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PayFlex, the new FSA claims administrator, has prepared a number
of frequently asked questions accessible online at www.mypayflex.com.
 Introduction
Eligibility
Contributions
Enrollment
and Effective Dates
Claims
Introduction
What is the Health Care Account?
The Health Care Account assists in funding eligible out-of-pocket
health care expenses. Participants make pre-tax Contributions by
payroll deduction and the Contributions are allocated to an account
maintained on the participant's behalf by the University.
After paying an eligible out-of-pocket expense, a tax-free reimbursement
check may be received from the account. The result of paying for
dependent care expenses through the FSA Plan may be lower income
taxes and, often, an increase in take-home pay.
How does the Health Care Account work?
After you enroll, the Health Care Account works like this:
The amount you have specified is taken from your paycheck each
month and deposited in your Health Care Account. You pay your
health plan expenses as usual.
For 2009 services, you may pay for physician office visit copayments
or prescription drug copayments using a PayFlex debit card. You
may also pay for these services by cash or check and then submit
a claim form to PayFlex for reimbursement. You may pay for other
services and then submit a claim form and documentation such as
an Explanation of Benefits (EOB) to PayFlex.
Eligibility
Who is eligible to participate in the FSA Health Care Account?
See the FSA Summary
Plan Description. ( PDF)
.
Generally, employees who are scheduled to work a minimum of 17.5
hours per week or appointed on at least a half time basis. Individuals
must be paid from the University's payroll system and receive sufficient
earnings to cover FSA deductions.
What if I separate from the University?
If you separate from the University, you may submit claims only for eligible expenses incurred through the date of termination (last day worked) or if you elect to temporarily continue Health Care Account participation under COBRA, through the COBRA continuation period. Expenses incurred after this date are not eligible for reimbursement. Contributions made during the COBRA continuation period are made on an after-tax basis and must be the same monthly amount made during active employment.
Can I participate in the Health FSA if I enroll in the Value PPO Plan?
No. Value PPO members may not participate in the traditional Health FSA. They may, however, use the Health Savings Account (HSA) to pay for out-of-pocket health care expenses and the Limited-use Health FSA for dental and vision expenses..
Contributions
Can I view My FSA Account Information
On-Line?
Yes, your 2009 FSA account information including annual pledge
amount, year to date contributions and claims may be viewed on-line
using
the PayFlex
web site.
Contributions
How much can I contribute to my Health Care
Account?
The maximum annual contribution is $10,000
for 2009.
For individuals who become eligible mid-year, the maximum monthly
contribution is the maximum annual amount divided by the number
of remaining months in the year.
Can I change the contribution amount at a
later date?
Yes, IRS regulations state that an individual may change (increase
or decrease) or stop his or her FSA contributions only within 31
days from the date of a qualified change in family or employment
status such as marriage, birth of a child, divorce. The contribution
amount may not be changed during the COBRA continuation period unless
there is a qualifying change in family or employment status.
Enrollment and Effective Dates
When may I enroll in the Health Care Account?
Employees must enroll in the Health Care Account within 31 days
from the date of employment or assuming a benefits eligible position,
or
During Open Enrollment, employees
must complete the online enrollment process in order to participate
in the Plan, or within 31 days from the date of a qualifying change
in employment or family status.
What is an eligible change in status?
IRS regulations state that an individual may change or stop his
or her FSA Contributions only within 31 days from the date of a
qualified change in family status such as:
- The addition of an eligible dependent through birth, adoption,
or legal guardianship
- Marriage or divorce
- The death of a dependent
A change in employment status such as:
- Your spouse's gain or loss of employment
- The beginning or end of a leave of absence without pay for you
or your spouse
Changes that do not qualify include:
- Change in your dependent care arrangement (for example, if you
change to a provider who charges less)
- A change in the amount of expenses you incur for part of the
year (for example, during summer months)
Must I enroll every year to continue participation
in the Health Care Account?
Yes, during Open Enrollment, an individual must enroll online in order to continue participation
in the Health Care Account.
Claims
How do I file claims?
After an individual has paid for an eligible expense, he or she
may submit a claim for reimbursement from his or her FSA account.
For 2009 services, an individual must submit claims directly to
Payflex.
