Health care FSA

Money you set aside for health care expenses

  • Use PayFlex to manage your FSA account online. You can check your balance, pay providers, upload receipts to get reimbursed, and more.

  • A health care FSA lets you set aside pre-tax dollars to pay for eligible health care expenses, even for dependents not covered under your Aldine ISD medical plan.

  • It’s available to participants in all plans.

  • You can contribute up to $2,650 pre-tax per year through automatic payroll deductions over 24 pay periods.

  • Even so, the full amount you set aside is available to you from the day coverage begins.

  • Since your contribution is pre-tax, it takes less out of your paycheck.

What your health care FSA covers

Because the tax benefits of using a health care FSA, the IRS restricts that you can use it for. IRS publication 502 includes a full list of these medical services and materials.

Here is a summary of what's covered and not covered by your FSA:

  • Deductibles, coinsurance and copays under your medical, dental and vision plans
  • Other eligible health costs that are not covered by your health care plan (for example, dental costs not covered by your dental plan)
  • Prescription drugs

 

Acupuncture Special medical equipment
Hearing aids Special education devices
Individual psychiatric and psychological counseling Smoking-cessation programs or related prescription drugs
Lasik or other vision correction surgery Weight-loss programs for individuals diagnosed as obese

 

Over-the-counter medical supplies and products, such as:

Bandages and wraps Contraceptives and family planning items
Braces and supports Denture adhesives
Catheters Insulin and diabetic supplies
Contact lens solutions and supplies  
What's not covered
  • Cosmetic surgery
  • Health plan premiums
  • Vitamins
  • Weight reduction programs (unless prescribed by a physician for obesity)
  • Over-the-counter smoking cessation medications, such as nicotine gum and patches

 

Over-the-counter medicines without a doctor’s prescription, such as:

Acid controllers Digestive aids
Allergy & sinus Feminine antifungal/anti-itch
Antibiotic products Hemorrhoid preparations
Antidiarrheal Laxatives
Anti-gas Motion sickness
Anti-itch & insect bite Pain relief
Anti-parasitic treatments Respiratory treatments
Baby rash ointments/creams Sleep aids and sedatives
Cold sore remedies Stomach remedies
Cough, cold & flu  
Rules and restrictions

In return for the favorable tax advantages, the IRS has strict rules on these accounts.

  • You can’t change the amount you contribute until the next plan year, unless you have a qualified life event

  • You can’t transfer money from this account to another FSA account

  • To be reimbursed, you must be enrolled in the FSA when you incur expenses

  • You need to keep all of your records to substantiate all claims

  • You may use your FSA funds for expenses incurred through March 15 of the following year, and you have until May 15 of that year to submit documentation for those expenses

  • For 2019 accounts, for example, you lose any funds that you don’t spend by March 15, 2020
  • If your employment terminates prior to the end of the plan year, your debit card is permanently inactivated. You can only submit manual claims for eligible expenses incurred from January 1 through your termination date. Claims must be received by May 15 of the following year. If no claims are received, the remaining funds are forfeited.
Determining your contribution

Only list expenses that are not paid through your medical, dental, vision, cancer and specified diseases, hospital indemnity, other district health care coverage selections or any other health plan. Using last year’s expenses can help. You can also use the Health Care Flexible Spending Account Worksheet. Estimate from the date your coverage begins if you’re hired or if you become eligible for benefits during the year.

And remember, if you’re enrolled in the Memorial Hermann ACO or Open Access Select plans, payment for all eligible medical care costs, excluding copays, comes from any money remaining in your HealthFund account first. 

How it works

The easiest way to access your FSA funds is with your PayFlex debit card, which you receive after you enroll. Here are some guidelines:

At the store

  • Certain stores accept your debit card for prescriptions and over-the-counter (OTC) items. Others accept your debit card for prescriptions only. For example, you can use your PayFlex debit card for OTC medications at CVS, Walmart, Sam’s Club, Walgreens and drugstore.com. You can only use your PayFlex debit card for an OTC medication if you have a doctor’s prescription for the medication.

At the doctor or dentist

  • Don't use your PayFlex debit card for out-of-pocket medical expenses. Those are automatically paid from your FSA. Your debit card won't work at your doctor's office. Ask the medical provider to file the claim with Aetna or, if your provider is out of network, file a claim yourself to make sure you’re paying the correct out-of-pocket amount, including any contract discounts.

For dependents not covered by your medical plan

  • Tax dependents of FSA participants who aren’t covered on the same medical plan as the FSA participant can use the debit card for medical, dental and vision expenses. Again, you’re required to submit receipts for these expenses when you submit your claim.

 

The IRS limits the misuse of FSA debit cards. Retail locations that contain pharmacies and also sell non-pharmacy items must use the Inventory Information Approval System (IIAS) to automatically substantiate pharmacy purchases and allow you to use your FSA debit card. Visit Aetna’s FSA website to find out which non-traditional pharmacy providers use IIAS. You may still use your FSA debit card at traditional pharmacies and with the Express Scripts mail service program.

If you don’t use your PayFlex debit card, you must submit a claim form and any additional required documentation to Aetna to be reimbursed. You can file claims online through Aetna’s secure website, through the PayFlex Mobile app or by fax at 888-238-3539.

2019 health care FSA account calendar

January 1, 2019 – March 15, 2020       

Eligible health care FSA expenses are covered

May 15, 2020

Deadline to submit documentation for 2019 health care FSA expenses

If you’re close to March 15 and have money in your health care FSA that you don’t know what to do with, use the money to stock up on covered OTC products listed above.

Helpful resources

For more information, call Aetna FSA customer service at 888-238-6226 or PayFlex at 888-678-8242. Both are available between 7 a.m. and 5 p.m. weekdays, excluding holidays. Also, review the flexible spending account FAQs.

Your cost

Maximum amount $2,650

Based on 24 pay periods $0.00

New for 2019, The RediMD telehealth service allows you to have a doctor’s appointment online or by phone, day or night to diagnose a health concern, recommend treatment or prescribe medications, for only $35. 

For any benefits question or concern, including 24/7 Nurse Line access, one call does it all.
Call us at 866-284-AISD (2473)