursed for eligible services that rendered on or before your date of termination. For example, if you terminated on June 1, 2017, you may be reimbursed for eligible expenses that incurred after your effective date and before June 2, 2017. If the paid claims are less than your contributions, you will be notified of how to continue the FSA plan coverage through COBRA. If you choose COBRA continuation, you must make after-tax contributions to the account in order to be reimbursed for expenses that incurred after your termination of employment.
Dependent Care Flexible Spending Account
You may submit claims incurred after your termination date. You will be reimbursed for qualified expenses until the funds in your account are exhausted or until the end of the plan year; whichever occurs earlier.
You must make a new election to the Health and/or Dependent Care FSA each plan year by completing and signing the enrollment form.
Insurance premiums are not eligible for reimbursement through the FSA.
Through the Health FSA, you can claim eligible expenses for yourself and any dependents you report on your federal income taxes. Therefore, if you claim your college age children as dependents on your taxes, their qualified medical expenses are eligible.
The child care fees you pay to your relatives may be eligible for reimbursement through the Dependent Care FSA. The child care provider must have a Federal Tax ID or a valid Social Security Number, and they must claim the fees as income on their income taxes.
As of January 1, 2011, over-the-counter medicines, other than insulin, are no longer eligible for reimbursement from the FSA unless you have a prescription. Medical devices, such as eyeglasses and braces, which are purchased over-the-counter may still be considered eligible for reimbursement from the plan.
Your account information is available online at www.nyhart.com. Customer service representatives are also available Monday through Friday from 7:30 a.m. – 5:00 p.m. EST. Toll Free: 1-800-284-8412 E-mail: email@example.com
Throughout the plan year, you may submit your claim forms as often as you like. The Health FSA plan has a 2- 1/2 month grace period, so any expense incurred through March 15, 2017 will deduct from the remaining election in your 2016 Health FSA, before the 2017 Health FSA. The grace period does not apply to the Dependent Care FSA. All 2016 claims must be submitted to Nyhart no later than March 31, 2017 in order to be considered for reimbursement.
Claims can be submitted to Nyhart via mail, email, fax, or online.
Flex Reimbursement Nyhart
8415 Allison Pointe Boulevard, Suite 300
Indianapolis, IN 46250
If you presently have a card that expires in December of 2016, a new card will be issued before the current card expires. You will need to start using the new card effective January 1st. If your current card does not expire in 2017, your 2017 election will be reloaded on that card. For future reference, when the flex card is issued, it is good for three years.
Due to the HIPAA Privacy Rule, Nyhart is requiring participants to have an Authorization to Disclose Protected Health Information form on file if a participant would like PHI disclosed to an individual. By signing this form, you are authorizing the disclosure of your PHI in connection with this plan. Nyhart will be unable to disclose any information to an individual without a signed form on file.
The Authorization to Disclose PHI form is included in the enrollment packet, or the form is available on our website www.nyhart.com. You can also request a form through our customer service line (800-284-8412) or firstname.lastname@example.org.
Go to www.nyhart.com and click on the red login button on the right hand side. Click Login for any of the below services. Your default username will be your Social Security number and your default password will be your zip code. Both username and password can be changed after your first login. Once you log on, click on Your Balances on the left hand side. Next, click on the Tools and Support tab at the top. In that section, you will see a quick start guide that will give you instructions for Nyhart’s Online Services.