Generally, with the exception of expenses for cosmetic procedures and health insurance premiums, any health care expense that is tax-deductible and not covered by insurance is eligible for reimbursement through a Health Care FSA.
The IRS defines eligible health care expenses as expenses incurred for medical care, including amounts paid for the diagnoses, care, mitigation, treatment, or prevention of disease or illness and for treatments affecting any part or function of the body. This includes dental and vision care. See the PayFlex Eligible Expense Items for more information.
When you enroll in a Health Care FSA, you can be reimbursed for eligible expenses that were incurred for you, your spouse, your children, and any other person who is a qualified dependent under the Internal Revenue Code.
You can only be reimbursed for expenses incurred while you are enrolled in the plan. The date you pay for the item or service is not relevant.
PayFlex will mail a debit card to new enrollees in a Health Care FSA to pay for eligible health care expenses. If you are only enrolled in a Dependent Care FSA, you will not receive a card. If you are enrolled in a Health Care FSA and did not receive a card, call PayFlex at (877) 343-1346. Learn more about using your PayFlex card.
Eligible Health Care Expenses
Eligible Health Care FSA expenses include, but are not limited to:
- Physician's office/clinic visit copays
- Dental care including copays, fluoride treatments, orthodontia See "Using Your FSA to Pay for Dental Care" for tips
- Vision Care (exams, glasses, contacts, solutions)
- Hearing Care/Hearing Aids
- Prescription Drugs (including copays)
- Over-the-counter medications (with a prescription)
- Immunizations/Well Baby Care
- Mental Health Care
- Laboratory Tests
Note: this list is subject to change. Comprehensive information is available from PayFlex. Refer to "Using an FSA to pay for OTC items" for more information on using your FSA for OTC purchases.
The following expenses are not eligible for reimbursement from a Health Care FSA:
- Cosmetic surgery
- Diaper service
- Ear piercing
- Expenses claimed on your income tax return
- Expenses reimbursed by other services, such as insurance companies
- Hair loss treatment, drugs or transplants
- Health care expenses paid under any health plan
- Household help, even if recommended by a physician
- Insurance premiums
- Illegal treatments, operations, or drugs
- Late payment fees
- Marriage counseling, unless performed for purpose of alleviating or preventing a physical or mental defect or illness
- Herbal remedies
- Social activities, such as dance classes, even if recommended by a physician
- Teeth whitening
- Vitamins/nutritional supplements (only eligible if necessary to treat a specific medical condition and accompanied with a Letter of Medical Necessity)
- Weight reduction programs for general well being
Estimate Your Annual Expenses Carefully
Use the PayFlex Medical Expense Planning Worksheet or the Savings Calculator to help you determine your estimated annual expenses that could be reimbursed from a Health Care FSA. Once enrolled you cannot change your annual contribution limit or cancel participation unless you experience a qualified family status change.
If you pay out-of-pocket for eligible expenses, you may file a claim for reimbursement after you or your eligible dependents receive health care services or you make eligible purchases. The entire annual contribution is available for reimbursement at the FSA effective date, even if you have not made all of your contributions from your paychecks yet.
You have the option of submitting a claim online or completing a paper claim form and mailing or faxing it along with your itemized documentation. There is also a smartphone app for filing claims. See Submitting Claims for Reimbursement for details on filing claims.
If you use your PayFlex/HealthHub card to pay for eligible expenses, it works as a credit card, only the funds are deducted from your FSA, and you have to have the full amount in your Health Care FSA to cover the bill. You do not need to file claims when you use the card, but you will need to provide itemized receipts to PayFlex later on to verify transactions. Request and keep all receipts when using your PayFlex/HealthHub card. See Using Your PayFlex Card for details.
File all claims by May 31 of the following year. According to IRS rules, any money left in your Health Care FSA on June 1 following the plan year is forfeited and turned over to the university for administrative fees.