Human Resources Benefits Unit

Health Flexible Spending Account

Annual Enrollment for FSA

Annual Enrollment Period: October 21, 2019 - November 8, 2019

Return to Flexible Spending Accounts

EOBHealth Accounts cover medical, dental and vision expenses that are only partially covered or not covered at all by your insurance, including insurance deductibles, insurance co-payments and over-the-counter medications by prescription.

Health FSA Annual Election Amount

If you make an election under the Health FSA, the amount that you elect will be immediately credited to the account in your name. Starting on the first day of the Plan Year, you will be entitled to be reimbursed for claims up to the entire elected amount at any time during the Plan Year, even if the total salary reduction contributions that you have made to your Health FSA are less than the total amount of claims that you have submitted.

Please Note: The Health Flexible Spending Account is the only account where participants have access to their full annual election immediately. All other accounts accrue the election amount on a per pay deduction basis.

2019 Health FSA

Plan Year (Benefit Period): January 1, 2019 through December 31, 2019
Coverage Period: Eligibility Start Date through the Eligibility End Date

The Eligibility Start Date is January 1, 2019 for all elections made during the Annual Enrollment Period or before the first day of the Plan Year. For any enrollment elections or changes made during the plan year, the Eligibility Start Date is the Pay Date when the first contribution is made.

The Eligibility End Date is December 31, 2019 (the last day of the plan year) for active participants who make a contribution on the last Pay Date of 2019. If contributions stopped during the Plan Year, then the Eligibility End Date is the Day before the Pay Date when no contribution is made.

Please Note: Only eligible Health Care expenses/costs that are incurred during the participant’s Coverage Period are eligible for reimbursement.

Rollover

Rollover Amount (if eligible): Up to $500 (remaining amounts in excess of $500 will be forfeited)

The Health FSA plan allows active participants to roll over up to $500 of unspent funds to the following year, providing the following eligibility criteria are met:

  • Must be an active participant on December 31, 2019
  • Must make a contribution on the last Pay Date of the 2019 plan year; through payroll deduction, COBRA premium, or OTC (Over-the-Counter) payment.

Important Dates

Last Day to incur expenses: December 31, 2019 or Eligibility End Date (if contributions stopped)
Last Day to submit claims: March 31, 2020 (for expenses incurred during the Coverage Period.

Required Claim Documentation

  • Insurance company statement or Explanation of Benefits (EOB)
  • Itemized bill from the provider showing date of service, services rendered, provider of service, amount aid and, if applicable, amount covered by insurance
  • Prescription claims MUST include the Rx pharmacy receipt with Rx number. Credit card receipts are not acceptable

Eligible Health FSA Expenses

  • Acupuncture
  • Alcoholism treatment
  • Ambulance hire
  • Artificial teeth/dentures
  • Bandages
  • Blood pressure monitors
  • Braces
  • Braille-books and magazines
  • Breast pumps and lactation supplies
  • Cancer screening
  • Chiropractors
  • Co-insurance amount you pay
  • Co-pay amount you pay
  • Condoms
  • Contact lenses and eyeglasses
  • Contact lens solutions
  • Cold/Hot Packs
  • Cost of operations and related treatments
  • Crutches
  • Deductible medical coverage (amounts you pay)
  • Dental fees
  • Diabetic supplies
  • Drug addiction treatment
  • Eye exams, eye glasses, eye surgery
  • Fertility treatments (in vitro fertilization, surgery)
  • Guide dog/service animal (including purchase, maintenance)
  • Intellectually/developmentally disabled person’s school and education (i.e., payments made for a mentally impaired or physically disabled person to attend a special school including tuition, meals and lodging)
  • Hearing devices and batteries
  • Hospital services
  • Incontinence products
  • Insulin
  • Laboratory fees

Yes

  • Lead-base paint removal (for children with lead poisoning)
  • Medical alert bracelets
  • Medical information plan
  • Mentally handicapped persons cost of special home care
  • Nurses fees (including nurses’ board and social security tax paid by you)
  • Obstetrical expenses
  • Operations
  • Oxygen
  • Prosthesis
  • Pregnancy tests
  • Psychiatrists’ and psychologists’ fees
  • Radial keratotomy and Lasik eye surgery
  • Rolfing therapy
  • Routine physical & other non diagnostic services or treatments
  • Smoking cessation programs
  • Speech Therapy
  • Special education for the blind
  • Special plumbing for handicapped
  • Sterilization (i.e., tubal ligation,vasectomy)
  • Surgical fees
  • Telephone, special for hearing impaired
  • Television audio display equipment for hearing impaired
  • Therapeutic care for drug and alcohol addiction received as medical treatment
  • Thermometers
  • Transportation expenses for person to receive medical care
  • Vaccines
  • Walkers
  • Wheelchair
  • X-rays

Maybe

  • Analgesics, fever reducers, pain reducers (aspirin, ibuprofen, acetaminophen)
  • Antacids and heartburn relief
  • Antibiotic ointments
  • Anti-itch creams and hydrocortisone creams
  • Allergy medication, nasal sprays
  • Arthritis pain relieving creams
  • Athlete’s foot treatment, anti-fungal creams
  • Birth control
  • Chondroitin
  • Cold medicines, tablets, syrups, cough drops & lozenges
  • Compression Hose
  • Diaper rash ointment
  • Dietary supplements
  • Doula
  • Ear wax removal kits
  • Eczema treatments
  • Exercise programs or equipment
  • Fiber supplements
  • First-aid cream
  • Glucosamine
  • Hemorrhoid treatments
  • Humidifier
  • Hypnosis
  • Infertility treatments

Eligible Expenses Only with a Prescription or Letter of Medical Necessity

  • Lactose intolerance tablets
  • Lamaze classes
  • Latex gloves
  • Laxatives
  • Massage therapy
  • Menstrual pain relievers
  • Mineral supplements
  • Motion sickness pills
  • Nasal spray and strips
  • Nicotine gum, patches
  • Occupational therapy
  • Orthopedic shoe inserts
  • Over-the-counter medications
  • Petroleum jelly
  • Prenatal vitamins
  • Rogaine®
  • Scooter, electric
  • Sinus medication
  • Stomach & Digestive relief items
  • Sunburn cream (Solarcaine)
  • Toothache and teething pain relievers
  • Umbilical cord blood storage
  • Urinary pain relief medication
  • Varicose vein, treatment of
  • Vitamins
  • Wart removal medication
  • Yeast infection medication

Never Eligible

  • COBRA premiums
  • Concierge service fees
  • Cosmetic products and cosmetic surgery (unless to remediate damage from an illness or injury)
  • Disposable diapers
  • Diet program foods
  • Electrolysis
  • Feminine hygiene products
  • Fitness programs*
  • Hair transplants*

No

  • Hand sanitizer
  • Household help
  • Maternity clothes
  • Teeth whitening*

* Unless prescribed by a doctor to treat an existing illness or injury.

Expense eligibility is subject to change.

If you are unsure if an expense is eligible for reimbursement, please call the P&A Group at (800) 688-2611 or chat with a customer service representative through our online chat available at www.padmin.com. For a more extensive eligible expense list, please visit www.padmin.com . Go to Employee Participants → Benefit Programs → Tools & Resources and select PDF of FSA Eligible Expenses.

Contact Information

Benefits Unit

Human Resources Department

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

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