New York State's Flexible Spending Accounts

Flex Spending Account, A State employee benefit that puts money in your pocket

Health Care Spending Account

What Is The Health Care Spending Account?
Who Is Eligible To Enroll?
How Do I Enroll?
Eligible Expenses
Ineligible Expenses
Changes In Status
HCSAccount Claims Process
Payroll Changes
Saving With The HCSAccount
Health Care Spending Account Worksheet
Health Care Spending Account Forms

Message From The Director

Overview

Health Care Spending Account

Dependent Care Advantage Account

Frequently Asked Questions

NYS Flex Spending Account Home

Health Care Spending Account
Worksheet

To help you plan the amount of your Health Care Spending Account contribution, use this worksheet. You may want to look at what you spent on health care last year before making your decision. Include annual estimated expenses for health care services anticipated for the upcoming Plan Year that will not be reimbursed by your medical, dental, or other benefit plans.

If you are joining the program during the year (that is, after the open enrollment period is over) use the chart to calculate your expenses for the remainder of the calendar year. If you are a new employee, remember that your coverage won't begin until your 61st day of employment.

Type of Expense	Amount per Year
MEDICAL EXPENSES, SUCH AS:
Health Plan Deductible
Office Visit and Hospital Copayments
Prescription Drug Copayments
Routine Physicals
Non-covered Prescriptions
Hearing Aids
Planned, Non-covered Medical Procedures
Other Eligible Expenses
DENTAL EXPENSES, SUCH AS:
Deductibles and Copayments
Routine Check-ups, Cleaning and X-rays
Orthodontia (braces, etc.)
Planned dental work (crowns, dentures, dental implants, etc.)
VISION CARE EXPENSES, SUCH AS:
Exams
Eyeglasses
Corrective contact lenses & contact lens solutions
Total Estimated Out-Of-Pocket Health Care Expenses

Back to Table of Contents

This Page Last Updated: Tuesday, September 16, 2003 at 1:06:46 PM