What is an FSA?
A Flexible Spending Account is an account funded by employee salary deferral elections and, in some cases, employer contributions, for the purpose of reimbursing expenses on a pre-tax basis. Most plans offer two types of accounts: Medical (also called Health Care) for reimbursement of eligible medical, dental, vision, prescription and over-the-counter drug expenses; and Dependent Care for reimbursement of day care expenses.
Your employer will set a maximum contribution amount at the beginning of each plan year. Participants may elect to contribute an amount each plan year up to that maximum.
What medical expenses may be reimbursed through a Medical FSA?
In most cases, a participant may be reimbursed for a medical care expense which is defined as a deductible expense for federal income tax purposes, but which has not been or will not be reimbursed by any other source and which will not be deducted on the employee's income tax return. Please note: cosmetic procedures are not considered reimbursable. Some examples of eligible expenses include co-payments and deductible payments required by health insurance; also vision, hearing, dental, most prescription drug expenses not covered by health insurance and over-the-counter drugs.
What are some examples of expenses reimbursable under a Medical Flexible Spending Account?
Please click here for a list of items reimbursable under a Medical Flexible Spending Account.
What Over-the-Counter (OTC) health care expenses are eligible under a Medical FSA?
Eligible Over-the-Counter items must be considered medically necessary; examples of this include:
- Allergy Relief
- Analgesics (e.g. aspirin, acetaminophen, ibuprofen)
- Antacids and heartburn relief
- Antibiotic cream and ointment, hemorrhoid preparation
- Anti-itch and hydrocortisone creams
- Arthritis pain relief
- Cold medications
- Dental care (e.g. toothache relief, temporary filling, denture adhesive)
- Ear Care (e.g. ear drops, ear wax removal, ear plugs)
- Eye Care (e.g. contact lens solution, lubricant drops, patches, reading glasses)
- Family Planning (e.g. condoms, contraceptive creams, pregnancy test, ovulation predictor kits)
- Feminine Care (e.g. yeast infection products)
- First Aid (e.g. heat wraps, hot/cold packs, bandages, Band-Aids)
- Foot Care (e.g. arch and insole supports, callous removers, athletes' foot treatment)
- Home diagnostic test or kits (i.e. blood pressure, cholesterol, diabetes)
- Knee or elbow supports
- Laxatives
- Motion sickness Treatments
- Smoking-cessation relief (e.g. patches, gum)
- Stomach Digestive relief
- Tooth and mouth pain relief
- Urinary Pain Relief
- Vaporizers
- Wart removal medication
If there are items of interest to you not on the list; please email the Crosby Benefit Systems Service Center or call 800-462-2235.
Can I change or cancel my Medical or Dependent Care Flexible Spending Account (FSA) Election at anytime during the plan year?
The FSA election you make during an enrollment period is required for the entire plan year. Changes to your FSA election (i.e. increase or decrease in your elections) can only be made during open enrollment, OR under special circumstances like when a qualified status change occurs.
What are considered qualified status changes?
In general, acceptable status changes are as follows (Please note: definitions of your employer's acceptable status changes can be found in your Summary Plan Description or SPD (speak with your Human Resources representative about acquiring a copy of your SPD):
1. Change in legal marital status
2. Change in employment status
3. Change in number of dependents
4. Dependent satisfies or ceases to satisfy eligibility requirements
5. Entitlement to Medicare or Medicaid
How do I submit a claim for reimbursement?
To submit a request for reimbursement, please send proof of an incurred expense(s) (i.e. an itemized bill or receipt along with a completed Reimbursement Request Form found here).
Receipts must include: name of the person who received service, name and address of the service provider, nature of the service or supplies (drug name if submitting a prescription or over-the-counter medication), amount of the reimbursable expense and the date(s) of service(s).
Please submit Reimbursement Request and supporting documentation to Crosby Benefit Systems via:
Email: servicecenter@crosbybenefits.com
Fax: 617-928-0001
Mail: Crosby Benefit Systems
PO Box 929125
Needham, MA 02492-9125
For Harvard Participants:
Email: servicecenter@crosbybenefits.com
Fax: 617-928-0001
Mail: Crosby Benefit Systems
PO Box 920445
Needham, MA 02492-0005
Please Note:
1. Expenses must be incurred during the current plan year and during your dates of participation
2. Reimbursement checks/direct deposits are sent according to a pre-determined processing schedule.
3. A "run out period" will immediately follow the plan year during which participants may submit claims for expenses incurred during the previous plan year.
