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What is a Flexible Spending Account?
A Flexible Spending Account, or FSA, is an employee benefit program that allows you to set aside money, on a pre-tax basis, for certain health care and dependent care expenses. That means YOU keep MORE of your MONEY. FSAFEDS offers three types of accounts:
A Health Care FSA (HCFSA) is used to pay for eligible health care expenses that are not covered under your insurance plan, such as co-payments and over-the-counter medicines, such as Tylenol and Sudafed. It is sometimes referred to as a general purpose HCFSA
A Limited Expense Health Care FSA (LEX HCFSA) is used in place of the general purpose Health Care FSA if the participant enrolled in a High Deductible Health Plan with a Health Savings Account (HSA). The Limited Expense HCFSA allows you to submit eligible dental and vision expenses only.
A Dependent Care FSA (DCFSA) is used to pay for childcare or adult dependent care expenses that are necessary to allow you and your spouse, if married, to work, look for work or attend school full-time. However, if you did not find a job and have no earned income for the year, your dependent care costs are not eligible. For more information, refer to Do I, or my spouse if married, have to earn income during the year to use a Dependent Care FSA (DCFSA)?
I have a Health Savings Account. Can I still participate in FSAFEDS?
Yes! While you are not eligible to enroll in a standard Health Care FSA, you do have the option of enrolling in the standard Dependent Care FSA (DCFSA) and/or a Limited Expense HCFSA. The Limited Expense HCFSA allows you to set aside money, on a pre-tax basis, to pay for eligible vision and dental expenses.
See the Limited Expense HCFSA for more information.
How do I know if my expense is eligible?
The FSAFEDS Eligible Expenses Juke Box provides a detailed listing of the most common expenses online at www.FSAFEDS.com. If you do not find the item in question, you may contact an FSAFEDS Benefits Counselor toll-free, at 1-877-FSAFEDS (372-3337), TTY: 1-800-952-0450, Monday through Friday, 9:00 A.M. until 9:00 P.M., Eastern Time.
Is there a way to submit claims without all the paperwork?
Yes! Paperless Reimbursement (PR) allows participants the option of having claims submitted to FSAFEDS directly by their FEHB Plan, thus eliminating the need for to submit hard copies via fax or mail. We currently have several FEHB and FEDVIP plans participating and each handles claims differently. All our participating FEHB Plans may take up to four weeks to forward medical/dental/retail pharmacy claims and up to six weeks for any mail-order pharmacy claims. For specific information, such as what claims are forwarded to FSAFEDS under the Paperless Reimbursement program, refer to the Paperless Reimbursement Quick Reference Guide and select your plan. If your plan participates in PR, you may enroll outside of Open Season by logging into MY Account Summary and selecting Paperless Reimbursement from the menu.
What happens if my claim is denied?
You have the right to appeal any FSAFEDS denial that involves your Health Care, Limited Expense Health Care, and/or Dependent Care Flexible Spending Account, including:
- A claim or request that is not paid in full
- A product or service determined to be ineligible that you believe is eligible
- Your request to change your election due to a Qualifying Life Event that is not approved
If you disagree with our decision, or do not understand why your claim for reimbursement had been denied in part, or in full, you may contact an FSAFEDS Benefits Counselor within 30 calendar days from the date of the decision to request a more detailed explanation. If you are not satisfied after asking us to review your claim, you may submit a formal appeal in writing to FSAFEDS for reconsideration within 60 calendar days of the initial decision.
For more information on how to file an appeal, please see How do I appeal a claim that has been denied? on the Summary of Benefits with Frequently Asked Questions.
What does “medically necessary” mean?
Some expenses are eligible for reimbursement only when a doctor or licensed health care practitioner certifies that the service/procedure is medically necessary. A few examples include wigs due to chemotherapy/radiation treatment, cosmetic surgery following an accident or surgery, etc. You must submit a Letter of Medical Necessity with the claim for it to be approved. It details the diagnosis, recommended treatment, specific length of treatment and how it will alleviate your medical condition. If the treatment extends beyond the timeframe included on the original form submitted, you must submit a new Letter of Medical Necessity for the treatment to continue to be eligible.
