At any time during the year, you may submit a claim for reimbursement from your HCRA, up to the full amount of your annual election amount (less any amount already paid to you from the account). If you file a claim for an amount that is more than your current account balance, your future payroll deductions will offset the balance of your claim.
Claims can only be submitted for expenses already incurred and only for expenses incurred during the plan year.
Example: Let’s assume that Jeff elects to contribute $1,000 to the HCRA for the Plan Year. In early February, Jeff undergoes major surgery and submits a claim for $800—his first claim of the year. Jeff will be reimbursed the entire $800, even though he has only contributed from his paycheck three times that year and his current HCRA balance is less than $800. For the remainder of the year, his payroll deductions will be used to make up the amount that has already been paid from his HCRA.
Important Note: You can never be reimbursed for more than the total annual amount you are contributing to your account. In the example above, let’s assume Jeff’s claim is for $1,300 (or $300 above his total annual election amount). In this case, Jeff’s reimbursement would be for $1,000 and he would not receive reimbursement for the $300 over his election amount
You can take advantage of HCRA even if you or your dependents have health care expenses that are not covered by any health, dental or vision plan. Eligible expenses are those that would qualify as a federal deduction for medical expenses, such as:
Deductible and copayments
Drugs (prescription only)
Eyeglasses including exam fees, contact lenses and solutions
Laser eye surgery
Smoking cessation programs
Expenses That Are Not Eligible
The following are examples of expenses not eligible for reimbursement through HCRA, as determined by the IRS.
Expenses associated with long-term care
Expenses incurred prior to your enrollment in HCRA or after your participation ended
Expenses you claim as a deduction or credit for federal or state income tax purposes
Expenses already reimbursed under another benefit program, including Medicare or another government program
Expenses for funerals or burials
Most over-the-counter medications
Maternity clothes, diaper services or hired household assistance
Cosmetic surgery or procedures (unless it’s medically necessary, such as a procedure to correct a birth defect or a disfiguring illness or injury)
Weight loss programs
Important – Please be advised these are not complete lists of eligible and ineligible health care expenses. For a complete list, refer to IRS's website at www.IRS.gov.
Estimating Your Expenses
You should contribute only as much as you expect to spend for unreimbursed health care expenses in the coming year. Although health care expenses are hard to predict there are ways to estimate certain expenses:
Things to Consider
Review your out-of-pocket health care expenses for the past few years, including deductible and copayment amounts, and consider contributing a little less than your annual average.
Include any unusual health care expenses you expect to incur that are not covered or are only partially covered by your health insurance during the year you participate in the plan (for example, the cost of orthodontia treatment, elective surgery or prescription sunglasses).
Remember that any health care expenses you pay using before-tax dollars through the HCRA cannot be itemized as deductions on your income tax form. You may only receive reimbursement for eligible expenses that will not be paid by another source.