Q. Whose expenses qualify under my Medical Reimbursement Account?
This site, and the content herein, are designed specifically for State of Californial employees. This information is not deemed to function as the California Flex Elect Handbook. If there is any conflict between this information and the California Flex Elect Handbook, the California Flex Elect Handbook will override this information.
A. Qualifying expenses are for medical care for the participant, a spouse (if filing a joint tax return), and a child, qualifying child or qualifying relative. You may also claim medical expenses you incur and pay to medical providers of a child for whom you don’t get the tax exemption due to a divorce decree, as long as one parent claims the child as a tax dependent. (The tax exemption may switch from year to year between parents. As long as one parent gets the tax exemption, the medical expenses you pay on behalf of the child to the medical provider qualify under the Medical FSA.) Also see Can I Use my Medical Reimbursement Account to cover medical expenses for my qualified domestic partner?
Q. Can I claim my 25 year old son's medical expenses through my Medical Reimbursement Account even if I don't claim him as a tax dependent?
A. Yes. The Patient Protection and Affordable Care Act (PPACA) that was passed in March, 2010, modified the rules regarding whose expenses were eligible for reimbursement. There are two stipulations are that the individual:
- Be a “child” of the taxpayer (son, daughter, stepson, stepdaughter, adopted child or an eligible foster child (defined as an individual who is placed with the employee by an authorized placement agency, or by judgment, decree or other order of any court of competent jurisdiction); and
- Be age 26 or younger for the entire plan year in which medical expenses are claimed (i.e. if you have a child who turns 27 in a given plan year, his/her expenses cannot be claimed in that plan year).
Q. Why do I have to sign my claim form?
A. Internal Revenue Code (Section 125) regulations require that a participant provide a statement, with each claim submitted, that the expenses claimed were not paid by insurance or other means and reimbursement will not be sought from anyone else.
Q. What documentation do I have to submit with my claim form?
A. Each item claimed must be supported by a statement of services from a provider. The insurance explanation of benefits (EOB), for items covered by insurance, may also be used. Documentation must contain the following information in order for payment to be issued:
- the provider of services;
- the person obtaining the care;
- as well as the date of service(s);
- the charge for the services;
- a general description of services provided.
Q. Do I have to send the original provider statements or insurance benefit statements?
A. No. Copies of provider statements are acceptable, as long as they are readable and have not been altered.
Q. Do I have to provide proof of payment with my claim form?
A. Generally, no. The Internal Revenue Code does not require proof of payment prior to submitting the items claimed. ASIFlex has additional information available and requirements for orthodontic expenses.
Q. Why do I have to provide support, from the provider, of the date the services were provided rather than the date I paid or was billed for services?
A. The Internal Revenue Code regulations require that the statement from the provider include what type of service was provided for what period of time. The expenses must have been provided for care during the period that you were covered during the plan year. Statements showing payments made or bills for services are acceptable as long as they identify what service was provided, for whom, by whom, and for what period of time.
Q. Why do I have to provide support, from the provider, of the general type of services provided?
A. The Internal Revenue Code regulations require that the statement of services from the independent provider indicate the type of services provided. The regulations also require that each item claimed be adjudicated by the plan (or administrator) to determine whether the expense qualifies under the plan and whether the services were incurred (services were provided) during the period that the participant was covered under the plan.
Q. What items are required to be on the documentation from the provider?
A. The supporting documentation must identify the provider of services and the person obtaining the care as well as the date, cost and general description of services provided. Your health plan's explanation of benefits, for items covered by insurance, may also be used.
Q. Can I fax my claims and, if so, to what phone number? Is this a toll-free number?
A. Yes, you may fax your claims. ASI’s fax number for claims is 1-877-879-9038. This is a toll-free number.
Q. What is the mailing address for mailing flexible spending account claims?
A. ASIFlex’s mailing address for flexible spending account claims is:
PO Box 6044
Columbia, MO 65205-6044
This is the preferred mailing address. However, if sending something through a courier service such as UPS or FedEx, you can send it to:
201 W. Broadway, Bldg 4 Suite C
Columbia, MO 65203
Q. Where do I get more claim forms?
A. You may make copies of a blank claim form or download additional forms here
. Or contact ASIFlex's Customer Service Department via email at firstname.lastname@example.org
or by calling ASIFlex at 1-800-659-3035 to request additional forms.
