HEALTH CARE REIMBURSEMENT ACCOUNT (HCRA) - Cal Poly
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HEALTH
CARE
REIMBURSEMENT
ACCOUNT
(HCRA)
1
This brochure is intended to provide highlights of the California State University (CSU)
Health Care Reimbursement Account (HCRA) Plan. This plan has many important rules,
so please read this material carefully. Complete details of the plan are provided in the
official plan document, which at all times is the ruling plan document. If you have
questions about the plan or wish to review a copy of the plan document, contact your
campus benefits office. The claims administrator for the plan is currently ASIFlex. You can
visit their website at www.asiflex.com.
OVERVIEW ELIGIBLE EMPLOYEES
The CSU Health Care Reimbursement You are eligible to enroll in the Health Care
Account (HCRA), a voluntary benefit for eligible Reimbursement Account if you are in an
employees, offers you the ability to pay for eligible Executive, Management Personnel Plan (MPP),
out-of-pocket health care expenses with pretax Confidential or other non-represented position, or
dollars. If you enroll in the plan, the contributions are covered by a collective bargaining agreement
you make to your account are deducted from that provides the benefit. Rehired annuitants and
your pay before federal, state and FICA taxes are employees under the Faculty Early Retirement
calculated. Your taxable income is reduced and, Program (FERP) are not eligible to participate.
consequently, your taxable income reflected on
your annual W-2 statement is reduced. Expenses
eligible to be reimbursed from the Health Care
ENROLLMENT AND EFFECTIVE DATE
Reimbursement Account are expenses that OF COVERAGE
are medically necessary but not covered by
Employees may enroll in the plan within 60 days of
your own or another insurance plan, and are
hire, or a subsequent change in status (see
expenses incurred by you, your spouse and your
explanation under the “Change in Status”
dependents as defined under IRS Code 152.
section of this brochure) or during open
The “Eligible Expenses” section of this brochure
enrollment. For new employees who enroll after
provides more information on reimbursable
the plan year begins, participation in HCRA will be
expenses. Expenses solely for cosmetic reasons
for the remainder of the plan year and coverage
or expenses that are merely beneficial to your
will become effective on the first of the month
general health are not reimbursable, because
following enrollment (subject to campus and
they are not medically necessary. HCRA plan
State Controller’s Office processing timelines).
enrollment is based on a calendar year, from
Once coverage begins, you will not be able to
January 1 through December 31.
change your contribution amount unless you have
*Please note:You must enroll each year if you a change in status as described in the “Change in
wish to participate in this plan.Your annual Status” section.
enrollment will not automatically renew.
The annual open enrollment period is usually held HOW TO ENROLL
through select dates from September to October.
The effective dates of the plan coverage will be Check with your campus benefits office on how
January 1 through December 31 of the following to enroll. Upon enrollment, you will designate the
year. amount you want deducted each month on your
paycheck on a pretax basis. You will be charged a
small administrative fee that is deducted from your
salary on an after-tax basis.
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YOUR HEALTH CARE REIMBURSEMENT ELIGIBLE DEPENDENTS as defined in Section 213(d) of the Internal
ACCOUNT (HCRA) Revenue Code.
Under HCRA, an eligible dependent as defined in
Internal Revenue Code (IRC) Section 152 means You may include all medical, dental and vision
The Health Care Reimbursement Account
your spouse (as defined under federal law), expenses for the diagnosis, cure, treatment or
provides reimbursement for eligible health care
“qualifying child” or “qualifying relative.” A prevention of disease, and for treatments
expenses that you or your eligible family members
“qualifying child” means an individual who: affecting any part or function of the body that are
incur, via a special tax-free account set up for
not covered or not reimbursed by insurance.
this purpose.
(1) Resides with you for more than half the year;
Expenses may also be those used to alleviate
Each month, the dollar amount you preselect
(2) Is your child, stepchild, sibling, stepsibling or any or prevent a physical defect or illness. Expenses
is deducted from your salary before federal,
of the descendants of these relatives incurred solely for cosmetic reasons or expenses
state and FICA taxes are withheld. These
(adopted and qualified foster children are that are merely beneficial to a person’s general
deductions are held in your personal Health Care
considered your children); health are not eligible for reimbursement.
Reimbursement Account until you incur eligible
expenses and file a reimbursement claim. (3) Is under age 19, or under age 24 in the case of You may refer to IRS Publication 502 for general
Reimbursement claim payments are not taxable. a full-time student. No age limit applies to any information on deductible medical expenses.
of the listed individuals if they are totally and However, please be aware that not all
Tax-free Health Care Reimbursement Accounts are
permanently disabled; and the expenses listed as deductible in IRS
governed by a number of rules, most of which are
Publication 502 are eligible for reimbursement
set by the Internal Revenue Service (IRS) and can (4) Does not provide over one-half of his or her
under the HCRA plan. For example, federal
be changed only by that agency. own support. A “qualifying relative” means an
regulations do not allow any insurance premiums
individual who:
or long-term care expenses to be reimbursed
AMOUNT YOU CAN CONTRIBUTE (a) Receives over half his support from you; under the HCRA plan, although they are listed as
deductible expenses under IRS Publication 502.
