| The Healthcare FSA is a way for you to pay with tax-free
dollars for many of your health-related out-of-pocket expenses
that are not covered or fully reimbursable under your medical
plan. Examples of expenses for which you may be reimbursed
are those that are incurred for physician office visit co-pays,
prescription co-pays, vision care expenses and even certain
over-the-counter drugs and medicine. However, federal regulations
do not allow any insurance premiums, warranties, service
contracts, or long-term care expenses to be reimbursed under
this plan.
Examples of Eligible Healthcare Expenses
• Medical plan deductibles
• Most co-payments
• Prescription drugs
• Over-the-counter (OTC) drugs and medicines purchased
to alleviate or treat personal injuries or sicknesses
• Routine checkups and physicals
• Dental and orthodontia expenses
• Vision care expenses, including exams, glasses,
and contract lenses
• Laser eye surgery
• Many treatments for alcoholism or drug addiction
• Weight loss programs prescribed to treat an existing
disease • Smoking cessation programs and prescriptions
prescribed by a physician
• Psychology and Psychoanalysis medical expense amounts
• Medically necessary cosmetic surgery
• Hearing Aids/batteries
• Birth control pills, devices and procedures
• Sterilization & Vasectomy
• Well baby care and immunizations
• Occupational/Physical therapy
• Chiropractor expenses for medical care
• Infertility treatments
• Massage therapy used to treat injury or trauma
• Acupuncture or related procedures when treating
a medical condition
You may choose any annual Health Care Reimbursement amount
you desire, subject to the following minimum and maximum
annual amounts:
Payroll Schedule |
Annual Minimum |
Minimum Per Pay
Period |
Annual Maximum |
Maximum Per Pay
Period |
12-Month |
$240 |
$10.00 |
$600 |
$25.00 |
10-Month |
$240 |
$12.00 |
$600 |
$30.00 |
Eligible medical expenses must be incurred during the
Plan Year (or the 2-½ month Grace Period thereafter)
and while you are a participant. You may not be reimbursed
for any expenses arising before the Healthcare FSA becomes
effective or for any expenses incurred after the close
of the Grace Period or after a separation from employment.
If you do not incur an amount of eligible medical expenses
that match the pre-tax dollars set aside and allocated
to your account, the allocated amount is forfeited.
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