Q. If my claim is received via fax or mail today in ASIFlex's office, when will it be reviewed?
A. ASIFlex typically reviews all claims within one business day of receipt. There are three payment cycles for processing valid reimbursement claims:
• If ASI receives your claim by the 1st of the month, your reimbursement check will be issued by the State Controller's Office (SCO) between the 14th and 16th of that month.
• If ASI receives your claim by the 10th of the month, your reimbursement check will be issued by the SCO between the 24th and 26th of that month.
• If ASI receives your claim by the 20th of the month, your reimbursement check will be issued by the SCO between the 3rd and 5th of the next month.
The minimum reimbursement amount that will be paid from your account is $10. If you submit a claim for less than $10, the payment will be held until your total reimbursement claims equal $10 or more.
Q. Do all prescription medicines qualify for my Medical FSA?
A. Generally, yes, as long as they are prescribed by a physician and are legal under Federal and State laws. However, prescriptions that are purchased solely for cosmetic purposes that are not treating an existing medical condition do not qualify.
Additionally, Federal law doesn't allow the importation of drugs from foreign countries; as such, drugs purchased in foreign countries, even if they are prescription drugs, are not an allowable expense through your flexible spending program. The only exception to this rule is if you are in a foreign country and purchase and consume
the drug while you are in the foreign country.
Q. Do I need to itemize the prescriptions on my claim form?
A. Each prescription does not have to be listed on a separate line of the claim form. You can group prescriptions from the same pharmacy on one line of the claim form, indicating the range of fill dates and total of the prescriptions filled on those dates.
Q. Can I send a credit card receipt as support for my claim form?
A. No. A credit card receipt only supports that a payment was made. Federal regulations require that the supporting documentation identify the provider of services and the person obtaining the care as well as the date, cost and general description of services provided.
Q. When can I begin filing claims against my Medical Reimbursement Account?
A. You may file claims as soon as you incur charges (have services provided) after the plan year has begun.
Q. How often can I submit claims?
A. You may submit claims as often or as infrequently as you prefer. You do have to file at least one
claim each year prior to the claims filing deadline.
Q. Is there a minimum claim amount?
A. No. ASIFlex does not have a claim minimum. Please note that payment will not be released until you have at least $10 in valid reimbursement requests.
Q. What does incurred mean?
A. Incurred is defined in Internal Revenue Code Section 125 as the date that the services are provided that gave rise to the expense. Expenses are not
considered to be provided at the time you are billed for or pay for services.
Q. How long do I have to submit claims after the Plan Year is over?
A. All claims must be submitted no later than June 30th following the end of the plan year.
For instance, all claims for the 2016 plan year must be submitted by June 30th of 2017.
Q. What happens if I leave employment mid-year?
A. The Medical Reimbursement Accountis an active employee benefit. If you sever employment with the State of California mid-year you have two options. Option one is to claim expenses that were incurred while you were actively employed by the State. If you select this option, you have until June 30th following the close of the current plan year to submit claims. Option two is to elect COBRA coverage, and pay the monthly contribution amount on a post-tax basis. This option allows you to extend your period of coverage for the remainder of the plan year.
Q. What are the requirements for reimbursements for over-the-counter (OTC) medicines and drugs?
A. OTC medicines & drugs can qualify for the Medical FSA if purchased to treat an existing or imminent medical condition. As of January 1, 2011, The Health Care Reform legislation has directed that many over the counter (OTC) medications will no longer be reimbursable with Flexible Spending Account funds, unless purchased in conjunction with a physician’s prescription. Items purchased to treat an existing or imminent medical condition can be claimed but the participant must indicate on the claim submission what medical condition is being treated and the prescription.
Items such as vitamins, herbs or nutritional supplements are considered to be expenses incurred for general good health purposes and do not typically qualify for reimbursement through your FSA . In order to claim these items, you must have:
- An existing or imminent medical condition;
- A pre-printed receipt from the provider documenting the purchase;
- A physician diagnosis and prescription for the specific item(s) if it is a vitamin, herb or nutritional supplement.
