Harvard University

A Health Care Flexible Spending Account (HCFSA) helps pay for certain medical, dental, vision, and prescription expenses not covered by health insurance or another plan. You can be reimbursed for eligible expenses incurred by you, your spouse, or any person that you claim as a dependent on your income tax returns. The benefits of a HCFSA include:

• Your full HCFSA election is available to you as of the date you enroll (January 1 if you enrolled during the annual enrollment period)
• You do not need to be enrolled in a medical plan to participate in a HCFSA
• Pre-tax deductions are calculated on a per pay period basis and taken throughout the year
• Paying for benefits on a pre-tax basis means your taxable income is lower, and consequently, your taxes are lower
• As you incur eligible expenses, you may submit a claim to draw funds from your HCFSA

Eligible Expenses

• Medical, dental, and vision copays, coinsurance, and deductibles
• Eye glasses and contact lenses
• Orthodontia
• Other medical, dental, vision, and hearing products and services

Helpful Resources

• HCFSA Brochure
  Overview of Health FSA and Dependent Care FSA
• Spanish HCFSA Brochure
• FSA Eligible Expense List and Election Worksheet
  List of most common Health FSA eligible expenses and a worksheet to help determine an election amount
• Spanish FSA Eligible Expense List and Election Worksheet
• List of most common Healthcare FSA eligible expenses
• Healthcare FSA Claim Form
  To be submitted by members seeking reimbursement from their Healthcare FSA, Limited Purpose FSA
• Healthcare FSA Physician Statement
  To be submitted by members who have Healthcare FSA or Limited Purpose FSA claims for Dual Use expenses
• FSA Store Coupon
• Online Shopping Options

FSA Store

A Dependent Care Flexible Spending Account (DCFSA) helps pay for qualified day care expenses for your dependent child under age 13, disabled spouse, elderly parent, or other qualified dependent who is physically or mentally incapable of self-care. With a DCFSA:

• Funds can be used to pay for eligible expenses for the care of a dependent child under age 13 or disabled adult while you are gainfully employed, looking for employment, or attending school full-time
• The contribution limit is $5,000 annually per household
• Pre-tax deductions are calculated on a per pay period basis and taken throughout the year Paying for benefits on a pre-tax basis means your taxable income is lower, and consequently, your taxes are lower
• You can be reimbursed up to the amount in your DCFSA account at the time you file for reimbursement

Eligible Expenses

• Day care centers and nursery schools
• Summer day camps
• Before/After school programs, babysitters including nannies inside or outside the home (Relatives must be over 19 and not able to be claimed on your federal tax return. Non-relatives can be under the age of 19)
• Adult day care centers

Please note: Your dependent’s healthcare expenses are not eligible for reimbursement through the DCFSA.

Helpful Resources

• List of most common Dependent Care FSA eligible expenses
• Dependent Care Claim Form
  To be submitted by members seeking reimbursement from their Dependent Care FSA

A Limited Purpose Flexible Spending Account (LPFSA) is available to members enrolled in the Health Savings Account (HSA). With an LPFSA, you can use pre-tax dollars to help pay for eligible dental and vision expenses for you, your spouse, or any person that you claim as a dependent on your income tax returns. The benefits of an LPFSA include:

• Your full LPFSA election is available to you as of the date you enroll (January 1 if you enrolled during the annual open enrollment period)
• Pre-tax deductions are calculated on a per pay period basis and taken throughout the year
• Paying for benefits on a pre-tax basis means your taxable income is lower, and consequently, your taxes are lower
• As you incur eligible expenses, you may submit a claim to draw funds from your LPFSA

Eligible Expenses

Dental and vision expenses such as bridges, crowns, dental copays, dental deductibles, dental work, eye glasses and contact lenses, Lasik, orthodontia and other dental, orthodontia and other dental expenses, orthodontic and vision services

Helpful Resources

• 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
  List of most common Limited Purpose FSA eligible expenses and a worksheet to help determine an election amount
• Limited Purpose FSA Claim Form
  To be submitted by members seeking reimbursement from their Limited Purpose FSA

Introduction To HSA

Requesting HSA Distributions

Requesting HSA Contributions

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

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

• Supplemental Health Fund FAQ and Claim Form.

• COBRA FAQ
• Summary of Benefits and Coverage (all Harvard-sponsored medical plans)
• Member Portal Login & Recurring ACH Guide
• COBRA Termination Request Form

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

Substantiation is the supporting documentation or data (receipts, explanation of benefits (EOB), etc.) that confirms an expense or claim is eligible to be paid through your Flexible Spending Account (FSA). The IRS has established specific guidelines that require all FSA — even those made using an FSA debit card — to be substantiated.

Common Misconceptions about Substantiation Requirements

1. If the FSA debit card is used for an eligible expense, no further substantiation is needed to support the expense.
2. Claims at a doctor, dentist, or vision provider will not require substantiation.

Since many services from a medical, dental, vision or a non IIAS pharmacy provider are NOT FSA-eligible expenses, itemized receipts are required to verify eligibility. For example, a dentist may perform teeth whitening, which is not eligible for reimbursement through an FSA.

EOBs contain all of the required information and are also excellent sources of documentation.

Requests for substantiation

If substantiation of an FSA debit card transaction is required, you will be notified by email or an alert on the Consumer Portal home page. FSA debit card transactions that require substantiation are displayed through messages in both the Message Center on the home page and your account summary page. You may also see if a claim requires substantiation by logging into your online account or mobile app to check the status of the claim.

How can documentation be submitted?

• Mobile app – Take a picture of the receipt with a phone camera and upload directly to claim
• Consumer portal – Upload saved copies of itemized receipts, invoices or EOBs directly to claim
• Fax – Include copy of receipt reminder with copy of itemized receipts, invoices or EOBs
• Mail – Include copy of receipt reminder with copy of itemized receipts, invoices or EOBs