frequently asked questions
A flexible spending account (FSA) allows you to have pre-tax dollars withheld from your paycheck to pay for eligible health care or dependent care expenses. It covers not just your medical expenses, but also the expenses of your spouse and tax dependents. Depending on your tax bracket, you may save up to 30 percent or more in taxes.OR
As with most health plans, you are likely to have out-of-pocket expenses each year. If you have children and have to pay for child care, a dependent care account can help stretch your hard-earned dollars. There are two types of flexible spending accounts:
- A health care FSA and limited-purpose FSAs can cover medical, prescriptions, hearing, dental or vision expenses that you would otherwise pay for out of pocket. Common qualified expenses that an FSA will usually cover include the deductible, coinsurance or copayment amounts for your health plan, eyeglasses or contact lenses, dental work and orthodontia, medical equipment, hearing aids, and chiropractic care. Many over-the-counter drugs, such as cold and allergy medicines, and pain relievers and antacids, can also be reimbursed through an FSA with a doctor’s not/letter of medical necessity. Your employer may limit what expenses your plan reimburses, so please contact your Human Resources office for more information. For a list of eligible expenses please, see the IRS Publication 502. Another great feature is that the funds a FSA are front loaded to the account and are available at the start of your plan year.
- A dependent care FSA— also known as a dependent care assistance program (DCAP) — covers employment-related expenses for child care. Qualified expenses must be for services that allow for you to be able to go to work. Typical expenses under this account include charges for day care, nursery school and elder care (though not if it is for medical care) for your legal tax dependents. The Dependent Care FSA is not front loaded.
- Your contributions are pre-tax or tax-deductible.*
- Tax-free withdrawals are made to pay your out-of-pocket expenses related to health care and dependent care.
- Because of these tax advantages, the more you use your FSA, the more money you could save. The amount of savings will depend on your personal tax rate.
*Contributions are tax-deductible on your federal tax return. Some states do not recognize FSA contributions as a deduction. Consult a qualified tax adviser for advice.OR
Your biggest advantage is the tax savings. Every dollar you set aside in your account reduces how much you pay in income taxes. Plus, you can be reimbursed for qualified expenses that you are already paying for.OR
You can use your FSA to pay for eligible expenses incurred by any of the following individuals:
- Qualifying child
- Qualifying relative
New rules allow a dependent to be eligible for the plan, even when that dependent does not qualify to be claimed as your tax dependent on your tax return. Optum recommends that you check with your tax advisor before you make your election for the plan year.OR
- Funding. You will contribute a pre-determined amount to your account. In some cases, your employer may also contribute to employee FSAs. Your funds will be available for use on the first day of your plan year.
- Accessing funds. When you have eligible health care expenses, pay for them with your payment card, or pay out of pocket and request reimbursement online. Remember to always keep your receipts.
- Requesting reimbursement/substantiating purchases. It’s quick and easy to request reimbursement for eligible expenses paid using personal funds, or to submit documentation for card purchases. Our documentation upload features online and on the mobile app will save you time and make your life easier.
Please remember that credit card receipts, non-itemized cash register receipts and cancelled checks are not acceptable forms of documentation. Always request an itemized receipt or EOB from your health care provider or merchant.
- Claims processing. We will promptly process your request and reimburse you either by check or direct deposit if you sign up for that feature.
- Account management. Log in to your online account or the mobile app to check your account balance, set up your family profile, add a bank account to enable faster reimbursements, or request a debit card in a dependent’s name.
Qualified medical expenses can be found in IRS Publication 502.
Due to frequent updates to the regulations governing FSAs and HSAs, this list does not guarantee reimbursement but, instead, is to be utilized as a guide for the submission of claims.OR
Certain qualifying events allow employees to increase/decrease their election or begin/cease participation in a plan. Common qualifying events can be found on the FSA status change form and include marriage, divorce, birth, death or a change in the cost of dependent care.
The adjustment to the election must be consistent with the event. For example, an increase in the cost of daycare would not allow you to decrease your election (although if the increase made the cost of care unaffordable, one could justify no longer participating in the plan).
Please refer to your employer’s plan document for further guidance on qualifying status change events applicable to your plan.
