Health Care Reimbursement Account (HCRA)

Program

The California State University Health Care Reimbursement Account (HCRA) is a voluntary benefit, which allows you to take pre-tax dollars from your pay warrant in order to pay for eligible out-of-pocket medical, dental and vision expenses. If you enroll in the plan, the contributions you make to your account are deducted from your pay before Federal, State and Social Security (FICA) taxes are calculated. You must re-enroll in the plan during the open enrollment period as this plan requires an annual enrollment.

Please note: There have been important changes to the HCRA program. Please review the section below regarding Over the Counter Medications. Plan brochure can be downloaded through Acrobat Reader or you can obtain hardcopies through the Office of Human Resources.

Eligibility

New employees may enroll in the plan within 60 days of becoming eligible. Coverage will become effective on the 1st of the month following enrollment, subject to State Controller's Office processing timelines. Employees, who do not enroll during the initial 60 days, will be eligible to enroll during any subsequent annual open enrollment period or due to an eligible change in family status.
You are eligible to enroll in the HCRA if you are in an Executive, Management Personnel Plan (MPP), Confidential or other non-represented position, or are covered by a collective bargaining agreement that provides this benefit.

Enrollment

To enroll or re-enroll in the plan, employees must submit an election via MyHR. Once you enroll, you will not be able to change your contribution amount until the next open enrollment period unless you have had an eligible change in status. If you have a change in status, you may be able to increase (up to the appropriate IRS limit), decrease, start, or stop your contributions by completing the online request within 60 days of the status change. If you stop your contributions, you may continue to submit eligible expenses incurred prior to the date your plan participation ends. If your CSU employment terminates for any reason, or you go on a leave of absence without pay, please contact the Office of Human Resources for COBRA/Direct Pay information.

Family Status Change

Allowable status change events are listed below:

  • Change in Marital Status - marriage, divorce, death of spouse, legal separation or annulment.
  • Change in Number of Dependents - the birth, death, adoption or placement for adoption of a child. The definition of dependent includes a spouse who is physically or mentally unable to care for him/herself;
  • Dependent begins or ceases to meet eligibility - the dependent satisfies (or ceases to satisfy) dependent eligibility requirements for HCRA;
  • Termination/Commencement of Employment - the beginning or the end of employment of the employee, spouse or dependent;
  • Work Hours Change - change in work schedule, including a reduction or increase in hours, full-time/part-time switch, start/stop or unpaid leave of absence or a strike or lockout of employee, spouse or dependent;
  • Entitlement to Medicare or Medicaid - Employee, spouse or dependent gains or loses eligibility for Medicare or Medicaid; or
  • Eligible Judgment, Decree, Court Order, or Qualified Medical Child Support Order (QMCSO).

Eligible Dependents

Please be advised that eligible expenses may be incurred by your tax dependents that qualify for the program, even if they are not on your employer's insurance program as defined in IRS Publication 502, located at the following website: . This publication may be used as a general guide, however, be aware that in some instances CSU Policy may differ. Questions should be directed to the Third Party Administrator, ASI, 1-800-659-3035 (M-F from 6am to 5pm).

Contributions

You can contribute any amount from a minimum of $20.00 a month to a maximum of $237.50 per month, up to $2,850 for 2023 and a maximum of $254.16 per month, up to $3050 for 2024. Please Note: The IRS may impose additional limits in special situations. It is strongly recommended that you consult with a tax advisor before enrolling in this account. You must estimate your eligible expenses very carefully. Any money left in your Health Care Reimbursement Account after your expenses have been paid for the year will be forfeited. The IRS will not permit excess contributions to be refunded.

Deductions & Reimbursements

Your monthly contribution to your Health Care Reimbursement Account (HCRA) will be deducted from your paycheck (pre-tax) and deposited into a special tax-free account. Deposited funds are held in your account until you incur eligible expenses and file a claim form for reimbursement. Even when paid out as reimbursements, the funds remain tax-free. You may file claims for expenses incurred during a plan year any time up to six months after the end of the plan year (June 30 of the next year). Any balance remaining in the account after that date will be forfeited.

