| Q |
How do I know if I should enroll in the HCSAccount? |
| A |
If you answer "yes" to any of the following questions, and pay income taxes, you can save money if you enroll in the HCSAccount:
- Do you expect to pay deductibles and copayments under your medical, dental, and prescription drug insurance plans during the next year?
- Is anyone in your family planning on receiving orthodontia or other dental treatment during the next year?
- Are you or another family member planning to undergo a non-cosmetic medical procedure that is either not covered or only partially covered under your health insurance plan?
- Is anyone in your family planning on buying a hearing aid, corrective contact lenses or eye glasses, and expecting to pay more than your health insurance plan will allow?
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| Q |
Is an employee required to participate in the New York State Health Insurance Program (NYSHIP) in order to participate in the HCSAccount? |
| A |
No. If an employee has coverage elsewhere, he or she may still enroll in the HCSAccount, as long as the eligibility criteria for the program are met. |
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| Q |
Does the HCSAccount replace my medical plan? |
| A |
No. This program offers you a way to pay for eligible out-of-pocket health care expenses with pre-tax money. You cannot submit expenses for which you have or will seek reimbursement from your health care plan or any other source. So, you should first submit your claims to your health care plan so that they can pay according to the plan limits. Then, the remaining out-of-pocket eligible expenses can be submitted to the HCSAccount for reimbursement. |
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| Q |
Whose expenses are eligible for reimbursement under the HCSAccount program? |
| A |
The HCSAccount may be used to reimburse health care expenses for you, your spouse and anyone who is claimed as a dependent on your federal tax return. |
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| Q |
Are my domestic partner's health care expenses eligible for reimbursement from my HCSAccount? |
| A |
According to the IRS, health care expenses for a domestic partner cannot be reimbursed through a Health Care Spending Account unless the domestic partner qualifies as a dependent under the Internal Revenue Code. |
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| Q |
If my spouse and I are State employees, can we both enroll in the HCSAccount? |
| A |
Yes. Any eligible State employee may enroll in the Health Care Spending Account, up to the maximum contribution of $3,000 per individual. However, if both spouses enroll, each health care expense can only be reimbursed once. |
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| Q |
Can the HCSAccount pay my doctor directly? |
| A |
No. Payment is made only to the enrollee. |
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| Q |
Can I request reimbursement from the HCSAccount program for services I receive before the Plan Year begins if I am not billed until after the Plan Year starts? |
| A |
No. According to IRS guidelines, a qualified expense is "incurred" at the time the service is provided, not when you are billed (or charged) or actually pay for the service. Therefore, reimbursements made during a Plan Year are only for eligible expenses incurred during that same Plan Year. |
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| Q |
Can health care services that require up-front payment to the provider be reimbursed from the HCSAccount in a single Plan Year, even if the health care is delivered over several Plan Years? |
| A |
No. IRS regulations do not allow medical expenses to be reimbursed through the HCSAccount until expenses have been incurred. Expenses are not incurred until treatment is provided to the participant, regardless of when the participant pays the provider. |
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| Q |
Are expenses that are reimbursed by the HCSAccount eligible to be deducted on my federal tax return as a medical expense? |
| A |
No, because you have already received reimbursement with tax-free dollars. Only expenses that are not reimbursed through an insurance plan, some other source, or the Health Care Spending Account may be claimed on your federal income tax return. |
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| Q |
Can travel expenses related to my medical care be reimbursed through my HCSAccount? |
| A |
Yes. The IRS permits you to be reimbursed for amounts paid for transportation primarily for, and essential to, medical care. You can receive reimbursement for car mileage (14 cents per mile in 2004), parking fees, tolls, subways, buses, trains, air travel, and lodging if the costs are incurred primarily to receive medical care. |
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| Q |
Will the HCSAccount reimburse the cost of my prescription drug, even if my insurance plan won't pay for part of it? |
| A |
Any prescription drug can be reimbursed as long as it is used to treat a medical condition. Prescription drugs that are primarily used for cosmetic purposes can't be reimbursed. |
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| Q |
Can over-the-counter drugs, herbal medicines and homeopathic remedies be reimbursed if my doctor or medical provider prescribes them to treat my medical condition? |
| A |
No, the Health Care Spending Account can't reimburse you for the cost of over-the-counter drugs, herbal medicines, or homeopathic remedies even if you have a medical condition. |
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| Q |
If I should incur an eligible change in status can I increase or decrease my HCSAccount amount? |
| A |
Yes, however your change must be consistent with the event. The IRS requires that the Plan Administrator treat the periods prior to and subsequent to the change as two separate periods of coverage for reimbursement purposes. |
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| Q |
If I leave State service before the end of the year, what happens if the reimbursements I have received during the Plan Year are greater than the amount of money I have contributed to my account? Do I have to pay any of it back? |
| A |
If you have been reimbursed more money than you have contributed to the Plan, you are not required to pay the money back when you leave State service. |
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| Q |
Are dental implants reimbursable? |
| A |
Yes, dental implants are reimbursable as long as they are not a cosmetic treatment. |
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| Q |
How do I know if my child's orthodontia will be reimbursed? How are orthodontic expenses reimbursed if I pay my provider on a monthly payment plan? |
| A |
Orthodontic expenses are reimbursable if they are not cosmetic in nature. At the beginning of the Plan Year in which you first request reimbursement for these expenses, you must submit a letter from your orthodontist indicating that the services are medically necessary. You will also need to provide a copy of the service contract between you and the orthodontist describing the payment arrangement/schedule.
Orthodontia costs that are paid on a monthly payment plan will be reimbursed after each monthly payment is due. However, if you pre-pay the entire cost of orthodontia treatment up front, you will only be reimbursed in a particular Plan Year for the value of the services that will be provided during that Plan Year. |
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| Q |
Will the Plan pay for upgrades to my prescription glasses? |
| A |
Yes. You can be reimbursed for the cost of upgrades or add-ons (such as scratch-resistant coating) to your prescription lenses and frames. There is no limit on dollar amounts of the upgrades or add-ons. Non-prescription glasses and sunglasses are not reimbursable. |
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| Q |
If I am divorced and my divorce decree allows my ex-spouse to claim our child as a dependent at tax time, can I still use my Health Care Spending Account to pay for my child's unreimbursed health care expenses? |
| A |
Yes, the IRS still considers your child as a dependent for your Health Care Spending Account, so you may submit your child's medical claims to the Plan for reimbursement. |
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| Q |
What happens if I retire or terminate employment with the State mid-year? |
| A |
If you retire or terminate employment during the Plan Year, your coverage will be terminated once you leave the payroll and stop contributing to your account, unless you plan ahead during open enrollment. You can contribute your full annual election before you leave the payroll, which will enable you to use your account for expenses incurred after you leave. When you apply for enrollment, make sure to indicate the number of paychecks you expect to receive before you retire or leave employment. If you are unable to plan ahead, you may still continue to participate in the Health Care Spending Account by making after-tax payments directly to FBMC. |
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| Q |
What happens to the money in my account if I separate from State service during the Plan Year? Can I use it after I leave? |
| A |
If you retire, leave State employment, go on leave without pay, or otherwise stop contributing to your account, the money in your account can only be used for services that occurred before you left the payroll. However, if you continue to contribute to the Health Care Spending Account after you leave the payroll by making after-tax payments directly to FBMC, you will be able to submit claims for services that occurred after you leave your State job. |
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