You can contribute any amount from a minimum (b) Is your child, sibling, stepsibling or any of
of $20 to a maximum of $229.16 each month your descendants; a parent or stepparent Below is a partial list of expenses eligible for
($2,750 a year). Contributions must be made by or any of the employee’s ancestors; an reimbursement under HCRA. A more detailed and
payroll deduction. aunt, uncle, niece, or nephew; children or comprehensive list of eligible expenses also can
parents-in-law; or an unrelated individual be obtained by visiting www.asiflex.com.
The limit noted above may be lower for who shares the taxpayer’s residence as a
employees who are classified as “highly member of the household; and
compensated employees” according to IRS rules. MEDICAL EXPENSES
You will be notified of the limit on your Health (c) Is not a qualifying child of yours or that of
another taxpayer during the plan year. • Deductibles;
Care Reimbursement Account contributions, if
any apply. Note: Registered domestic partners (and/or a child • Copayments;
of a registered domestic partner) may be
Your payroll deductions are exempt from federal, • Charges for routine checkups, physical
considered a dependent for purposes of
state and FICA taxes. However, they are not examinations and tests connected with
reimbursement of medical expenses if the
exempt from CalPERS retirement contributions. routine exams;
registered domestic partner (and/or a child of a
Your account contributions have no impact on any
registered domestic partner) meets the definition • Charges over the “reasonable and customary”
other employer-provided benefits that are based
of dependent as described above. limits;
on your salary. There may be some impact on
your Social Security benefits as discussed in the • Expenses not covered by the medical plan
section titled “Effect on Social Security.” ELIGIBLE EXPENSES because of a preexisting condition, or exclusion
by the insurance company;
Expenses qualify for reimbursement based on
when incurred, not when paid. • Prescription drugs or medicines (cost not
covered by insurance);
Expenses eligible to be reimbursed from the
Health Care Reimbursement Account are those • Medical equipment, supplies and diagnostic
that are not eligible for reimbursement under devices (e.g., breast pumps, lactation supplies,
another plan and medically necessary expenses bandages, hearing aid batteries, blood sugar
that are incurred by you, your spouse and your tests, contact lens solution, etc.);
dependents during the plan year for medical care
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• Smoking cessation programs and related drugs VISION AND HEARING EXPENSES • Health club dues are eligible with a letter of
(must be accompanied by letter of medical medical necessity;
necessity and prescription); • Vision examinations and treatment (cost not • Marriage and family counseling; and
• Weight loss programs, supported by a covered by insurance plan);
• Nonprescription medicines and vitamins, if
physician’s statement, including membership, • Cost of eyeglasses, prescription sunglasses purchased only for purposes of general health.
or program fees for individuals diagnosed with and contact lenses, including lens solution and
hypertension or obesity (weightloss programs enzyme cleaner;
for general health improvement do not qualify CHANGE IN STATUS
as an eligible expense); and • LASIK surgery; and
• Cost of hearing aids and batteries. Once the plan year has begun, you cannot make
• Other expenses not covered by the medical
changes in your authorization unless there has
plan that qualify as a federal income tax
been a change in your status, as defined by the
deduction, such as special services and TRANPORTATION EXPENSES IRS. Please note that your election must be on
supplies for the disabled.
account of and consistent with one of the
You may claim up to a certain amount per mile for following events:
DENTAL EXPENSES transportation required for health care (the “per
mile” amount is set by the IRS and may vary per • Change in marital status—Marriage,
tax year) Refer to www.asiflex.com for additional divorce, death of spouse, legal separation or
• Deductibles;
information. annulment;
• Copayments;
Submit claims for travel expenses at the same • Death of domestic partner;
• Expenses that exceed the maximum annual time you file a claim for the medical expense • Change in number of dependents—Birth,
amount allowed by your dental plan; associated with that travel. You also can claim death, adoption or placement for adoption of a
• Charges over the “reasonable and customary” parking and/or toll expenses if you provide a child, legal custody, domestic partner, or loss
limits; and receipt. Public transportation also requires a of legal custody or domestic partner;
receipt. Indicate the number of round-trip miles
• Orthodontia treatments that are not strictly on your reimbursement claim form. • Termination/commencement of
cosmetic. Eligible orthodontic expenses may employment—The beginning or the end
include required down payments, monthly of employment of the employee, spouse or
payments and banding fees. INELIGIBLE EXPENSES dependent;
Effective January 1, 2021 initial requests for Effective January 1, 2020, over-the-counter • Change in work hours—Change in work
reimbursement no longer needs to include a (OTC) medicines, drugs and feminine products are schedule, including a reduction or increase in
contract or statement. Employees will receive now considered reimbursable expenses hours, full-time/part-time switch, start/stop of
full reimbursement for full payments, down under HCRA. A prescription is no longer needed unpaid leave of absence or a strike or lockout
payments, monthly payments and/or banding for items such as allergy medications, smoking of employee, spouse, domestic partner or
fees. Participants who expect treatment to cessation medications, aspirin and cold dependent;
extend beyond the plan year they are currently medications. For a full list of eligible OTC
medications and how to submit a claim, please • Eligibility changes—Your dependent satisfies
enrolled in are encouraged to reenroll for the
visit ASIFlex Eligible Expenses List. (or ceases to satisfy dependent eligibility
following plan year for reimbursement of
requirements for HCRA;
pending expenses.