Please refer to ASIFlex's Over-The-Counter Quick Reference Guide
for more information. ASIFlex has provided a sample letter of medical necessity
Q. Do health club dues, massages, vitamins, herbs and nutritional supplements and exercise equipment qualify for my Medical FSA?
A. Generally, no. Items such as those listed above are typically considered to be utilized for general good health purposes and, as such, typically do not qualify for the Medical FSA. However, if you have been diagnosed with a medical condition that necessitates the purchase of these items and you would not have purchased them if it were not for the medical condition, then they can qualify for your Medical FSA. To claim these items, you must have a letter of diagnosis and recommendation/prescription for these items to qualify under your Medical FSA. This letter is valid for 12 months from issue date. A sample letter of medical necessity is available by following this link.
Q. What transportation expenses qualify for the Medical FSA?
A. Transportation that is primarily for and essential to obtaining medical care.
- Bus, taxi, train or plane fares or ambulance services,
- Transportation expenses of a parent who must travel with a child who needs medical care,
- Transportation expenses of a nurse or other person who can give injections, medications and other treatment required by a patient who is traveling to get medical care and is unable to travel alone, and
- Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as part of treatment.
Mileage is reimbursable for use of a car for medical reasons. You can also include parking fees and tolls. You can add these fees and tolls to your expenses whether claiming actual car expenses or using the standard mileage rate.
Q. What do I need to submit to support mileage with my claim form?
A. You must list the number of miles you traveled to
obtain the medical care on the claim form as a separate
line item, multiplied by the current allowable amount
(for automobile travel expenses, you can use a standard
rate of 19 cents per mile for services provided in 2016 and
23 cents per mile for services provided in 2015) allowed by the Internal Revenue Code. It is preferable that you claim the mileage on the same claim form when you claim the cost for medical care. If you do not include the number of miles traveled within your claim submission packet, the request for reimbursement for your mileage expenses will be denied.
Q. How do I know if my claim form was received?
A. You can see all your claims processed by ASIFlex on our Web site by going to Account Detail
the morning following ASIFlex’s review. Follow the prompts to view your account. You also may call ASIFlex, the afternoon after your anticipated review of the claim to discuss your claim. ASIFlex customer service representatives are available to assist you Monday through Friday from 5 a.m. to 5 p.m., Pacific Time, and Saturday 7 a.m. to 11 a.m. Pacific Time.
Q. How can I check on my remaining balance?
A. You may view your remaining balance and account activity on ASI’s web site by clicking on the Account Detail
button. In order to access your account, you must use your Flex PIN which was sent to you with your Confirmation of Enrollment statement and is included with statements sent out by ASIFlex. If you do not have your Flex PIN, please call ASIFlex at (800) 659-3035 Monday through Friday from 5 a.m. to 5 p.m., Pacific Time, and Saturday 7 a.m. to 11 a.m. Pacific Time to retrieve your access code. ASIFlex cannot release this information via e-mail and the PIN will only be given out to the primary subscriber.
A participant may also call ASIFlex's Customer Service Center at 800-659-3035 to obtain the account balance. Again, due to Federal Privacy regulations, ASIFlex can only release this information to the primary subscriber.
Q. Where can I see a list of qualifying expenses for my Medical FSA?
A. The list of Eligible Expenses
is a general overview. If you have questions after reviewing the list, contact ASIFlex at 800-659-3035.
Q. Can I change my election amount after the plan year has started?
A. Generally no. Your election under the Plan is irrevocable for the Plan Year unless you have a qualifying event. These are the changes generally allowed. For specific information, please refer to the California Flex Elect Handbook.
Q. Can I use my FSA to cover medical expenses for my qualified domestic partner?
A. The IRS does recognize a same-sex spouse for tax purposes. However, qualified Domestic Partners may not file a joint tax return and expenses of a Qualified Domestic Partner do not generally qualify as a dependent under the definition of a "qualifying relative" under Internal Revenue Code Section 152. If you are unsure, you may confirm eligibility by using the Internal Revenue Code worksheet for determining dependent status found on page 20 of IRS Publication 501.
Q. How much can I contribute to my Medical Reimbursement account as a state employee?
The annual minimum contribution is $120 and the maximum is $2,550.