To request an election change, complete and submit the FSA status change form to your employer. To download the form, and visit the Forms tab.OR
You are eligible for this benefit if you have a dependent (whose expenses are eligible) who requires care to enable you to work. In addition, you must meet one of the following eligibility criteria:
- You are unmarried.
- Your spouse works, is a full-time student, is actively seeking work or is disabled (incapable of self-care).
- You are divorced or legally separated and have custody of your child even though your former spouse may claim the child for income tax purposes. Your dependent care FSA can be used to pay for child care services provided the period the child resides with you.
Important notes: Expenses are treated as having been incurred at the time the medical care was provided, not when you are formally billed, charged or pay for the medical expenses. You cannot receive reimbursement for future or projected expenses. All submitted expenses are reviewed for eligibility according to Internal Revenue Code Section 125 guidelines.OR
Recurring expenses are daycare expenses for eligible dependents (see below) that are incurred so you and your spouse can work. To qualify, you and your spouse must be employed, or your spouse must be a full-time student.
If you’re married and you file a joint return, or you file a single or head-of-household return, the annual IRS limit is $5,000. If you’re married and file separate returns, you can each elect $2,500 for the calendar year.
Eligible dependents include:
- Children under age 13 who are claimed as a dependent for tax purposes
- Care of a disabled spouse or disabled dependent of any age
- Costs already claimed as a dependent care tax credit on your income tax return
- Nursing home, respite care or other residential care centers
- Services provided by one of your dependents
- Nighttime babysitting expenses that are not work related
- Expenses while absent for work for more than two weeks at a time
- Costs paid to your own dependents, under age 19, who are caring for your dependents
- Expenses paid for schooling for kindergarten or higher
- Overnight Camps
Automatic dependent care enables participants to be automatically reimbursed for dependent care expenses by filling out one form instead of filing multiple claims throughout your plan year.
Automatic dependent care works in one of two ways:
If the cost of child care per month meets or exceeds your monthly payroll deduction, reimbursement will be issued as payroll deductions post to your dependent care reimbursement account.
If the cost of daycare is less than your monthly payroll deductions, reimbursement will be made once per month at the end of the month.
To set up automatic dependent care reimbursement, complete the FSA recurring dependent care request form.
The FSA Automatic Dependent Care Request Form needs to be completed each plan year. Changes can be made at any time by submitting an updated FSA Automatic Dependent Care Request Form.OR
Maybe. If you have two or more qualified dependents and pay more than $5,000 per calendar year in daycare expenses, you can take the remaining amount and apply it toward the tax credit maximum. Based on your family’s income level, you’ll receive a credit for a percentage of that amount. For example, if your family’s income is $33,000 a year, you have two dependents, and you spent $7,000 in childcare expenses, you would be eligible to take an additional tax credit of $250 ($1,000 x 25 percent tax credit percentage based on income level).OR
Optum payment cards can be utilized at health care–related merchants, such as hospitals and vision, dental and doctor’s offices. It can also be used at drugstores, pharmacies and grocery stores that have implemented the IIAS (Inventory Information Approval System) or certified 90 percent of their gross sales are FSA eligible (see “Useful Links & Resources” on our website).
As always, save itemized receipts, bills or statements any time the payment card is utilized.
The payment card may also be used at daycare providers that accept Mastercard® or Visa® and have a valid merchant category code signifying they are a daycare provider. The payment card may not be used if you pre-pay daycare expenses, since the IRS requires the expense must be incurred before reimbursement can be made from your dependent care spending account.OR
If you do not use your Optum payment card, you may file claims for reimbursement in two ways:
- File an online claim. First, log in to your account. Click on the file claim link on your home page and walk through the steps to enter the details of the claim. Once you have filed your claim, you must agree to the terms and conditions and click the Submit button. To complete the reimbursement process, send your confirmation page along with your supporting documentation to us. Or do the same process on the App.
- File your claim using the FSA reimbursement request form (see Forms on our website). Follow the provided instructions to complete this form. Claims and copies of your supporting documentation can be submitted via email, fax or mail.