What information should be provided on the supporting documentation submitted with the reimbursement request?
Attach receipts or statements that clearly show: Name of person receiving service, nature of service or supplies, name and address of care provider, amount charged, date the service was provided. For some expenses, a doctor's note may be required to verify that the expense qualifies as medical care. Please note: for dependent care expenses, the IRS requires that participants provide the tax identification number and (or Social Security Number) of the day care provider(s). In addition, this information must also be provided on the Child Care Expenses Tax Schedule.
What Qualifies as a Medical Practitioner's (Doctor's) Note?
For some expenses, a medical practitioner note is required to verify that the expense qualifies as medical care. To be allowable, a medical practitioner note may be written by a doctor of medicine, dentistry, podiatry, optometry, an authorized chiropractor, an alternative healer or other qualified medical practitioner. A medical practitioner note must contain all of the following items:
1. Date (a note must be provided each year)
2. Patient's name
3. Medical practitioner's name, address and signature
4. The medical condition or statement of medical necessity
5. The prescribed treatment
6. The duration of treatment required.
Are canceled checks or bank statements an acceptable form of documentation?
No. According to IRS guidelines, canceled checks and bank statements (including credit card statements) are not acceptable documentation.
Which types of medical expenses are generally not eligible for reimbursement under a Medical FSA?
The following are generally not eligible for reimbursement under a Medical FSA:
- Premiums for health insurance
- Premiums for Medicare
- Any expenses reimbursable by insurance, Workers' Compensation, or any other means
- Expenses for cosmetic procedures and products
- Toiletries
- Dietary supplements for general good health
What is my Employee ID?
Generally, your Employee ID is a unique number assigned to you by your employer. If you are unsure about what your Employee ID is, please contact your Human Resources Department.
What is the maximum amount which can be contributed to a Dependent Care FSA?
Your employer will set a maximum contribution amount at the beginning of each plan year. Participants may elect to contribute an amount each plan year up to that maximum. Per IRS requirements, employers may allow eligible participants to contribute up to a maximum of $5,000 ($2,500 for married individuals filing separately) for any one tax year. The contributions, however, cannot exceed the earned income of the lower-paid spouse. Also, participants may need to choose between a dependent care reimbursement account and the dependent care tax credit because the tax credit maximum is reduced dollar for dollar for each dollar placed into a reimbursement account. Please be aware that the plan year may not coincide with the tax year.
What expenses may be reimbursed through a Dependent Care FSA?
Expenses must be "Eligible Employment Related Expenses" as defined in your Summary Plan Description or SPD (speak with your Human Resources representative about acquiring a copy of your SPD). Generally, "Eligible Employment Related Expenses" are expenses for the custodial care of one or more Qualifying Individuals that enable you (and your spouse, if applicable) to work or look for work.
When can I submit my claims for Dependent Care expenses?
Under IRS guidelines, a dependent care expense can only be reimbursed AFTER it has been incurred. Only claims received for services provided in the current month or prior months in a plan year will be eligible for reimbursement.
What is the definition of a Qualifying Individual?
- A "Qualifying Child" (as defined in Code Section 152(c)) who is under the age of 13 and who resides with you for more than half of the year;
- A dependent (as defined generally in Code Section 152) that is incapacitated and resides with you for more than half of the year*; or
- A legal spouse who is incapacitated and resides with you for more than half of the year.
*Currently, an individual (other than an individual who qualifies as a "qualifying child" of the employee) cannot qualify as a dependent under Code Section 152 if he/she has income equal to or in excess of $3,200 (adjusted for inflation). You should consult with qualified tax or legal advisor to determine if individuals for whom you are submitting reimbursement requests qualify as Qualifying Individuals.
In general, when am I not required to submit receipts?
- Recurring expenses (the amount charged and merchant information must match the exact dollar amount and merchant information for each successive expense)
- Co-payments (if enrolled in employer's medical plan)
- Prescriptions
- IIAS retailers
In general, when am I required to submit receipts?
- Co-payments (if not enrolled in employer's medical plan)
- Optometry and dental expenses
- Combined eligible and ineligible transactions
- Other non-confirmable transactions
How does the Flex Debit Card work?
