Program

The California State University Health Care Reimbursement Account (HCRA) is a voluntary benefit, which allows you to take pre-tax dollars from your pay warrant in order to pay for eligible out-of-pocket medical, dental and vision expenses.  If you enroll in the plan, the contributions you make to your account are deducted from your pay before Federal, State and Social Security (FICA) taxes are calculated.   A monthly administration fee of $1.00 will be deducted from your salary on an after-tax basis. 

 

Health Care Reimbursement Account Enrollment Authorization Form, plan brochure, or claim form can be downloaded through Acrobat Reader or you can obtain hardcopies through Human Resources.  

 

Eligibility

New employees may enroll in the plan within 60 days of becoming eligible.  Coverage will become effective on the 1st of the month following enrollment, subject to State Controller's Office processing timelines.   Employees who do not enroll during the initial 60 days, will be eligible to enroll during any subsequent annual open enrollment period or due to a change in status.

 

You are eligible to enroll in the HCRA if you are in an Executive, Management Personnel Plan (MPP), Confidential or other non-represented position, or are covered by a collective bargaining agreement that provides this benefit.

 

Enrollment

Participants currently in the Health Care Reimbursement Account program must re-enroll during the annual open enrollment period if you wish to participate the following tax year.

 

Once you enroll, you will not be able to change your contribution amount until the next open enrollment period unless you have had a change in status.  If you have a change in status, you may increase (up to the appropriate IRS limit), decrease, start, or stop your contributions by filing a new Authorization Form within 60 days of the status change. 

 

If you stop your contributions, you may continue to submit eligible expenses incurred prior to the date your plan participation ends.   If your CSU employment terminates for any reason, or you go on a leave of absence without pay, please contact Human Resources for COBRA/Direct Pay information.

 

Family Status Change

Allowable status change events are listed below:

 

• Change in Marital Status - marriage, divorce, death of spouse, legal separation or annulment.
 
• Change in Number of Dependents - the birth, death, adoption or placement for adoption of a child.  The definition of dependent includes a spouse who is physically or mentally unable to care for him/herself;
 
• Dependent begins or ceases to meet eligibility - the dependent satisfies (or ceases to satisfy) dependent eligibility requirements for HCRA;
 
• Termination/Commencement of Employment - the beginning or the end of employment of the employee, spouse or dependent;
 
• Work Hours Change - change in work schedule, including a reduction or increase in hours, full-time/part-time switch, start/stop or unpaid leave of absence or a strike or lockout of employee, spouse or dependent;
 
• Entitlement to Medicare or Medicaid - Employee, spouse or dependent gains or loses eligibility for Medicare or Medicaid; or
 
• Judgement, Decree, Court Order, or Qualified Medical Child Support Order (QMCSO).

 

Eligible Dependents

Please be advised that eligible expenses may be incurred both by tax dependents and dependents not claimed as an exemption on an employee’s tax return, as defined in IRS Publication 502, located at the following website:  http://www.irs.gov/ .   This publication may be used as a general guide, however, be aware that in some instances CSU Policy may differ.  Questions should be directed to the Third Party Administrator, ASI, 1-800-659-3035 (M-F from 6am to 5pm).

 

Contributions

You can contribute any amount from a minimum of $20 to a maximum of $416.66 per month ($5,000/year).  Please Note:  The IRS may impose additional limits in special situations.  It is strongly recommended that you consult with a tax advisor before enrolling in this account.

 

You must estimate your eligible expenses very carefully.  Any money left in your Health Care Reimbursement Account after your expenses have been paid for the year will be forfeited.  The IRS will not permit excess contributions to be refunded or carried over into the next plan year.

 

Deductions & Reimbursements

Your monthly contribution to your Health Care Reimbursement Account (HCRA) will be deducted from your paycheck and deposited into a special tax-free account.  Deposited funds are held in your HCRA until you incur eligible expenses and file a claim form for reimbursement.  Even when paid out as reimbursements, the funds remain tax-free.