PO Box 30516
Salt Lake City, UT 84130OR
Federal regulations require Optum to obtain itemized receipts for transactions that are not automatically substantiated at the point of sale.
Card transactions can be automatically substantiated without additional paperwork if they are:
- Copayment amounts tied to your health plan. These amounts need to be communicated to Optum by your employer.
- Transactions that match the provider and dollar amount exactly for previously approved transactions (e.g., orthodontia claims, maintenance prescription drugs) and were noted by you as recurring on the request for substantiation notification.
- Purchases made at merchants using the Inventory Information Approval System (IIAS). (See “Useful Links & Resources” on our website.)
In the event a charge does not meet these three criteria, Optum will send three requests for documentation. These requests are generally sent five days, 20 days and 45 days after the date of purchase and will cease once documentation has been received.
Should a charge remain unsubstantiated 60 days after the date of the card transaction, the benefits payment card will be placed in a temporary hold status. The payment card will be reactivated as soon as the necessary documentation has been received to substantiate the expense.OR
Documentation for medical FSA expenses required by the IRS includes a third-party receipt or explanation of benefits containing the following information:
- Date(s) of service
- Itemized list of purchases
- Name of the merchant or health care professional
- Dollar amount(s) (after insurance, if applicable)
For example: An explanation of benefits from your insurance company or itemized statements from the health care provider is excellent documentation.
Documentation for dependent care reimbursement account (DCRA) expenses required by the IRS includes a third-party receipt containing the following information:
- Date(s) of service
- Dollar amount
- Name of daycare provider
In the event the provider is unable to provide a receipt with this information, he or she may simply sign the FSA reimbursement request form or the confirmation page (if the claim was filed online). To download the form, and visit the Forms tab.
Commonly submitted documentation that results in denials includes:
- Statements only indicating a paid amount, balance forward or previous balance
- Credit card receipts only reflecting a payment
- Bills for dependent care/medical expenses where services have not yet been incurred
When submitting a receipt for a copayment amount, please be sure the copayment description is on the receipt. In some cases, you will need to ask for a receipt at the point of service. If “copayment” is not clearly identified, have the provider write “copayment” on the receipt and sign it.OR
To ensure efficient processing, include the proper form or letter along with your documentation.
This can be submitted via email, fax or mail.
PO Box 30516
Salt Lake City, UT 84130OR
Participation in the FSA ends if you terminate employment. This means only expenses incurred prior to the date your participation in the plan ends are eligible for reimbursement. Claims for expenses incurred prior to the plan termination date must be submitted within the “run-out” period.OR
The “run-out” is a specified period of time after the end of the plan year, or following your termination in the plan, in which you may continue to submit claims incurred during your period of coverage. This is not a period when you are able to continue to incur new expenses, but rather it allows you time to gather and submit expenses before forfeitures are applied. For example, if your plan has a 90 day run-out period, you will have 90 days from your date of termination to submit expenses incurred prior to the termination date.OR
A service or expense must be incurred before it is eligible for reimbursement. An FSA expense is considered “incurred” when the service is performed, not when you pay for the service. In addition, the service must be performed during your participation in the plan. Services or expenses incurred before or after your plan participation dates do not qualify for reimbursement.OR
Please follow these steps to access your account online:
- Go to the Optum home page at optumbank.com.
- Click the account holder login button found on the left side of the page.
- If you are a new user, select the option to Register for site access.
- If you forgot your username, click the “Forgot username” link.
- If you forgot your password, click the “Forgot/Change Password” link.
Due to HIPAA regulations, Optum cannot disclose your personal health information (PHI) to any unauthorized representatives.
To authorize an individual or entity to discuss your account detail, complete the authorized release form.OR
Generally speaking, money remaining in your FSA at the end of the plan year will be forfeited. This is commonly known as the “use-it-or-lose-it” rule. However, some plans may allow you to continue submitting claims beyond the end of the plan period for any eligible expenses you incurred before the deadline. Additionally, some plans may allow you to continue spending your FSA dollars through a defined grace period or allow you to carry over a portion of your remaining balance. Be sure to check your specific plan rules in your summary plan description (SPD) by contacting your HR Department or requesting additional details from Optum Consumer Services.OR