Attach the appropriate Explanation of Benefit statements (EOB),
receipts, invoices or other documents indicating provider or full
name of product, patient name, amount and date(s) of service. If
the patient receiving service is not yourself, please specify the
relationship (spouse or dependent child). Eligible expenses may
have been incurred for you, your spouse, children and any other
person who is a qualified dependent under the Internal Revenue Code.
You can be reimbursed only for expenses associated with services
incurred January 1, 2009 through March 15, 2010 and while making
Contributions to the Plan. The date you pay for an item or service
is not relevant. Cancelled checks will not be accepted in lieu of
an itemized bill or receipt. Statements showing only a previous
balance are not acceptable documentation.
PPO Health Plan Members. Individuals enrolled
in the Blue Cross Premier or Select PPO plans, may access
claims information
online, print
out the listing of claims and attach the listing to a completed
FSA claim form. The listing provides the necessary information
referenced above such as service date, provider, patient, etc.
If you separate from the University, you may submit claims only
for eligible expenses incurred through the date of termination (last
day worked) or if you elect to temporarily continue Health Care
Account participation under COBRA, through the end of the COBRA
continuation period. Expenses incurred after this date are not eligible
for reimbursement. Contributions made during the COBRA continuation
period are made on an after-tax basis and must be the same monthly
amount made during active employment.
Individuals participating in the Health Care Account may be reimbursed
up to the full annual amount in his or her Account regardless of
the amount contributed to the Account.
The deadline for submitting reimbursement claims for the FSA Health
Account for calendar year services is the end
of the following March.
Any monies remaining in a participant's account
as of March 31st are forfeited in accordance with IRS Regulations.
What is the deadline for submitting claims?
Claims for 2009 services should be submitted to PayFlex and may
be submitted on as frequently as on a daily basis. Payment will
be made within several days of receipt.
In order to avoid account balances being forfeited, claims for
services received in a calendar year must be submitted no later
than the end of March of the next year. Effective for the 2009 plan year, Northwestern University adopted the IRS Grace Period for the Healthcare FSA which permits claims with dates of service through March 15, 2010 to be reimbursed using 2009 contributions.
How is reimbursement payment made?
For 2009 services, PayFlex will process reimbursement by check
or direct deposit. Reimbursement for office visit copayments and
prescription drug copayments may also be made using the PayFlex
debit card. Please see the PayFlex FAQs (including
the need to keep receipts) for further information about the debit
card.
Which expenses are eligible?
While health insurance premiums qualify
as a tax exclusion when completing IRS Form 1040 (annual tax return),
IRS regulations specifically exclude any insurance premium as an
eligible expense for FSA reimbursement.
Go to
listing of eligible and ineligible expenses
Over-the-Counter Medications and Other Items. Expenses
associated with certain over-the-counter non-prescription drugs
are eligible for reimbursement. Examples are allergy medicines,
pain relievers, antacids, cold remedies and flu remedies. All forms
of these medications (e.g., tablet, liquid, capsule, drops) are
eligible and include generic and store or name brand. Also included
are drugs which were recently made available over-the-counter and
no longer require a prescription such as Claritin and Prilosec.
Expenses must be for treatment of an existing disease or to prevent
a disease that is likely to occur if the medication is not taken.
They do not include toiletries and cosmetics, vitamins and dietary
supplements or herbal remedies.
Other over-the-counter items such as gauze and Band Aids also
qualify for reimbursement. Many pharmacy and other retail receipts
may show items with a code which means the item qualifies for FSA
reimbursement.
What happens to health care funds I don't use?
All eligible funds must be claimed for services provided in 2009 by March
31, 2010.
Claims made during the IRS Grace Period between January 1, 2010 and March 15, 2010 must also be submitted by March 31, 2010 in order to be reimbursed using remaining funds from the 2009 plan year. If they are not submitted by March 31, 2010, reimbursements will be made using 2010 contributions. Under Internal Revenue Service (IRS) regulations, any monies not
claimed from the Healthcare Account as of March 31st are forfeited.
Any forfeited funds are used by the University to pay the cost of
administering the Flexible Spending Account.
Therefore, careful planning of projected health care expenses is
essential.
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