 

You may file claims for expenses incurred during a plan year any time up to six months after the end of the plan year (June 30 of the next year).  Any balance remaining in the account after that date will be forfeited.

 

Eligible Expenses

Below is a partial list of eligible expenses reimbursable under the HCRA plan.  A comprehensive list of qualifying/non-qualifying expenses can be found in IRS Publication No. 502, located at the following website:  http://www.irs.gov/   This publication may be used as a general guide, however, be aware that in some instances CSU Policy may differ.  Questions should be directed to the Third Party Administrator, ASI, 1-800-659-3035 (M-F from 6am to 5pm PST).

 

Medical Expenses

• Deductibles and co-payments;
• Charges for routine check-ups, physical examinations, and tests;Charges over the “reasonable and customary” limits;
• Expenses not covered by the medical plan due to a pre-existing condition, or exclusion by the insurance company;
• Drugs requiring a doctor’s prescription that are not covered by insurance;
• Smoking cessation programs and related prescription drugs;
• Weight loss programs, supported by a physician's statement, including membership, or program fees for individuals diagnosed with hypertension or obesity (weight-loss programs for general health improvement, do not qualify as an eligible expense); and
• Expenses not covered by the medical plan that qualify as a federal income tax deduction, such as services and supplies for the disabled.

 

Dental Expenses

• Deductibles and co-payments;
• Expenses that exceed the maximum annual amount by your dental plan;
• Charges over the “reasonable and customary” limits;
• Orthodontia treatments that are not strictly cosmetic. Eligible orthodontic expenses can include: required down payments, monthly payments, and banding fees.   Initial requests for reimbursement of orthodontic treatment must include a contract or statement from the orthodontist.  This document must reflect the beginning of the treatment, total cost of treatment, and estimated length of treatment.  The entire cost of treatment must be prorated over the entire anticipated treatment period.   This means that you can only receive reimbursement for orthodontic costs incurred during each plan year of participation, even if you pay the entire treatment cost in current plan year.   Participants who expect treatment to extend beyond the plan year he/she is currently enrolled in, are encouraged to re-enroll for the following plan year for reimbursement of pending expenses.

 

 

 

Vision and Hearing Expenses

• Vision examinations and treatments not covered by insurance plan;
• Cost of eyeglasses, prescription sunglasses, contact lenses including lens solution and enzyme cleaner;
• LASIK surgery; and
• Cost of hearing aids and batteries.

 

Reimbursement Of Over-The-Counter Medicines

Effective January 1, 2004, participants in CSU’s Health Care Reimbursement Account (HCRA) plan can claim reimbursement for over-the-counter (OTC) medicines available without a prescription, provided the expense is properly substantiated.  The IRS ruling specifically mentions such OTC medicines as antacids, allergy medicines, pain relievers, and cold medicines purchased without a doctor’s prescription, but specifically disallows reimbursement for vitamins taken “for general good health.”

 

Claims for OTC drugs or medicines must include the following:

1. The receipt or documentation from the store must include the name of the drug purchased printed on the receipt.  This information must be provided by the store, not just listed by the participant on the receipt or claim form. 
2. The participant must indicate the existing or imminent condition on the receipt, on the claim form, or on a separate enclosed statement each time these items are claimed.  Purchases for general health will not be accepted.
3. To claim reimbursement for vitamins, herbs or nutritional supplements, the participant must have a written diagnosis of the medical condition from a doctor and “prescription” of all specific items for that condition on file with the claims office.  The participant must renew this physician notice every 12 months and file it with the claims office with the first claim submitted for that participant each plan year.

 

Specific questions should be directed to Application Software, Inc. (ASI) at (800) 659-3035.  The following provides a brief summary of qualifying and non-qualifying drugs and medicines:

(Purchased due to an existing or imminent condition)	(Purchased for general health purposes)
Allergy medicines Cold medicines Aspirin or pain medicines Creams or ointments Antibiotics Vitamins, herbs and nutritional supplements (only if to treat a specific medical condition – refer to the claims procedures listed above)	Vitamins, herbs and nutritional supplements Cosmetic supplies Large supply of qualifying items, not for existing or imminent condition Band-aids or other non-medicines General hygiene items (toothpaste, deodorant, etc.)

