Members

Members

Flexible Spending Accounts

The Internal Revenue Code Section 125 tax law allows you to contribute some of your pre-tax pay to accounts you can use to pay yourself back for qualified health care or dependent care expenses. As you have qualifying expenses during the year, you submit a request for reimbursement and appropriate documentation, such as Explanations of Benefits (EOBs) from your health plans to TCA. Reimbursements will be paid to you by check

Expenses Must Take Place During the Current Plan Year.

The flexible spending accounts only cover expenses submitted by the claim deadline for the calendar year – for care received during that calendar year while you are working for The District and enrolled in a flexible spending account. If you terminate participation in a flexible spending account because of a qualifying event during the calendar year, for example on June 1, you cannot be reimbursed for expenses you have after June 1 unless you select COBRA coverage. COBRA applies only to the health care flexible spending account.

COBRA

If you have a qualifying event, you may be eligible for COBRA continuation of coverage with regard to unused money in your health care flexible sending account. Coverage may continue through the end of the calendar year in which you have a qualifying event. If you:

  • Take COBRA continuation coverage for your health care flexible spending account, you may use your balance to pay for expenses incurred during the calendar year. You continue to make after-tax contributions and pay an administrative fee for the rest of the calendar year.
  • Choose not to continue your health care flexible spending account, you may use any remaining account balance only to cover expenses for care received while you were working at the District.

Use It or Lose It.

Under current regulations, if you have any money left in your account(s) after the claim deadline for the calendar year, you forfeit those unused amounts. The claim deadline is March 31 of the following calendar year. You cannot convert any leftover money to cash or roll it over to the next plan year. This rule means you must be very careful when estimating the amount of money, you allocate to your spending account. Only allocate funds you know you will spend. Forfeited account balances will be used to pay the administrative expenses of the plan.

Uniform Reimbursement Requirement.

Once you make your initial contribution for the year, the health care flexible spending account will reimburse you for up to the total amount that you have chosen to contribute for the plan year regardless of the actual balance in your account. This does not apply to the dependent day care flexible spending account. You will only be reimbursed up to the amount actually in your dependent day care flexible spending account. Any reimbursement requested beyond your current balance will not be paid until further contributions are received as the dependent day care flexible spending account cannot be overdrawn.

Health Care

You may set aside pre-tax dollars from your paycheck in your health care flexible spending account – up to a maximum of $2,500 a year for eligible expenses. You can use the account for eligible prescription drugs, and medical, dental and vision expenses. The account is available to your spouse and dependents who qualify as your dependents for federal tax purposes, regardless of whether they are covered by any other benefits offered by Broward Health. Keep in mind that you cannot use the health care flexible spending account for expenses that are covered by any benefit plan or for the premiums you pay for coverage.

The following chart offers a partial guide to what is – and is not – considered a qualifying health care expense. You can get additional information on qualifying expenses from the Internal Revenue Service – by going online to www.irs.gov and selecting Publication 502 – Medical and Dental Expenses, or by calling 1-800-TAXFORM to request a printed copy of the publication. For a final determination on eligible expenses, contact Total Claims Administration, Inc. at (954) 767-5500 if calling from Broward – or toll-free at (800) 867-4446 if calling from outside the Broward area.

Eligible Expenses - Health Care

Dependent Care

You may set aside up to $5,000 each calendar year to reimburse yourself for qualifying dependent day care expenses so that you – and your spouse if you are married – can work outside the home or attend school full-time.

