Harvard University

Introduction To HSA

Requesting HSA Distributions

Requesting HSA Contributions

• Limited Purpose FSA Brochure
  Overview of Limited Purpose FSA and Dependent Care FSA for those enrolled in an HSA
• Limited Purpose FSA Eligible Expense List and Election Worksheet
  Listing of most common Limited Purpose FSA eligible expenses and a worksheet to complete to help choose an election amount
• FSA Brochure
  Overview of Health FSA and Dependent Care FSA
• FSA Eligible Expense List and Election Worksheet
  Listing of most common Health FSA eligible expenses and a worksheet to complete to help choose an election amount
• FSA Extended Eligible Expense List
• Dependent Care Eligible Expense List
• FSA/LP FSA Claim Form
  To be submitted by participants seeking reimbursement from their Health FSA, Limited Purpose FSA or Dependent Care FSA
• FSA Physician Statement
  To be submitted by participants who have Health FSA or Limited Purpose FSA claims for Dual Use expenses
• FSA Tax Savings Calculator
• FSA Store Coupon

FSA Store

Over-the-counter items eligible under an FSA
FSA money may be used to purchase over-the-counter drugs and medicines such as ibuprofen, acetaminophen and cough syrup with a prescription from the employee’s doctor. A copy of the prescription for over-the-counter medications is required once a year for claims payment. Employees may use their FSA to purchase over-the-counter items that are not considered a drug or a medicine such as bandages, wound care and contact lens solution without a prescription.

• 2019 Copayment Reimbursement Plan SEIU Arboretum – FAQ and Request Form
• 2019 Copayment Reimbursement Plan ATC, HUCTW, HUPA, HUSPMGU, LOCAL 26, & SEIU Custodians – FAQ and Request Form
• 2018 Copayment Reimbursement Plan Local 26, SEIU Arboretum – FAQ and Request Form
  Overview and claim request form for the Copayment Reimbursement Plan for union staff
• 2018 Copayment Reimbursement Plan ATC, HUCTW, HUPA, HUSPMGU, SEIU Custodian – FAQ and Request Form
  Overview and claim request form for the Copayment Reimbursement Plan for union staff

• 2019 Reimbursement Plan FAQ and Request Form
• 2018 Reimbursement Plan FAQ and Request Form
  Overview and claim request form for the Reimbursement Plan for active faculty and non-union staff

• 2019 Supplemental Health Fund FAQ and Claim Form.

• ACH Form
• COBRA FAQ
• Summary of Benefits and Coverage (all Harvard-sponsored medical plans)

For more information on the Tuition Reimbursement Program (TRP) and/or the Tuition Assistance Program (TAP) please click here.