Page 9 - NH Non NC Guide
P. 9
Flexible Spending Accounts




Available Through Health Equity Examples of FSA Eligible

An FSA allows you to set aside before-tax dollars from your paycheck Expenses
to cover qualiied expenses you would normally pay out of your pocket „ Healthcare Spending Account
with after-tax dollars. You pay no federal income, state income, or Social
Security taxes on the money you place in your FSA. „ Doctor’s visit copays

„ Prescription drug copays
Funds you elect to contribute to the Healthcare FSA are available in full „ Medical and dental deductibles
on the effective date of your coverage and may be used for expenses
incurred through November 30, 2016. Our FSA program includes a $500 „ Over-the-counter medications (with a
rollover provision. You can roll over up to $500 of unused FSA dollars written prescription)
into your account to use next year. The amount you roll over is in addition „ Hearing aids

to your regular annual election. Funds you contribute to the Dependent „ Eye glasses
Care FSA function like a debit card; you need to accumulate the funds
before you can use them. „ Contacts
„ Contact lens solution
Healthcare FSA
„ Dental services
The Healthcare FSA lets you pay for certain IRS-approved medical care

expenses not covered by your insurance plan with pre-tax dollars. For „ Orthodontia
example, cash you now spend on deductibles, copayments, or other „ Acupuncture
out-of-pocket medical expenses can instead be placed in the Healthcare „ Laser vision correction surgery
Reimbursement FSA pre-tax to pay for these expenses. You may also use
Healthcare FSA funds to reimburse eligible expenses for your dependents
who are not covered under the MG+BW medical plan. The maximum
contribution to the healthcare reimbursement FSA is $2,500 per plan year.


If you enroll in the MG+BW medical plan, the HRA will reimburse eligible
medical plan expenses which apply to you or a covered family member’s plan year
deductible. You may use your healthcare FSA funds to reimburse your share of the

medical deductible you must pay before your MG+BW funded HRA begins to pay.

Once you have paid the irst $500/$1,000 of your plan year deductible, your

available HRA funds will be used to reimburse the provider. You are not required
to submit claims for reimbursement from your HRA.










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