Guidelines for Using Your Health FSA

Your health flexible spending account is a reimbursement account offered by your employer as part of your benefits package. Enrolling in a health FSA plan saves you money. It allows you to use pre-tax dollars toward eligible health FSA expenses that are not covered by your health, vision, or dental plan.

Participation in a health FSA is your choice. If you decide to sign up, you must satisfy any FSA eligibility requirements set up by your employer. Upon enrollment, your employer will provide a Summary Plan Description (SPD) that gives the complete rules and regulations for your plan.

IRS Regulations

Health FSAs are regulated by IRS rules for Section 125 plans. Some rules in this Section are specific to a health FSA and do not apply to a dependent care FSA.

Important: Please review the following information so you are aware of the rules that apply to your health FSA. Use the links below to navigate to a specific section.

Eligible Health FSA Expenses

Only eligible expenses can be reimbursed under the FSA. These expenses are defined by Internal Revenue Code § 213(d) and your employer’s plan.

Generally, eligible expenses include items that are meant to diagnose, cure, mitigate, treat, or prevent illness or disease. This also includes transportation for medical care. However, expenses such as cosmetic surgery, insurance premiums, vitamins, and items for general well-being are not eligible expenses.

As you may know, health care reform impacted FSAs, including the eligibility of over-the-counter (OTC) medicines and drugs. OTC medicines are only eligible expenses if prescribed by a doctor (or another individual who can legally issue a prescription) in the state where you purchase the OTC medicines.

Health FSA expenses must be incurred by you, your spouse, or your eligible dependents during the current plan year and while you are an active participant in the FSA plan. Medical care expenses are incurred when you (or your spouse or dependents) are provided with medical care — not when you are formally billed, charged for, or pay for the medical care.

Only qualified “out-of-pocket” expenses are eligible for reimbursement. Expenses previously reimbursed by your health FSA or covered by any other plan or program are not eligible for reimbursement. There’s no “double-dipping” allowed.

Expenses reimbursed under your health FSA may not be used to claim any federal income tax deduction or credit.

Important: To find out the specific eligible expenses for your FSA plan, review your employer’s Summary Plan Description (SPD).

Need more information or expense examples? Go to our Health FSA Eligible Expenses page.

Your FSA Election

The election is your contribution amount — the amount that you put into your health FSA when you enroll. Your employer determines the minimum (if any) and maximum election amounts for your plan.

Health FSAs are unique. Your annual health FSA election is available on the first day of the FSA plan year. But your total FSA election amount is deducted from your paycheck in equal amounts throughout the year. You can use your health FSA funds anytime during the plan year — as long as funds remain in your account.

Reimbursement Requests

A Request for Reimbursement Form is used to submit a reimbursement claim. The expenses listed must be incurred by you, your spouse, or dependent during the coverage period and the dates noted on the reimbursement form.

After you complete the Request for Reimbursement Form, submit it to CONEXIS along with appropriate supporting documentation.

Supporting Documentation

  • For office visits and other services — Your health plan’s Explanation of Benefits (EOB) statement or an itemized receipt or bill from the provider that includes the patient’s name, a description of the service, the original date of service and your portion of the charge.
  • For prescription drugs — A pharmacy statement or receipt from your pharmacy including the patient’s name, the Rx number, the name of the drug, the date the prescription was filled, and the amount.
  • For over-the-counter medicines — A written or electronic OTC prescription along with an itemized cash register receipt that includes the merchant name, name of the OTC medicine or drug, purchase date, and amount, OR a printed pharmacy statement or receipt from a pharmacy that includes the patient’s name, the Rx number, the date the prescription was filled, and the amount.
  • For over-the-counter health care-related products — An itemized cash register receipt with the merchant name, name of the item/product, date, and amount.

Credit card receipts, canceled checks, and balance forward statements do not meet the requirements for acceptable documentation.

For some expenses, a Medical Determination Form from a doctor may be required. See our Eligible Health FSA Expenses page.

Find a Request for Reimbursement Form and a Medical Determination Form by logging in to your online account.

Submitting Reimbursement Requests

Submit your reimbursement requests these ways:

  1. 1. MyCONEXIS app — The easiest way to submit a reimbursement request is by using your smartphone or tablet to upload a photo of your supporting documentation. Visit our Mobile Services page for details on how to get this app!
  2. 2. Online — Log in to your online account, download and complete a reimbursement form, and then upload your supporting documentation. You will need access to a scanner to do this.
  3. 3. Fax — Submit your completed reimbursement form and supporting documentation using the fax number listed on the form.
  4. 4. Mail — Send in your completed reimbursement form and copies of your supporting documentation using the address noted on your form.

Change in Status Events

Your election cannot be changed during the plan year, unless you experience a qualifying change in status event based on IRS regulations, such as:

  • A change in legal marital status (marriage, divorce or death of your spouse)
  • A change in the number of your dependents (birth or adoption of a child, or death of a dependent)
  • A change in employment status of you, your spouse or dependent
  • An event causing your dependent to satisfy or cease to satisfy an eligibility requirement for benefits
  • A change in residence of you, your spouse, or dependent

Not all plans allow you to change your election when you experience one of the events listed above. For more information regarding eligible status change events under your plan, see your Summary Plan Description (SPD).

Additional FSA Features

You’ll want to review your employer’s Summary Plan Description (SPD) to find out if your health FSA plan includes any of these features:

  • Carryover lets you carry over up to $500 of unused funds to the following plan year. (Carryover amount may vary by plan.)
  • Grace period gives you extra time to incur eligible expenses and use funds remaining in your account after the plan year ends. (Your plan cannot include a carryover feature and a grace period.)
  • Run-out period provides additional time to submit reimbursement requests for eligible expenses incurred during the plan year.

Unused Funds

If your plan includes a carryover feature, you may only carry over the maximum amount allowed by your plan. The IRS “use-it-or-lose-it” rule still applies. After the plan year ends, you will forfeit any money left in your account that’s over the maximum limit.

If your health FSA plan doesn’t include a carryover feature, IRS rules require you to use your FSA dollars within the plan year, or if applicable, the run-out period. If you don’t use all of your FSA funds, they don’t carry over to the following year and can’t be returned to you. Funds that remain in your account will be forfeited after the plan year ends.

If you terminate your employment during the plan year or you otherwise cease to be eligible under the plan, your active participation in the FSA plan and your pre-tax contributions will end automatically. Expenses incurred after your coverage end date are not eligible for reimbursement.

Important: You may be entitled to elect COBRA continuation coverage under the health FSA and receive reimbursement for qualified expenses incurred after your termination if you continue to make your required contributions on a post-tax basis. However, you generally do not have the right to elect COBRA if the cost of continuation coverage for the remainder of the plan year equals or exceeds your remaining account balance. Please see your Summary Plan Description (SPD) for specific rules governing your plan.

Important: The information on the CONEXIS website provides basic information regarding participation in your employer’s FSA plan. Our site does not contain all of the rules that are specific to governing your employer’s plan. For complete rules and plan information, review your plan’s Summary Plan Description (SPD). Ask your HR or benefits representative for details.


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