Eligible Expenses

Below is a partial list of eligible expenses reimbursable under the HCRA plan. A comprehensive list of qualifying/non-qualifying expenses can be found in IRS Publication No. 502, located at the following website: This publication may be used as a general guide, however, be aware that in some instances CSU Policy may differ. Questions should be directed to the Third Party Administrator, ASI, 1-800-659-3035 (M-F from 6am to 5pm PST).

Ineligible Expenses

Listed below is a partial list of expenses that are generally NOT reimbursable under the HCRA plan.

  • Payroll contributions made to HCRA plan;
  • Surgery or procedures that are strictly cosmetic, such as electrolysis, hair transplants, plastic surgery, spider vein removal, teeth whitening or veneers (unless necessary to improve a deformity arising from or related to a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease);
  • Health Club dues (even if doctor prescribed);
  • Marriage and family counseling;
  • Cost of Weight Loss Program (unless the program is recommended by a physician to treat an existing disease, i.e., heart disease)
  • Any and all insurance premiums, warranty fees, or service contracts; and
  • Long Term Care Insurance premiums (including nursing home charges).

Medical Expenses

  • Deductibles and co-payments;
  • Charges for routine check-ups, physical examinations, and tests; Charges over the “reasonable and customary” limits;
  • Expenses not covered by the medical plan due to a pre-existing condition, or exclusion by the insurance company;
  • Drugs requiring a doctor’s prescription that are not covered by insurance;
  • Smoking cessation programs and related prescription drugs;
  • Weight loss programs, supported by a physician's statement, including membership, or program fees for individuals diagnosed with hypertension or obesity (weight-loss programs for general health improvement, do not qualify as an eligible expense); and
  • Expenses not covered by the medical plan that qualify as a federal income tax deduction, such as services and supplies for the disabled.

Dental Expenses

  • Deductibles and co-payments;
  • Expenses that exceed the maximum annual amount by your dental plan;
  • Charges over the “reasonable and customary” limits;
  • Orthodontia treatments that are not strictly cosmetic. Eligible orthodontic expenses can include: required down payments, monthly payments, and banding fees. Initial requests for reimbursement of orthodontic treatment must include a contract or statement from the orthodontist. This document must reflect the beginning of the treatment, total cost of treatment, and estimated length of treatment. The entire cost of treatment must be prorated over the entire anticipated treatment period. This means that you can only receive reimbursement for orthodontic costs incurred during each plan year of participation, even if you pay the entire treatment cost in current plan year. Participants, who expect treatment to extend beyond the plan year he/she is currently enrolled in, are encouraged to re-enroll for the following plan year for reimbursement of pending expenses.

Vision and Hearing Expenses

  • Vision examinations and treatments not covered by insurance plan;
  • Cost of eyeglasses, prescription sunglasses, contact lenses including lens solution and enzyme cleaner;
  • LASIK surgery; and
  • Cost of hearing aids and batteries.

Reimbursement for Over-The-Counter (OTC) Medicines

Health Care Reform legislation has directed that many over the counter medications will no longer be reimbursable with Flexible Spending Account funds, unless purchased in conjunction with a physician’s prescription. Items purchased to treat an existing or imminent medical condition can be claimed but the participant must indicate on the claim submission what medical condition is being treated and the prescription. Items such as vitamins, herbs or nutritional supplements are typically not eligible for reimbursement. In order to claim these items, you must have: an existing or imminent medical condition; a pre-printed receipt from the provider documenting the purchase; and a physician's diagnosis and prescription for the specific item(s).

