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Flex Spending Account, A State employee benefit that puts money in your pocket
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Savings spacer Health Care Spending Account

What Is The Health Care Spending Account?
Who Is Eligible To Enroll?
Who Is Not Eligible To Enroll?
How Do I Enroll?
Eligible Expenses
Ineligible Expenses
Over-The-Counter Drugs
Changes In Status
HCSAccount Claims Process
Payroll Changes
Saving With The HCSAccount
HCSAccount Frequently Asked Questions
Health Care Spending Account Worksheet
Health Care Spending Account Forms

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Message From The Director
Enrollment At A Glance
About Your Flex Spending Account
Getting Answers
Frequently Asked Questions
Health Care Spending Account
Dependent Care Advantage Account
2008 Open Enrollment Calendar

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 enrolling during the open enrollment period, use the chart below to estimate your expenses for the 2008 calendar year. If you are joining the program during the year (that is, after the open enrollment period is over) use the chart to estimate 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
Contact lenses & contact lens solutions
Total Expenses
Remember, your minimum contribution can be no less than $100 and your maximum contribution cannot exceed $4,000 for the plan year and calendar year.



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This Page Last Updated: Friday, August 17, 2007 at 5:33:42 AM

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