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
• Mobile App Brochure
• Authorization for Release of Records Form
• Direct Deposit Form

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
• Mobile App Brochure
• Authorization for Release of Records Form
• Direct Deposit Form

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
• Mobile App Brochure
• Authorization for Release of Records Form
• Direct Deposit Form

Introduction To HSA

• Copayment Reimbursement Plan Dumbarton Oaks (except those covered by HUCTW), Center for Hellenic Center, and VPPAC– 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 (Arboretum and Custodian) – 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
• Authorization for Release of Records Form

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

• Claim Substantiation