The list below contains examples of OTC medications that will no longer be reimbursed under HCRA, effective January 1, 2011, without a prescription:

  • Acid Controllers
  • Allergy and Sinus Medications
  • Anti-Diarrhea Products
  • Anti-Gas Products
  • Anti-Itch and Insect Bite Products
  • Baby Rash Ointments
  • Cold Sore Remedies
  • Cough, Cold and Flu Products
  • Digestive Aids
  • Feminine Anti-Itch/Anti-Fungal Products
  • Hemorrhoid Remedies
  • Laxatives
  • Motion Sickness Aids
  • Pain Relief
  • Respiratory Treatments
  • Sleep Aids and Sedatives
  • Stomach Ailment Remedies

You can also locate an extensive list of eligible expenses and services reimbursable under the Plans on

HCRA Claims Extension

The HCRA plan year is January 1st – December 31st of each calendar year, and you must submit claims no later than June 30th of the following year after the current plan year ends.

Claims applicable to HCRA cannot be reimbursed from DCRA account balances, and vice versa.

Employees may request that a claim incurred between January 1st and March 15th be applied to the current plan year balance rather than the previous plan year. Requests must be made in writing and submitted with the claim for special handling.

Open Enrollment

If you wish to re-enroll in HCRA and/or DCRA for the following plan year, you must enroll during the open enrollment period.

Enrollment Verification

Please ensure that you are enrolled in the appropriate flexible spending plan(s) (i.e., HCRA and/or DCRA) and that the annual contribution that you elected is appropriately reflected in the correct monthly deduction on your pay warrant. Please review your pay warrant dated January 1st, and contact the Benefits Office immediately if a correction is needed.

Consolidated Omnibus Budget Reconciliation Act (COBRA) AND Direct Pay

If you lose your eligibility to participate in HCRA for any reason during the plan year (i.e., leave of absence without pay, retire, terminate, etc.), you may continue to make contributions on an after tax basis to your account through the end of the plan year.

Enrollment in COBRA or Direct Pay must be done within 60 days of losing your eligibility. If you choose not to continue contributions under COBRA/Direct Pay, the funds you have already contributed to your account will not be available for reimbursement of expenses you incur after the date you are no longer eligible. COBRA and Direct Pay enrollment forms are available in the Office of Human Resources.

Third Party Administrator (TPA)

Application Software, Inc. (ASI) is located in Columbia, Missouri and has participated as a TPA for flexible spending account plans since 1988. ASI will be mailing confirmation packets to enrolled participants by the beginning of the 2004 plan year. Packets will include a confirmation statement, an assigned personal identification number (pin), detailed account access instructions, a supply of claim forms, and a direct deposit enrollment form.

Claim Forms

To obtain a claim form or file a claim on-line, visit . Completed claim forms should be mailed to ASI at the following address:

  • ASI
    P.O. Box 6044
    Columbia, MO 65202-6044

Bi-Monthly Claims Reimbursement

Reimbursements will be sent out on a bi-monthly basis based on the following payment schedule:

  • Claims received by the 5th of the month, will be mailed or sent electronically to participants’ account by the 15th of the same month.
  • Claims received by the 20th of the month, will be mailed or sent electronically to participants’ accounts by the end of the same month.

Direct Deposit or Mailing Claim Reimbursements

You have the option of receiving claim reimbursements by mail in the form of a check, or by direct deposit, if you submit a “Direct Deposit Authorization” form to ASI for processing. This form can either be downloaded from , or requested by contacting ASI at (800) 659-3035. If you choose to enroll in direct deposit, you also can request that reimbursement notifications and account statements be sent via e-mail, rather than U.S. mail.

Accessing Account Information

Participants in the Health Care Reimbursement Account plan are able to access their account information by telephone or via the Internet:

  • Toll-Free telephone access allows you to contact ASI Monday through Friday, from 6 a.m. to 5 p.m., Pacific Standard Time, by dialing (800) 659-3035. To properly serve your account during these hours, this telephone number gives you direct access to a “live” customer service representative.
  • InfoLine 125 is an automated, 24-hour telephone information line that provides you with information about account balances and claim reimbursements. InfoLine 125 is updated on a daily basis for accurate information, and can be accessed by dialing (800) 366-4827.
  • Online access allows you access to your personal account via the Internet at .

Claims Reimbursement

You may file claims for expenses incurred during a plan year any time up to six months after the end of the plan year (June 30 of the next year).