Below is a partial list of expenses ineligible for
expenses under HCRA. Detailed information can • Entitlement to Medicare or Medicaid—
be obtained at www.asiflex.com. Employee, spouse or dependent gains or loses
eligibility for Medicare or Medicaid; or
• Any and all insurance premiums, warranty fees
or service contracts; • Judgment, decree, court order or Qualified
Medical Child Support Order (QMCSO).
• Long-term care expenses (including nursing
home charges); The events listed qualify as a change-in-status
event only if they result in a gain or loss of
• Surgery or procedures that are strictly eligibility under the CSU or another plan.
cosmetic, such as electrolysis, hair transplants,
plastic surgery, spider vein removal, teeth If you experience a change-in-status event, you
whitening or veneers; may increase (to the appropriate limit), decrease,
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start or stop your contributions by reaching out
HOW TO CLAIM REIMBURSEMENT CLAIMS FILING PERIOD AND EXTENSION
to your campus benefits office within 60 days of
the status change. Any change you make must You can file a claim for reimbursement online You may file claims for expenses incurred during
correspond and be consistent with the change in by creating a profile and logging in with your the plan year (January 1 through December
status event. If you stop your contributions, you username and password, or by completing the 31) any time up to six months after the plan
may claim reimbursement for eligible expenses form and attaching an itemized bill for your health year ends. Therefore, your claim(s) must be
incurred prior to the date your plan participation care expenses. Photocopies of your bills are postmarked by June 30 following the end of the
ends. See the “COBRA” section for rules on acceptable but not copies of canceled checks, plan year or any balance remaining in HCRA
continuing coverage if your CSU employment which are insufficient documentation. Claims after June 30 will be forfeited.
terminates for any reason, or you begin a leave of cannot be paid without such verification of
absence without pay. If you are enrolled in HCRA through December
expenses.
31 of any plan year and have a remaining
You may also file a claim by using the ASIFlex account balance, you can also file claims for
HOW TO PLAN YOUR CONTRIBUTIONS mobile application. You can submit documentation reimbursement under the grace period extension
by taking a picture, find information about your for any eligible expenses that are incurred January
If you are already paying for health expenses
account and access your account statement at 1 through March 15 of the following plan year.
(including medical, dental and vision) not paid
any time. The mobile app can be downloaded on
by insurance, you probably know your annual Under the grace period extension, all HCRA
both the App Store and Google Play.
expenditures. By looking at your records for the claims for services incurred January 1 through
past year and identifying anticipated out-of-pocket CSU Health Care Reimbursement Account March 15 of the following calendar year will
medical, dental and/or vision costs, you can claim forms are available from your campus automatically be processed against the
estimate the contributions you want to make to benefits office or the Claim Administrator, ASI. previous plan year first if there is an account
the Health Care Reimbursement Account. These forms may also be downloaded from the balance remaining after December 31 and filed
Systemwide Benefits Portal at www.calstate. by the claims filing deadline. However, you can
Carefully estimate your eligible expenses.
edu/hr/benefitsportal and ASI’s website at request that a claim incurred January 1 through
As noted earlier, your authorization is irrevocable
www.asiflex.com. ASI can be contacted toll-free March 15 be applied to the current plan year
during the plan year unless you have a change-
at (800) 659-3035. In addition to the above claims (must be enrolled) rather than the previous
in-status event. In addition, any money left in
procedures, claim reimbursement for over-the plan year. Such requests must be in writing and
your Health Care Reimbursement Account after
counter drugs and medicines will no longer submitted with the claim for special handling.
your expenses have been paid for the enrollment
require a prescription. However, you will need
period will be forfeited. If you choose not to re-enroll in HCRA for the
to include the following to submit a claim for
subsequent plan year, you can utilize only the
In addition, the IRS prohibits the transfer of reimbursement:
remaining account balance in your account as of
funds from one pretax account to another. If
A copy of the merchant itemized receipt to show: December 31 for reimbursement of eligible grace
you participate in both the Dependent Care
period claims that are incurred January 1 through
Reimbursement Account and the Health Care • Merchant name;
March 15 of the following year.
