The Health Care Spending Account (HCSAccount) is a new employee benefit to help State employees pay for health-related expenses with tax-free dollars. This includes medical, hospital, laboratory, prescription drug, dental, vision and hearing expenses that are not reimbursed by your insurance.

1. Employees who work for the New York State Executive (excluding UUP-represented employees) and Legislative Branches and nonjudicial employees of the Unified Court System are eligible if they:
   • are permanent; and
   • are employed on an annual-salaried basis; and
   • receive regular, bi-weekly paychecks; and
   • work half-time or more on a regular schedule; and
     • are eligible to enroll in the New York State Health Insurance Program; and
     • are represented by a bargaining unit that is eligible to participate, or are designated Management/Confidential. For the 2001 Plan Year, Executive Branch Employees represented by CSEA, PEF, NYSCOPBA, Council 82 and District Council 37 are eligible to participate in the HCSAccount. In addition, all bargaining units in the Unified Court System are eligible to participate.
   All judges and justices of the Unified Court System, and paid elected officials and paid members of the legislative body are eligible regardless of their work schedule. Seasonal, session, temporary, per diem and hourly employees are not eligible to participate.
2. UUP-represented employees employed by the State University of New York are eligible if they:
   
   • receive regular, bi-weekly paychecks; and
   • are eligible to enroll in the New York State Health Insurance Program; and
   • are academic employees and teach two or more courses per semester; or
   • are part-time academic employees whose duties primarily exclude teaching but are hired at a specified annual rate ($10,196 between July 2, 1999 and July 1, 2000); or
   • are full-time professional employees; or
   • are part-time professional employees hired at a specified annual rate ($10,196 between July 2, 1999 and July 1, 2000)
   
   
   • Seasonal, per diem and hourly employees are not eligible to participate.

      

3. New employees will become eligible to participate after they have completed sixty (60) consecutive calendar days of State service and if they meet the eligibility criteria. To participate, new employees must submit an enrollment form within thirty days of their employment start date. Your Plan Year contribution amount will be prorated over the remaining pay periods.

• Use the Health Care Spending Account Worksheet included in the back of this enrollment kit to help you estimate what your out-of-pocket health care expenses will be for the 2001 calendar year. You may include expenses for anyone who will be included on your federal tax return (spouse, children, etc.). You should also verify with your health care provider that you are a suitable candidate for any surgical procedure, such as laser eye surgery, before committing the money to your account.

   

• Based on your estimate, decide how much of your salary ($150 to $3,000) you want to set aside in your HCSAccount. The amount you choose is taken out of your paycheck through automatic payroll deductions. The number of payroll deductions will be determined based on the number of paychecks you expect to receive during the Plan Year. No deductions will be taken out of the first and last paychecks of the calendar year.

   

• Complete the HCSAccount Enrollment Form in this kit. Completed and signed forms must be returned to your Health Benefits Administrator by November 17, 2000 for participation in the HCSAccount in 2001. If you do not enroll in the HCSAccount when you are first eligible, you must wait until the next open enrollment period before you can enroll. Please note that State University of New York employees who are otherwise eligible for this program but only work during the Fall semester may not enroll during the open enrollment period, but rather must wait until they return to work for the Fall semester.

• for you or an eligible dependent;
• permitted under the Internal Revenue Code;
• medically necessary; and
• not reimbursed by your health insurance.

• marriage, divorce, legal separation or annulment
• death of your spouse or dependent
• birth, adoption or placement for adoption of a dependent
• the taking of and/or return from an unpaid leave of absence
• beginning or end of employment
• other circumstances allowed under applicable law or regulation

If you have a Change in Status, call FBMC Customer Service to request an Enrollment Form. You must submit the Enrollment Form to FBMC within thirty calendar days of the qualifying event, but as promptly as possible to prevent unwanted deductions, which are not refundable. You will also need to include documentation to support the change, such as a copy of a marriage license, divorce decree, birth certificate, adoption decree or death certificate.

• Receive health care services. A health care service is incurred when the services are provided that create the expense. You must receive health care services before you file a claim for reimbursement.
• Use the Reimbursement Request form provided by FBMC and list each separate eligible expense individually on the claim form.
• Attach a statement from your health insurance plan showing the amount of the medical expense that has not been reimbursed or attach copies of receipts, billing statements, invoices or other appropriate supporting documentation from the health care provider. Cancelled checks or credit card receipts will not be accepted. The receipts, billing statements or invoices must include:
  1. the name of the person for whom service was provided;
  2. the name and address of the health care provider;
  3. the amount charged for each service; and
  4. the type of service and the date performed.
• Submit claims to FBMC after you have received health care services and know the amount of the bill for which you are responsible. All completed Reimbursement Request forms and supporting documentation must be mailed or faxed directly to FBMC.

• Submit your claims for reimbursement as soon as the service is provided.
• Be sure your Reimbursement Request form has been completed with all necessary information and is signed.
• Mail or fax your Reimbursement Request form to FBMC.
• Enter the RACE for direct deposit of your reimbursements into your checking or savings account.

Tip: Fax your Reimbursement Request form to the toll-free number (1-800-743-3271) and it will be reviewed the same day.

Tax Savings Example 1

A married employee earns $30,000, declares a spouse with 2 dependents and files a joint return. The annual HCSAccount contribution is $2,000 and the employee incurs $2,000 in reimbursable health care expenses.
	With HCSAccount	Without HCSAccount	Savings With HCSAccount
Annual Income	$30,000	$30,000
Expenses Paid through HCSAccount	-2,000	-0-
Adjusted Gross Income	$28,000	$30,000
Federal Income Tax	-1,474	-1,774	$300
State Income Tax	-521	-601	80
Social Security Tax	-2,142	-2,295	153
After-Tax Cost of Health Care Expenses	-0-	-2,000
Your Spendable Income (assuming there are no other payroll deductions)	$23,863	$23,330	$533
This employee could reduce their taxes by $533 by using the HCSAccount!

Tax Savings Example 2

A married employee earns $55,000, declares 1 dependent and files as head of household. The annual HCSAccount contribution is $2,500 and the employee incurs $2,500 in reimbursable health care expenses.
	With HCSAccount	Without HCSAccount	Savings With HCSAccount
Annual Income	$55,000	$55,000
Expenses Paid through HCSAccount	-2,500	-0-
Adjusted Gross Income	$52,500	$55,000
Federal Income Tax	-6,898	-7,598	$700
State Income Tax	-2,076	-2,247	171
Social Security Tax	-4,016	-4,208	192
After-Tax Cost of Health Care Expenses	-0-	-2,500
Your Spendable Income (assuming there are no other payroll deductions)	$39,510	$38,447	$1,063
This employee could reduce their taxes by $1,063 by using the HCSAccount!