Is mileage to and from my doctor's office, as well as parking fees, reimbursable?
Yes, under a health care FSA, your travel to and from the doctor's office as well as any parking fees associated with your visit are reimbursable, provided you have a receipt that validates your visit. See “Mileage” under the FSAFEDS Eligible Expenses Juke Box for more information.
Can I access my account information online?
Yes! Your account information is available 24/7 via My Account Summary. You can update your personal information and follow the status of your claims by selecting My Claims from the left-hand menu. Information is available regarding both your current and previous year accounts.
Still have questions regarding your account? You may contact an FSAFEDS Benefits Counselor toll-free at 1-877-FSAFEDS (372-3337), TTY: 1-800-952-0450, Monday through Friday, 9:00 A.M. until 9:00 P.M., Eastern Time.
Can I transfer money between my Health Care Flexible Spending Account, Limited Expense Health Care Flexible Spending Account and Dependent Care Flexible Spending Account?
No. The amount you designate to a Health Care, Limited Expense Health Care or Dependent Care Flexible Spending Account is used solely for those expenses. The funds cannot be transferred from one account to the others.
How do I change my annual election?
During Open Season, you can make as many changes to your annual election as needed. Outside of Open Season, you are only allowed to change your election if you experience a Qualifying Life Event, such as divorce or death of a spouse. Refer to the Qualifying Life Event QRG for more information.
How do I get reimbursed from my Flexible Spending Account(s)?
With Health Care and Limited Expense Health Care Flexible Spending Accounts, your entire election is available to you from the first day of your Benefit Period. And, we can begin to reimburse your eligible expenses as soon as we receive your first allotment even though you have not contributed your total annual election.
With a Dependent Care FSA, you can only be reimbursed up to the amount currently available in your account. If your claim is for more than is currently available, you would be reimbursed up to that balance and the remaining amount would be pended until your next allotment is received.
What is a Qualifying Life Event?
A Qualifying Life Event (QLE) is a major life event that allows you to change your election during the Benefit Period. A few examples of a QLE include a change in marital status, birth or adoption of a child or the death of a spouse. For more information, refer to the QLE Quick Reference Guide.
What happens if I separate or retire before the end of the Benefit Period?
The balances in your HCFSA or LEX HCFSA (you can’t be enrolled in both types of accounts at the same time) and DCFSA are treated differently if you separate before the end of the Benefit Period.
Your HCFSA or LEX HCFSA will terminate as of the date of your separation. There are no extensions. Any health care expenses incurred prior to the date of separation will still be reimbursable but those incurred after the date of separation will not. You can continue to use the remaining balance in your DCFSA to pay for eligible dependent care expenses until the end of the Benefit Period or until your account balance is used up, whichever comes first.
What happens if I change agencies during the Benefit Period?
As long as your new agency participates in FSAFEDS, your account will remain active, but you must notify FSAFEDS as soon as possible to ensure there is no disruption in service. Your participation terminates if you transfer to an agency that is not covered by FSAFEDS.
You can reach us via email at FSAFEDS@adp.com or, toll-free, at 1-877-FSAFEDS (372-3337), TTY: 1-800-952-0450, Monday through Friday, 9:00 a.m. until 9:00 p.m., Eastern Time.
How is my effective date determined if I enroll outside of Open Season?
If you enroll in FSAFEDS with a Belated Enrollment or as a new/newly eligible employee, your election will generally be effective the next business day after you enroll, but not before January 1. You may elect up to the full amount for the HCFSA and DCFSA. However, there is no proration. Only expenses incurred on or after your effective date through the end of the Benefit Period are eligible for reimbursement.
If you are a newly eligible employee due to a QLE, your election will be effective on the first day of the first pay period that starts after your election is approved by FSAFEDS. No enrollments—belated or otherwise—are accepted on or after October 1 of any Benefit Period.
How much can I elect for a Health Care, Limited Expense Health Care or Dependent Care Flexible Spending Account(s)?
The maximum annual election for a Health Care or Limited Expense FSA is $2,500 and the minimum is $100. The maximum annual election for Dependent Care FSA is $5,000 and the minimum is $100.