Reimbursement Account, you cannot use your
• Date of purchase;
Health Care Reimbursement Account for Claims applicable to HCRA cannot be reimbursed
reimbursement of dependent care costs, or • Itemized description of each product from Dependent Care Reimbursement Account
vice versa. purchased; and balances, and vice versa.
• Dollar amount paid for each item. Please note: If your participation in HCRA is
EFFECT ON SOCIAL SECURITY terminated before December 31, you are
Completed claims can be submitted to the Claims ineligible to file any claims under the grace
Depending upon your salary, your contributions Administrator via mail, facsimile, mobile or online. period extension.
to the Health Care Reimbursement Account also Currently, reimbursements are processed daily.
may reduce your Social Security deductions. This Your reimbursement will be either mailed to you
means your Social Security benefits at retirement or electronically deposited into your savings or
may be reduced, because you have paid Social checking account (if you choose this option). There
Security taxes on a lower wage amount. You is no minimum reimbursement amount.
should take this into consideration as you
decide whether to enroll in the Health Care
Reimbursement Account. You may wish to
consult your tax adviser or financial planner.
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terminate at the end of the month in which you
FSA DEBIT CARD
last contributed, and you will be reimbursed only
You will receive two FSA debit cards, called for eligible expenses that were incurred through
“ASFIex Cards” upon a new enrollment, You this period. If you choose not to continue
swipe the ASIFlex Card to pay for eligible contributions under COBRA, the funds you have
HCRA-related expenses incurred in the current already contributed to your account will not be
plan year (also includes expenses incurred during available for reimbursement of expenses you
the grace period) and the funds are automatically incur after the date you are no longer eligible.
deducted from your HCRA for payment. The card
eliminates most out-of-pocket expenses and TERMINATION OF YOUR
claims paperwork (exceptions apply), as well as PARTICIPATION/PLAN
the need to wait for reimbursement checks.
For additional, pertinent information about the Your participation in the Health Care
ASIFlex Card, please visit the ASIFlex website Reimbursement Account will end as of the
at www.asiflex.com or the CSU Systemwide later of the following:
Benefits Portal. • At the end of the month in which you last
contributed (for claim filing purposes, eligible
expenses only will be reimbursed for services
CLAIMS DENIAL AND APPEAL
provided through the end of this period). For
You will receive written notice of any denied example, if you terminate in May, your last
claims. You will have 60 days from the date of contribution to HCRA is taken from your May
the written notice to file an appeal of that denial salary, and your participation ends June 30.
with the Claims Administrator, ASI. The Claims Please note: If your participation in HCRA is
Administrator will provide you with a written terminated prior to December 31, you are
notice of the resolution of the appeal within ineligible to file any claims under the grace
60 days of the appeal. period extension specified above.
• The end of the current plan year if you do not
CONTINUATION OF COVERAGE re-enroll during annual open enrollment period.
Consolidated Omnibus Budget Reconciliation • Upon termination of your employment unless
Act (COBRA) you qualify for and elect COBRA.
If you lose your eligibility to participate in the • The date of your death, unless your beneficiary
Health Care Reimbursement Account for any qualifies for or elect COBRA.
reason during the plan year (e.g., leave of absence
• Upon termination of this plan.
without pay, retirement, termination, etc.),
you may continue to make contributions on an This plan may be terminated by the CSU only as
after-tax basis to your account under the CSU’s of the end of any plan year. Any account balance
Continuation of Coverage guidelines. The CSU as of the end of the plan year, and unclaimed
extends the HCRA benefit to employees who lose through the reimbursement process by the
coverage pursuant to COBRA through the end of following June 30, will be forfeited.
the plan year. You must have a positive account
balance at the time you separate or go on leave
without pay in order to participate. However, no FINAL NOTE
account balance is required if you are on an
Through the Health Care Reimbursement
unpaid leave through the Family Medical Leave
Account (HCRA), it is possible to pay for health
Act (FMLA). You must elect to continue coverage
care expenses on a tax-advantaged basis easily
within 60 days of notification of a qualifying event
and automatically. If you carefully consider
or the loss of eligibility, whichever is later. There
your decision to participate, you will find it
are no tax savings on contributions you make to
a worthwhile addition to your CSU benefits
your account under COBRA. Your eligibility will
package.
10 11
401 Golden Shore, Long Beach, CA 90802-4210
Refer to Internal Revenue Service (IRS)
Publication 502 for additional information.
Effective Plan Year 2022
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