Page 9 - NH NC Guide
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Flexible Spending Accounts




Available Through Health Equity

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


Funds you elect to contribute to the Healthcare FSA are available in full Examples of FSA
on the effective date of your coverage and may be used for expenses Eligible Expenses
incurred through November 30, 2016. Our FSA program includes a
$500 rollover provision. You can roll over up to $500 of unused FSA „ Healthcare Spending Account
dollars into your account to use next year. The amount you roll over is „ Doctor’s visit copays

in addition to your regular annual election. Funds you contribute to the „ Prescription drug copays
Dependent Care FSA function like a debit card; you need to accumulate
the funds before you can use them. „ Medical and dental deductibles

„ Over-the-counter medications (with
Healthcare FSA a written prescription)
The Healthcare FSA lets you pay for certain IRS-approved medical care „ Hearing aids
expenses not covered by your insurance plan with pre-tax dollars. For

example, cash you now spend on deductibles, copayments, or other „ Eye glasses
out-of-pocket medical expenses can instead be placed in the Healthcare „ Contacts
Reimbursement FSA pre-tax to pay for these expenses. You may also „ Contact lens solution
use Healthcare FSA funds to reimburse eligible expenses for your
dependents who are not covered under the MG+BW medical plan. The „ Dental services
maximum contribution to the healthcare reimbursement FSA is $2,500 „ Orthodontia
per plan year. „ Acupuncture


If you enroll in the MG+BW medical plan, the HRA will reimburse „ Laser vision correction surgery
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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