 

Ineligible Expenses

Listed below is a partial list of expenses that are generally NOT reimbursable under the HCRA plan.

• Payroll contributions made to HCRA plan;
• Surgery or procedures that are strictly cosmetic, such as electrolysis, hair transplants, plastic surgery, spider vein removal, teeth whitening or veneers (unless necessary to improve a deformity arising from or related to a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease);
• Health Club dues (even if doctor prescribed);
• Marriage and family counseling;
• Cost of Weight Loss Program (unless the program is recommended by a physician to treat an existing disease, i.e., heart disease)
• Any and all insurance premiums, warranty fees, or service contracts; and
• Long Term Care Insurance premiums (including nursing home charges).

 

Consolidated Omnibus Budget Reconciliation Act (COBRA) AND Direct Pay

If you lose your eligibility to participate in HCRA for any reason during the plan year (i.e., leave of absence without pay, retire, terminate, etc.), you may continue to make contributions on an after tax basis to your account through the end of the plan year. 

 

Enrollment in COBRA or Direct Pay must be done within 60 days of losing your eligibility.  If you choose not to continue contributions under COBRA/Direct Pay, the funds you have already contributed to your account will not be available for reimbursement of expenses you incur after the date you are no longer eligible.   COBRA and Direct Pay enrollment forms are available in Human Resources.

 

Third Party Administrator (TPA)

Application Software, Inc. (ASI) is located in Columbia, Missouri and has participated as a TPA for flexible spending account plans since 1988.  ASI will be mailing confirmation packets to enrolled participants by the beginning of the 2004 plan year.  Packets will include a confirmation statement, an assigned personal identification number (pin), detailed account access instructions, a supply of claim forms, and a direct deposit enrollment form.

 

Claim Forms

The Health Care Reimbursement Account Claim form can be downloaded through Adobe Acrobat, ASI’s website at http://www.asiflex.com/, or a hardcopy can be obtained from Human Resources, WA 615.  Completed claim forms should be mailed to ASI at the following address:

• ASI
  P.O. Box 6044
  Columbia, MO 65202-6044

 

Bi-Monthly Claims Reimbursement

Reimbursements will be sent out on a bi-monthly basis based on the following payment schedule:

• Claims received by the 5^th of the month, will be mailed or sent electronically to participants’ account by the 15^th of the same month.
• Claims received by the 20^th of the month, will be mailed or sent electronically to participants’ accounts by the end of the same month.

 

Direct Deposit or Mailing Of Claim Reimbursements

You have the option of receiving claim reimbursements by mail in the form of a check, or by direct deposit, if you submit a “Direct Deposit Authorization” form to ASI for processing.  This form can either be downloaded from ASI’s website, http://www.asiflex.com/, or requested by contacting ASI at (800) 659-3035.  If you choose to enroll in direct deposit, you also can request that reimbursement notifications and account statements be sent via e-mail, rather than U.S. mail.

 

Accessing Account  Information

Participants in the Health Care Reimbursement Account plan are able to access their account information by telephone or via the Internet:

• Toll-Free telephone access allows you to contact ASI Monday through Friday, from 6 a.m. to 5 p.m., Pacific Standard Time, by dialing (800) 659-3035.  To properly serve your account during these hours, this telephone number gives you direct access to a “live” customer service representative.
• InfoLine 125 is an automated, 24-hour telephone information line that provides you with information about account balances and claim reimbursements.  InfoLine 125 is updated on a daily basis for accurate information, and can be accessed by dialing (800) 366-4827.
• Online access allows you access to your personal account via the Internet at: http://www.asiflex.com/.

 

Claims Reimbursement

You may file claims for expenses incurred during a plan year any time up to six months after the end of the plan year (June 30 of the next year).