To enroll in a Health Care Spending Account (HCSA), an employee must:
1. Be a permanent part-time or permanent full-time employee with sufficient pay to cover the election amount; and
2. Enroll within 31 days of the hire date, if there is no probationary period served; or
3. Enroll within 31 days of completing probation; if there is a probationary period served.
Benefits are based on the current calendar year.
It is not necessary to be enrolled in the State of Ohio’s health benefits to participate in the Health Care Spending Account. If both a husband and wife are state employees, both may participate in the Health Care Spending Account as separate individuals.
If an employee does not enroll at hire or the end of probation as noted above, other enrollment opportunities are as follows.
1. During the annual open enrollment period.
2. Following a change in status: IRS regulations govern Section 125 Cafeteria Plans. A change in status can be made to the employee’s Flexible Spending Account election as a result of a life event. To make a change in status, you must complete the Change in Status form. The time frame for notification is within 31 days of the qualifying event.
3. Change in Status and new hire enrollment must be made from Jan. 1 through Sept. 30.
Consistency Rule: Proposed change in status must be consistent with the type of change experienced. For example, add a dependent and increase election amount, or drop a dependent and decrease the election amount.
Online enrollment is only available during Open Enrollment in October. Before you can enroll online, you must register.
Go to wageworks.com to register for access to your flexible spending accounts.
- Click on Employee Registration.
- Click Next.
- Enter the last four digits of your State of Ohio User ID and your date of birth (mm/dd). Be sure to use the forward slash in the date of birth.
- Follow the prompts.
- Enter your email address to receive notifications, such as when a claim is received or processed.
Your account is automatically set up to send a reimbursement check via U.S. mail.
Add your banking information if you want reimbursements directly deposited.
You will need to create a username and password.
Claims may be submitted to WageWorks by logging on to wageworks.com, where you can enter claim details and attach receipts directly. Below is the Quick Start Guide for more information. Also, you may fax claims to 855-291-0625 or mail to:
Claims Administrator - FBWW
PO Box 14326
Lexington, KY 40512
Health Care Spending Account Claim Form
Quick Start Guide
Claims can be filed by using:
To avoid any delays in claims processing, your documentation must include all IRS required information:
- WageWorks Health Care Card for instant payment
- Pay Me Back Form – Fax or mail the HCSA Pay Me Back Claim Form to WageWorks
- Pay My Provider – Request payment to be made directly to the provider via your HCSA at wageworks.com
- Smart phone app – WageWorks EZ – to upload the receipts
- Patient name
- Provider name
- Date of service
- Service description
- Amount charged or your cost (e.g. your deductible or co-pay amount or the portion not covered by your insurance
Top reasons that claims are rejected or additional information is requested by WageWorks include:
- Claim is submitted without a description or code for the type of service;
- Claim is submitted without the date of service;
- Claim is submitted without supportive documentation for expenses; or
- Claim form is submitted unsigned.
To Appeal a Denied Claim
If you feel your claim was denied in error, you have the right to file an appeal by writing a letter that explains why you believe the claim should be approved:
1.The appeal must be submitted in writing and mailed to:
WageWorks Claims Appeal Board
P.O. Box 991
Mequon, WI 53092-0991
2.The appeal must be received within 180 days of the date you receive notice that your claim was denied.
3. Submit additional information related to your claim along with your appeal, such as: written comments, documents, records, a letter from your health care provider indicating medical necessity of the denied product or service, any other information you feel will support your claim.
4. It is possible to request copies of all documents and information related to your denied claim. These will be provided at no charge.
5. You will be notified of the decision regarding your appeal in writing by WageWorks within 31 days of receipt of your written appeal.
If you have money remaining in your Health Care Spending Account on Dec. 31, a minimum of $50 up to a maximum of $500 will transfer to the next plan year. Any amount less than $50 or more than $500 is subject to the IRS forfeiture rule.
Visit wageworks.com for further information about the carryover.
Federal regulations require that any unspent balance at the end of the calendar year, or at the end of the month of your employment termination, will be forfeited, unless your employer participates in the carryover. To avoid possible forfeiture at the end of the year, use the Health Care Spending Account Worksheet to calculate the appropriate amount.
In order to meet the annual election amount, the program takes deductions from the first 24 pay-periods of the year if paid bi-weekly. Mid-year enrollment and Change in Status adjustments will be calculated over the remaining pay-periods of the year.
For employees paid monthly, the annual election amount will be divided by 12 and deducted from your monthly paycheck.
HCSA Debit Card
Your WageWorks Health Care Card works just like a gift card with current year election amount loaded onto your card. There is no annual fee. All that is needed is to swipe your card at a participating provider to purchase eligible items from your health care spending account. The card does not use a PIN so there is no need to remember yet another four-digit code. It’s versatile. The card enables health care spending account participants to access their account benefits more quickly to pay eligible expenses, and can be used at most retail pharmacies.
