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Microsoft word - otc participant communication 5.20.10
Important Information for Your Upcoming
Flexible Spending Account (FSA) Enrollment
As you may have heard, there is new legislation going into effect on January 1, 2011 which impacts healthcare
FSAs. Here’s what’s happening. Certain over-the-counter items will require a prescription* to be considered
an eligible FSA expense. The information below is important for you to know as you begin to think about your
healthcare FSA contribution for this year’s enrollment. How does this new legislation impact me?
It impacts you two ways:
1. Setting Your Contribution
Because OTC drugs and medicines will require a prescription beginning January 1, 2011, you might want to consider this when deciding on your healthcare FSA contribution.
2. Using Your Account Dollars
• OTC drugs and medicines are eligible for reimbursement without a prescription. • Healthcare debit cards, (e.g., PayFlex Card™) can be used to purchase eligible OTC drugs and medicines.
• Over-the-counter (OTC) drugs and medicines will be considered ineligible
expenses unless you have a
prescription from your physician.
OTC Drugs and Medicines Requiring a Prescription
• Healthcare debit cards, (e.g., PayFlex Card™) cannot be used to purchase OTC drugs and medicines. If a
healthcare debit card is used to pay for these items after January 1, 2011, the transaction will be denied at the point-of-sale.
Does this mean all OTC items will be ineligible after January 1, 2011?
No, many OTC items will continue to be considered eligible expenses and will not require a prescription See “Eligible
Healthcare Expenses” within this communication for examples.
*Please note: The documentation required for a prescribed OTC drug or medicine is still being clarified by the IRS. More
information will be provided as it becomes available.
Eligible Healthcare Expenses
Following is a condensed listing of eligible healthcare expenses. For a more complete listing, visit the participant portal.
Please note this listing is subject to change at any time and without notice due to new legislation.
Effective January 1, 2011,
the list of items that will require a prescription includes, but is not limited to acne medicine; allergy
medicine; cough, cold & flu medicine; eye drops; indigestion medicine; laxatives; nasal sprays, drops; ointment for cuts, burns,
Items that will remain eligible without a prescription include, but are not limited to band aids, birth control, braces & supports,
contact lens solutions & supplies, elastic bandages & wraps, first aid supplies, and reading glasses.
uide dog or other animal used to assist
chools and education, special (for
andages, band-aids, wraps and splints
mentally impaired or physically disabled
Birth control pills (Norplant, ovulation
hiropractor professional fees
Surgical fees (for legal operations not cosmetic in nature)
Cold medicine (see notice above)
herapy, physical or speech
eals (only as part of inpatient hospital
ental treatment (includes exams, x-
rays, fillings, root canals, gum disease
Treatment for learning disability caused
ursing home (if necessary for medical
care and only the portion for medical
Drugs (prescription drugs, insulin; see
perations (legal operations that are not
ye surgery (includes cataract, LASIK,
eight-loss program (only if medically
ain reliever (for arthritis pain,
ertility treatments (ovulation predictor
or joint pain, e.g., aspirin, ibuprofen;
supplements) (see notice above)
What is a Healthcare FSA?
A Healthcare FSA is a Flexible Spending Account that
My HealthHub Resources: Education & Planning Tools
allows you to set aside money for eligible healthcare
Savings calculator to help you estimate your healthcare
Digital library designed to help you understand an FSA
This account reimburses you for out-of-pocket medical,
Educational materials & forms to better assist you with
dental, prescription and vision services, such as
deductibles, co-pays, coinsurance and over-the-counter
(OTC) items. Starting January 1, 2011, certain OTC
medicines and drugs will be considered ineligible unless
What you need to know about an FSA
you have a written prescription from your doctor.
You may only determine your contribution in an
FSA during open enrollment or when you first
Quick Tip: View a listing of eligible expenses
Login to HealthHub.com > My HealthHub Resources > Planning
Once you establish your plan year contribution,
y only change it if you experience a change
An FSA is a smart way to save!
in status. This may include a change in one of the following conditions:
An FSA can help reduce your taxes and increase your take-home pay—giving you extra dollars for the things you
Legal marital status (marriage, divorce, legal separation, annulment or death of a spouse)
Number of tax dependents (birth, adoption or
With a salary of $20,000 and an annual contribution of $1,500
for healthcare.you could increase your take-home pay by $405!