You present the debit card to a qualifying provider or merchant. If charges meet basic eligibility requirements and the necessary funds are available, the provider receives direct payment. You will be notified by email or mail if you are required to submit receipts proving your expense was FSA eligible.
Is a Personal Identification Number (PIN) required to complete a transaction?
No PIN is required to complete a transaction. If asked to choose "credit" or "debit", choose "credit".
Are my transactions Credit or Debit Card transactions?
While visiting a merchant, if you are asked whether your transactions should be "debit or credit," your response should always be Credit.
Can I order a Flex Debit Card for one of my dependents?
If you would like to order an additional Flex Debit Card for one or more of your dependents, please email the Crosby Benefit Systems Service Center or call 800-462-2235. The following information is required:
1. Primary Cardholder Name
2. Last 4 Digits of SSN (or Employee ID if held by Crosby)
3. Primary Cardholder's Mailing Address
4. Primary Cardholder's Home Phone
5. Primary Cardholder's Work Phone
6. Primary Cardholder's Email Address
7. Dependent Name
8. Last 4 Digits of Dependent SSN
By submitting this information, you are authorizing Crosby to send an additional Flex Debit Card to your Dependent(s). All additional Flex Debit Cards will be mailed to the Primary Cardholder's address.
What is IIAS?
IIAS (Inventory Information Approval System) technology makes it possible to track which of your purchases are considered eligible under your Medical Flexible Spending Account at grocery stores, discount stores, wholesale clubs, mail-order vendors and web-based vendors. This means, effective January 1, 2008, that when you shop at IIAS compliant retailers, your items will be identified as either an "eligible" or "ineligible" FSA expense at the point of sale. You may use your Flex Debit Card to pay for eligible items and will be asked to use another form of payment for ineligible items. If your transactions are auto-adjudicated, you will not be asked to submit a receipt to Crosby.
If you use your card at a non-IIAS compliant retailer, your transaction may be denied.
What retailers are IIAS compliant?
Click here for a list of grocery stores, discount stores and wholesale clubs that have implemented certified IIAS technology.
What amount can I access by using my Flex Debit Card?
Your available balance is your annual election minus previous eligible transactions made with the Flex Debit Card or via traditional reimbursement. Please note: if your purchase exceeds your balance, the transaction will not be approved at time of purchase.
What happens if I do not substantiate my expense?
If you do not substantiate expenses, here is what you can expect:
- Two requests for receipts will be sent to you by email or mail
- If the request is not satisfied within 30 days of the transaction, your expense will be considered ineligible
- Your card will be temporarily deactivated
- You must mail a check to cover ineligible amounts along with a flex debit card refund form to re-activate your card. Your card will be reactivated approximately four business days after the check is received.
What if my card gets lost or stolen and someone tries to buy products or services with my card?
Contact Crosby immediately if your card is lost, stolen or if you do not recognize a transaction as one of your own. A Crosby representative will assist you with getting a new card and/or guide you through the transaction dispute process.
Am I issued a new card every year I participate?
No. As long as you do not have a break in participation, you should continue to use your current Flex Debit Card until the expiration date printed on the card. If you are an active participant at the time the card expires, a new card will be mailed to you.
What if I don't want to use the Flex Debit Card?
You do not need to use the Flex Debit Card. You can submit your eligible expenses directly to Crosby for reimbursement. To manually submit a request for reimbursement, please send proof of an incurred expense(s) (i.e. an itemized bill or receipt along with a completed Reimbursement Request Form found here).
Receipts must include: name of the person who received service, name and address of the service provider, nature of the service or supplies (drug name if submitting a prescription or over-the-counter medication), amount of the reimbursable expense and the date(s) of service(s).
What if I lose my receipt or purchase an ineligible item with the Flex Debit Card?
If you are unable to substantiate a Flex Debit Card expense because you have lost your receipt or purchased an ineligible item, you can refund your account by submitting payment along with a completed Refund Form, available here.
What is COBRA?
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. The legislation was signed into law on April 7, 1986.
COBRA amended federal law to require most employers to offer temporary continuation coverage to employees and dependents who would otherwise lose group health plan coverage because of certain "qualifying events." The legislation provides certain employees and dependents with coverage during the period between loss of coverage and obtaining other coverage, at group rates.
