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The new healthcare reform legislation includes important changes to your healthcare Flexible Spending Account (FSA) and your Health Reimbursement Arrangement (HRA) effective January 1, 2011.
Over-the-Counter Expense Limitations: Effective January 1, 2011, many over-the-counter (OTC) medicines and drugs will no longer be eligible for reimbursement from your FSA or HRA without a prescription. At this time, SHPS is awaiting additional guidance from the Internal Revenue Service (IRS) regarding the exact list of impacted OTC items; however, the table below provides an overview of the types
of OTC products that we anticipate will not be eligible unless you have a prescription. Once we have a final list, we will provide it.
Over-the-Counter Medications Requiring a Prescription after January 1, 2011
Please note: Insulin is the only OTC item not subject to the prescription requirement at this time. Additionally, we anticipate non-medicinal items such as band-aids, ace bandages, and contact lens solution will continue to be eligible for reimbursement.
How the new legislation will impact you:Using your debit card Beginning January 1, you will not be able to purchase any of the “prescription-required” OTC items with your debit card.1 However, you can submit a paper reimbursement request with documentation showing the OTC item was prescribed.
Submitting claims during your grace period Any OTC item purchased January 1, 2011 or after that is “prescription-required” wil fol ow the new OTC guidelines, even if you are stil using your 2010 FSA funds.
Obtaining a prescription prior to January 1 If you currently use a portion of your FSA or HRA funds for a newly-restricted item(s), you will need a prescription2 for the item prior to January 1. Otherwise, beginning January 1, reimbursement wil be delayed if a prescription for an OTC medicine or drug is not included with your claim.
Determining how much to elect for the 2011 plan year During the open enrollment period for the upcoming 2011 plan year, you should carefully estimate the amount you elect to contribute to your health FSA. Once the plan year begins, you cannot change the elected amount unless you experience a major life event which permits an election change (events include marriage, divorce, birth/adoption of a child, or having a child reach the plan’s age limit).
1 Although you will still be required to have a valid prescription for these OTC expenses, you may find that you can purchase these items at locations
considered “90% Merchants.” PLEASE NOTE: You WILL be required to submit a valid prescription after-the-fact. For a list of eligible 90% Merchants, please visit www.sigis.com.
2 SHPS is currently awaiting final notification from the IRS regarding what a valid prescription will be (i.e., what is the medium, who can prescribe, etc).
Once this information is available, additional notifications will be published.
The chart below provides summaries and examples of how the January 1 ef ective date may impact your OTC spending. These examples are for illustration purposes only, and are not a guarantee of benefits under your plan. The final decision regarding eligibility of an expense wil be made based on IRS guidance and plan provisions.
Sally buys a one-month supply of Claritin® on
automatically substantiated at the time of
She can pay for it with her debit card at the
Her expense can be reimbursed as long as
plan year, including during your close-out
she submits her claim prior to the plan’s run-
out period, and all other plan requirements are satisfied.
Sally wants to buy a one-month supply of
Sally’s debit card is rejected at the point-of-
sale because a prescription is now required.
She will need to submit the expense using a
card will no longer be permitted for the
paper form with accompanying prescription for
Sally buys Claritin® on 1/3/2011 but does not
have a prescription submitted with her claim
form. She will not be reimbursed for this
during the first two and a half months of
2011, unless submitted with a doctor’s
Sally buys Claritin® on 1/3/2011 and has
submitted a prescription with her claim form. So long as Sal y provides the necessary documentation along with her request, she can be reimbursed in accordance with plan provisions.
Dependent Eligibility to Age 26
The second item that wil be af ecting your health FSA or HRA for the 2011 plan year is the expansion of health plan
eligibility for adult dependents up to age 26, even if the child is married and irrespective of whether the child resides with,
or is financially dependent on, the covered employee. Based upon your health plan design, you may
be al owed to
claim reimbursement for these eligible dependents through your health FSA, so be sure you check your plan and
adjust your annual election amount accordingly. Please note that the tax exclusion under your health FSA does not
extend to the spouse of an adult dependent. This change does not impact dependent care FSAs—the criteria for eligible
individuals remains as-is.
Additional updates wil be provided as more information becomes available.
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