Keep your receipts! You may need to provide receipt documentation on occasion for some purchases that are made.
The IRS requires card suspension, when substantiating documentation is not provided when required. A grace period is provided to allow payment card users reasonable time to submit the required documentation.
If you do not submit documentation to WageWorks within 90 days, your WageWorks Health Care Card may be suspended, as required by IRS guidelines. Submit a completed Health Care Spending Account (HCSA) Claim Form to avoid deactivation of your card.
Warning: The debit card cannot be used to pay for any prior year claims.
After Jan. 1, any prior year claims must be submitted online or by paper, since the new program year's funds have been loaded onto your card. Failing to follow this process will cause the debit card to be suspended and may result in loss of the prior year funds.
Note: A payment card is not available for dependent care spending accounts.
Enrolling into direct deposit is the fastest way to receive your reimbursement. Flexible Spending Account reimbursement funds are automatically deposited into your checking or savings account within 72 hours of your claim approval. There is no fee for this service. You do not have to wait for postal service delivery of your reimbursement. However, you will receive notification via mail that the claim has been processed.
To apply, call WageWorks Customer Service at 855-428-0446 for assistance or update your account by logging in at: wageworks.com. Please note that processing your direct deposit enrollment may take four to six weeks.
Over-the-Counter and prescription purchases with the card are only accepted at IIAS certified merchants. For all other qualified expenses, such as medical and dental co-payments, the WageWorks Health Care Card may be used normally for current program year. To find out if a pharmacy or drugstore near you accepts the card, go to the Special Interest Group for Inventory Information Approval System (IIAS) Standards website at sigis.com for the most up-to-date list of merchants with the IRS-approved inventory system.
WageWorks is available at 855-428-0446 to answer questions or provide assistance in determining whether the selected provider is IIAS certified. Customer service representatives are available Monday through Friday, 8 am to 8 pm EST.
Change in Status
In order to make a change in an existing account, you must submit a Change in Status (CIS) Form along with supporting documentation to WageWorks. Upon approval, the change will become effective the first of the month following the approval date. If your FSA change request is denied, you have 60 days from the date you received the denial, to file an appeal. The State of Ohio only allows changes to be made between Jan. 1 and Sept. 30.
The requested change can only be made if the completed form and appropriate supportive documentation is received by WageWorks within 31 days from the date of the IRS qualifying event.
Below are examples of qualifying change in status events and acceptable forms of documentation:
*Coverage effective date is the date of the birth or the adoption.
Termination of Employment/COBRA
If you terminate employment or retire, you can continue certain Health Care Spending Account (HCSA) benefits through COBRA by calling WageWorks Customer Service at 877-502-6272 Monday - Friday, 8 a.m. to 8 p.m.
If you have unspent contributions in your HCSA, you may be eligible to continue your HCSA (on a post-tax basis) for the remainder of the plan year in which your qualifying event occurs. However, if you have already used or been reimbursed for more than you have contributed, you are not eligible to continue HCSA under COBRA.
COBRA Eligibility Examples
Contributions greater than claim reimbursements/card use:
If you elected a Health Care Spending Account benefit of $1,000 for the plan year, contributed $300 pre-tax dollars and received $100 in card use/claims reimbursements, you are eligible for COBRA coverage to continue your HCSA for the remainder of the plan year or until you receive the maximum HCSA of $1,000.
Contributions less than claim reimbursements /card use:
If you elected a Health Care Spending Account benefit of $1,000 for the plan year, contributed $300 pre-tax dollars and received $600 in card use/claims reimbursements, you are not eligible for COBRA coverage to continue your HCSA for the remainder of the plan year.
If you are not eligible or do not choose to enroll in COBRA, your benefits will terminate at the end of the month in which the event occurred. You have 90 additional days to file claims incurred while your account was active by submitting a HCSA Pay Me Back Claim Form. Any unclaimed funds will be forfeited according to IRS regulations.
If you are scheduled to retire within the upcoming calendar year, you are eligible to enroll during Open Enrollment to take advantage of FSA benefits while you are employed with the State of Ohio.
Upon retirement, you can continue your Health Care Spending Account (HCSA) benefits on a post-tax basis through COBRA for the remainder of the plan year if you have unspent contributions in your HCSA. However, if you have already received reimbursement for more than you have contributed, you are not eligible for COBRA.
If you are not eligible or choose not to participate in COBRA, your benefits will terminate at the end of the month in which you retire. You will have 90 days from the termination date to file claims for your account. Any unclaimed funds will be forfeited according to IRS regulations.