What is a qualifying event?
In general, an event is considered a qualifying event only if it meets all of the following conditions:
- It is one of the designated events under COBRA
- The event causes the qualified beneficiary to lose group health plan coverage provided by the employer
- The event occurs while the plan is subject to COBRA
What are the six "designated events"?
Generally, the following refer to the six "designated events:"
1. Covered employee's termination of employment - for any reason other than gross misconduct or a covered employee's reduction in hours to fewer than the number required to participate in the plan;
2. Covered employee's divorce or legal separation from spouse;
3. Covered employee's death;
4. Covered employee's entitlement to Medicare under Title XVIII of the Social Security Act;
5. Covered child's loss of dependent status under the generally applicable terms of the plan; or
6. Retiree's (or a retiree's spouse's or child's) substantial loss or elimination of coverage within one year of (before or after) the employer's filing of a Title XI bankruptcy proceeding on or after July 1, 1986.
An employee can only have 1 or 6 as an event. A spouse can have all of the above except for 5. A child can have all of the above as a qualifying event.
What is a "Qualified Beneficiary"?
A qualified beneficiary is someone who was covered under the Plan(s) immediately preceding the qualifying event and will lose coverage under the Plan because of the qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees (including infants born and children adopted during COBRA coverage) may be qualified beneficiaries.
Generally, what are the coverage periods?
Losing coverage due to:
- Termination of Employment (except for gross misconduct) or Reduction in Hours - 18 months coverage
- Death of Employee - 36 months coverage
- Employee's Medicare Entitlement - 36 months coverage
- Divorce or Legal Separation (applies to Spouse and Dependents) - 36 months coverage
- Dependent Child Ages-Out of Plan (applies to Dependents) - 36 months coverage
COBRA Timeframes
- 30 Days - Employer Reports Event to Plan Administrator
- 14 Days - Administrator Notifies Qualified Beneficiary
- 60 Days - COBRA Election Period
- 45 Days - First Premium Payment Due*
*Retroactive premium from loss of coverage to date of election; amount accrued
What types of enrollment changes can be made at the time of the COBRA event?
Generally, when an event occurs, you can choose to continue your existing coverage (i.e. medical, dental, etc.). You may not change from one plan to another, unless it is during a designated open enrollment period. You may however, change from Family to Individual coverage, though you may not change from Individual to Family coverage.
Do I have to elect to continue all of the coverage's that I was enrolled in prior to my COBRA event?
No, you may choose to continue only some of the coverage's that you already have. For example, at the time of the COBRA event, if you are enrolled in Medical, Dental and Vision coverage, you may then choose to only continue Medical, or any combination of the three. However, if you were not already enrolled in a benefit plan (i.e. dental), you may not add it at the time of the COBRA event.
How long will it take for my health insurance coverage to be reinstated with the insurance carrier(s) once I have mailed in my initial COBRA payment?
Once your initial premium payment is submitted to Crosby, your coverage will be reinstated approximately 2 to 3 weeks from the date you mail in your payment. Your coverage will be retroactively reinstated to the loss of coverage date.
While my coverage is being reinstated with the insurance carrier(s), what should I do if I have a medical appointment or prescriptions to fill?
Many health care providers and pharmacies understand the COBRA process and may be able to accommodate your needs while you wait for your COBRA coverage to be reinstated back to the date on which you lost your coverage. If you incur expenses, once your coverage has been reinstated, you may submit those expenses to your health insurance carrier for reimbursement. Please contact your health insurance carrier directly for information about the reimbursement process.
How do I actively terminate my COBRA coverage?
If you wish to actively terminate your COBRA coverage, you must notify Crosby in writing. The cancellation will be effective the first of the month following receipt of your written request and you will be responsible for premiums until that date.
Under what circumstances could my coverage be terminated?
Continuation coverage may be terminated before the end of the maximum period if:
- Any required premium is not paid in full on time;
- A qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary;
- A covered employee becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage;
- The employer ceases to provide any group health plan for its employees.
- A qualified beneficiary who has received an extension of continuation coverage due to an SSA disability determination is subsequently determined by SSA to no longer be disabled; or,
- The qualified beneficiary provides written notice to the COBRA plan record keeper (Crosby) that they wish to cancel continuation coverage.
Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).