Employment status that affects eligibility
With a salary of $40,000, an annual contribution of $2,000 for
Dependent satisfying or ceasing to satisfy
healthcare.you could increase your take-home pay by $540!
coverage requirements (reaching limiting age, gain/loss of student status, marriage)
With a salary of $60,000, an annual contribution of $3,000 for healthcare.you could increase your take-home pay by $810!
* To apply for a change, you must complete a change-in-election form through your employer’s
Human Resources/Benefits department within 30
Getting started is easy!
Start by estimating the amount that you will incur for
If your employer offers a ―grace period‖, you wil
eligible healthcare expenses during the plan year. Then
be allowed an additional 2 ½ months after the end
review your expenses from the prior plan year and use our
of your plan year to use your FSA dollars. For
planning tools available at HealthHub.com to determine
example, if your plan year ends on December 31,
your contribution. The amount that will be deducted from
your employer will allow expenses to be incurred
your paycheck each pay period can be determined by
dividing your annual contribution by the number of pay
Any claims that were incurred during the plan year
periods (e.g. 12, 24 or 26), in your plan year.
must be submitted for reimbursement by the end
of your run out period. This date is established by
Quick Tip: Find out how much you can save
your employer and is generally 90 or 120 days
Login to HealthHub.com > My HealthHub Resources >
Any amount left in your healthcare FSA at the end
Access account information you
For quick and easy reimbursement, simply submit your
need on My Dashboard
healthcare expenses online at HealthHub.com. Your
Login to HealthHub.com to view a snapshot of your
reimbursement will be deducted from your FSA and will
be provided by check or direct deposit into your checking
or savings account. If your employer offers the PayFlex
Card™, you can use this to pay for eligible expenses
and the amount will be automatically deducted from your
FSA without having to submit a claim. If you paid out-of-
Quick Tip: View your claim history and payments
pocket, remember to keep your receipt for your purchase
Login to HealthHub.com > Financial Center > Select Account
to submit along with the claim form for reimbursement.
Shop online with your FSA!
Quick Tip: Enroll in direct deposit
Access our Consumer Center to buy items such as
Login to HealthHub.com > Financial Center > Enroll in Direct Deposit
glasses, contacts, and eligible over-the-counter items
using your PayFlex Card™ (if offered by your employer)
or any other major credit card. If an item is not identified
as ―FSA eligible‖ you will need to use a form of payment
other than your PayFlex Card™. If using your own credit
card, make sure to keep the receipt you receive from
your purchase and submit along with a claim form for
Healthcare expense tips
Healthcare expenses must be for services received after
Quick Tip: Download a claim form
the effective date of your FSA election and during the
Login to HealthHub.com > My HealthHub Resources >
Each individual, allowed to use your healthcare FSA contribution generally includes your
Remember to save your receipts & Explanation of Benefits
spouse, your child younger than age 19 OR,
under age 24 and a full-time student OR any age and is permanently and totally disabled
Stay informed with eNotify
whom you are entitled to claim as dependent on
If you are enrolled in eNotify
, you will receive an email
your federal tax return. In addition, your child
from email@example.com confirming that your claim has
under the age of 27 may also be allowed to use
your FSA dollars, if this feature is part of your
Quick Tip: Sign up for eNotify to receive important e-mail
All expenses must be for services received, not
for services to be provided in the future. In
Login to HealthHub.com > Settings > Change Email
reimbursed and must not be reimbursable by
Contact Customer Service at 800.284.4885, 7am-7pm,
Monday – Friday and Saturday 9am-2pm CT.
deduction on your annual income-tax return.
New Jersey Department of Human Services State Upper Limit (SUL) List as of August 12, 2011 Pharmacy reimbursement for legend and non-legend drugs is based on the lowest of the Average Wholesale Price (AWP) less 17.5 percent; the Federal Upper Limit (FUL); the State Upper Limit (SUL), each with a dispensing fee of $3.73 to $3.99; or the pharmacy’s usual and customary charge C
In the Game Managing Heavy Periods So You Can Remain Active Great Lakes Hemophilia Foundation Headline News - August 2011 By Heather Boerner Originally Published in Hemaware, July 2011 When she was in high school, Meghan McDonald, 20, felt she could not tell her private dance instructor about her type 1 von Willebrand disease (VWD). It wasn’t that she was embarrassed by the . It was