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FLEXIBLE SPENDING ACCOUNT

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IRS Publication 502
IRS Publication 503
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What is an FSA?

Flexible Spending Accounts (FSAs) are voluntary accounts that allow you to use your before-tax pay for certain health care expenses and dependent care expenses as determined by IRS regulations. You can set up two separate accounts—one for eligible health care expenses and one for qualified dependent care expenses. These are two separate accounts for two separate purposes. The monies in one account can’t be used to satisfy expenses in the other account. You can participate in either of these accounts or both — or none at all — depending on your needs. Medical Mutual My Spending Accounts is the claims administrator for the FSA Program.

For those enrolled in the HSA Plan option, you are eligible for the Limited Purpose FSA and Dependent Care FSA.

HEALTH CARE FLEXIBLE SPENDING ACCOUNT

Contributions

You may contribute up to $3,200 per year as a before-tax contribution to your Health Care FSA.

Eligible Dependents

In general, an eligible dependent under the Health Care FSA is anyone you list as a dependent on your federal income tax return. This includes your immediate family members, a close relative or other person whose primary residence is your home and for whom you provide over 50% support.

ELIGIBLE HEALTH CARE EXPENSES

If you set up a Health Care FSA, you can be reimbursed for eligible expenses that you or your dependents incur after your effective date and during the calendar year in which you participate in the Plan.

Examples of eligible health care expenses, to the extent not covered by another plan, include:

  • Copayments, deductibles and coinsurance not covered by medical or dental insurance
  • Uninsured expenses, such as hearing aids, eyeglasses, contact lenses and certain eye surgeries
  • Orthodontia
  • Diabetic supplies
  • Smoking cessation programs
  • Fertility services

IMPORTANT REMINDER: When making your Health Care Flexible Spending Account election, please be aware that over-the counter medications and menstrual products are eligible for reimbursement beginning January 2020.

PAYING YOUR HEALTH CARE EXPENSES

There are two ways to pay for eligible expenses:

  • FSA Claim Form – You pay your health care providers directly and then file a claim for reimbursement. Simply complete a health care FSA claim form and submit the form by mail or fax along with the receipts. The form is available by logging on to www.MedMutual.com/member or by calling Member Services at 1-800-525-9252.
  • Debit Card – You can use this card to pay for eligible health care expenses at any health care provider or approved merchant. With the Debit Card, participants have instant access to the money in their FSA, which is automatically drawn from their account as purchases are made.

USING YOUR HEALTH CARE FSA DEBIT CARD

Per Internal Revenue Service (IRS) regulations, your Debit Card may only be used at health care providers who have a health care-related merchant category code (such as physicians, dentists, vision care offices, hospitals, and other medical care providers) or at grocery stores, discount stores and pharmacies who utilize an Inventory Information Approval System (IIAS). You may not use the Debit Card at any merchant, including pharmacies, that do not have a health care-related merchant category code unless that merchant or pharmacy utilizes an IIAS.

DEPENDENT CARE EXPENSES

For a complete list of eligible and ineligible health and dependent care expenses visit www.IRS.gov and review Publications 502 & 503. A list can also be obtained from your local IRS office.

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

Contributions

In the Dependent Care FSA, you may contribute up to $5,000 per year. The $5,000 annual maximum applies to all contributions made by you and your spouse to a dependent care account. If you are married and filing separately for federal income tax purposes, you may elect to contribute up to $2,500 per year.

Eligible Dependents

You can be reimbursed for day care expenses you have in a plan year, if the expenses are necessary to allow you and your spouse—if you’re married— to work. These services may be provided inside or outside your home by babysitters, companions or eligible day care centers. Services may not, however, be provided by someone you claim as a dependent on your tax return.

Your day care expenses must be for:

  • Your dependent under age 13 who lives with you for more than half the year and for whom you can claim an exemption
  • A child under age 13 for whom you have custody if you are divorced or legally separated
  • Your spouse who is physically or mentally incapable of self-care
  • A dependent of any age, such as an elderly parent or other adult dependent, who meets all of the following criteria:
    • Is physically or mentally incapable of caring for himself or herself,
    • Receives over half of his or her support from you,
    • Lives with you for more than half the year, and
    • Is your sibling, step-sibling or any of their descendants; a parent or step-parent or any of their ancestors; an aunt, uncle, niece, or nephew; children or parents-in-law; or an unrelated individual who shares your residence as a member of the household.