Eligible Dependent Day Care Expenses

  • You may use your dependent day care flexible spending account to pay for eligible expenses for care of: children under age 13 who you claim as dependents on your tax return anyone age 13 or older who lives with you at least eight hours a day and needs supervised care, such as an elderly parent or disabled spouse or dependent. You cannot claim the same expenses under a dependent day care flexible spending account and the dependent day care tax credit. Amounts claimed under a dependent day care flexible spending account reduce the available tax credit dollar-for-dollar. Qualifying dependent day care expenses include those for: dependent day care that allow you (and if married, your spouse) to work or your spouse to attend school full-time licensed nursery school or day care center costs. To qualify under dependent day care flexible spending account rules, the day care center must:
    • comply with all applicable state and local laws and regulations
    • provide care for seven or more individuals and
    • receive a fee for providing day care services
  • Child or dependent day care services, provided in or outside the home.
  • Household services which are, in part, attributable to the care of the child or dependent.
  • For expenses to be eligible for reimbursement, the person you pay to provide care for your eligible dependents cannot be your spouse, another dependent, or a child of yours under the age of 19. In addition, you must provide a tax ID number for a dependent day care provider to receive reimbursement of qualified expenses.
  • You can get additional information on qualifying dependent day care expenses from the Internal Revenue Service – by going online to www.irs.gov and selecting Publication 503 – Child and Dependent Day Care Expenses, or by calling 1-800-TAXFORM to request a printed copy of the publication. For a final determination on eligible expenses, contact Total Claims Administration, Inc. at (954) 767-5500 if calling from Broward or – toll-free at (800) 867-4446 if calling from outside the Broward area.

What Dependent Day Care Flexible Spending Does Not Cover

There are specific expenses that are not eligible for reimbursement under the dependent day care flexible spending account – for example:

  • any amounts you pay to an immediate family member under the age 19 or any person you claim as a dependent on your federal income tax return
  • costs for any person caring for your dependents when you or your spouse is not working
  • transportation expenses
  • child support payments
  • tuition expenses
  • education expenses for kindergarten and above
  • camp expenses, except summer day camps when children are out of school
  • food, clothing and entertainment
  • cleaning and cooking services not provided by the care provider
  • amounts you claim as a dependent day care tax credit.

Requesting A Reimbursement

When you or any eligible family member has an eligible expense, you pay the expense, and then submit a claim form with an Explanation of Benefits (EOB) or receipt if there is no EOB.

Claims Form

How To Appeal A Denied Claim

If you feel that your claim was incorrectly denied or that benefits were not paid, obtain an appeal form from your department and complete it. Submit the completed form to Total Claims Administration within 60 days of your claim being denied. At that time, you should be prepared to explain why you do not agree with the claim processing decision.

Your Right to Representation and Document Review

If you prefer, you may designate a representative to act for you in the review procedure. Simply give that person a written statement designating him to represent you in review of your claim. You or your authorized representative will have up to 45 days after TCA receives your request for review to review pertinent documents at the TCA office during regular office hours. Written releases permitting disclosure of information will be required from both you and the provider if the information is considered sensitive or confidential.

Review Procedures

You also have 60 days to submit issues and comments and any pertinent additional information. In unusual situations when you are unable to submit written issues and comments within 60 days and you advise Total Claims Administration, Inc. that you need more time within the 60 days, your request will be granted provided TCA has sufficient time to give you the extension notice that is required by law. You will be provided with a written decision within 60 days after Total Claims Administration Inc. receives your request for review. That written decision will indicate the reasons for the decision and refer to the section or sections of the plan on which the decision was based.In unusual situations, additional time may be needed to make a decision. In that case, before the 60 day period has expired, TCA will send you a written notice that more time is necessary, extending the time for a written decision to a total of 120 days from the date your request for review was received. TCA is precluded by law from delaying the decision beyond the 120 days period even at your request. Approval for payment of services or supplies must be given by Total Claims Administration, Inc.

2nd Level Appeal Process

In cases where the participant disagrees with the policy interpretation of a reimbursement after a 1st level of appeal/request for review has been decided by the Total Claims Administration, a 2nd level appeal process is available. Copies of previous documentation (ie. request for review, TCA’s decision letter) along with an explanation of the appeal should be resubmitted to Total Claims Administration for executive panel review.