Health Care Flexible Spending Account (HCFSA)
A Health Care FSA (HCFSA) is a tax-advantaged account offered by employers that allows an employee to contribute pre-tax dollars to an account that can be used for eligible health care expenses. Health Care FSAs can be used to cover the eligible expenses of the employee, a spouse, and qualified dependents. Funds expire at the end of the plan year (carryover or grace period provisions may apply).
Dependent Care FSA (DCFSA)
A Dependent Care FSA (DCFSA) is a tax-advantaged account offered by employers that allows an employee to contribute pre-tax dollars to an account that can be used for qualified day care expenses for children under age of 13 (or dependents over the age of 13 if physically or mentally incapable of self-care) so that the employee and spouse (if applicable) may go to work. Funds expire at the end of the plan year (carryover provisions do not apply, however a grace period provision may apply).
Commuter Benefit Account (CBA)
A Commuter Benefit Account (CBA) is a tax-advantaged account that can be used for commuter parking, commuter transit, or vanpool expenses incurred by an employee to commute to work. Carryover provisions may apply.
Health Reimbursement Account (HRA)
An Health Reimbursment Account (HRA) is an account provided by an employer to cover specified health care expenses in accordance with a plan document and Section 213(d) of the IRS code.
Health Savings Account (HSA)
A Health Savings Account (HSA) is a tax-advantaged account offered in conjunction with a qualified high deductible health plan. Funds can be used to cover qualified expenses of the employee, a spouse, and qualified dependents. Funds do not expire, and can earn interest when invested.
Limited Health Care Flexible Spending Account (LFSA)
A Limited Health Care FSA (LFSA) is a tax-advantaged account offered by employers to employees who participate in a Health Savings Account (HSA). The Limited Health Care FSA can be used for select dental, vision and post-deductible (when available) expenses. Funds expire at the end of the plan year (carryover or grace period provisions may apply).
A deductible is an out-of-pocket amount specified by your health plan that you must meet before your health plan will pay for certain services. Your plan may have both an in-network and out-of-network deductible.
The monthly amount you pay for your health plan coverage. If you participate in a group health plan offered by your employer, a portion of this amount may be covered by your employer.
This is an encounter fee, set by your health plan, you are responsible for each time you have an office visit. The co-pay may vary based on provider type and facility.
After you meet your plan deductible, the co-insurance is a cost share percentage of your expenses you will owe until you meet your out-of-pocket maximum.
An optional provision that allows up to $500 of your Health Care FSA or Limited Health Care FSA balance to carryover to a new plan year if eligibility requirements are maintained. Carryover is not offered for Dependent Care FSA plans. The carryover is an elective feature; check with your specific plan document to determine if it is available for your account.
An optional provision that allows for a 75-day extension of your benefit plan year where you can incur expenses that may be applied to your prior year FSA balance. The grace period is an elective feature; check your specific plan document to determine if it is available for your account.
Debit Card (Flores Benefit Card)
A Mastercard that can be used to pay a provider directly from your HCFSA, HSA or CBA. The Flores Benefit Card is not offered for DCFSA plan. A convenient no-wait claims filing alternative is available for the DCFSA.
A contribution made by your employer to your tax-advantaged account or group health insurance premium responsibility.
The portion you contribute to your tax-advantaged account or group health insurance premium responsibility.
If you are 55 or older, you may make an additional $1,000 contribution to your HSA beyond the IRS Maximum Allowed HSA contribution for your plan level.
A provision set forth for flexible spending account plans that requires unused funds to be forfeited. Services must be incurred within your benefit enrollment period during the plan year and claimed by your claims filing deadline, specified in your plan document, in order to be eligible for reimbursement.
A feature on HCFSA and LFSA plans that allows reimbursment up to the annual amount elected at any point after the plan year begins, regardless of the amount contributed to the account. The reimbursement must be an eligible expense that is for a service date within your benefit enrollment period for the plan year and the claim must be submitted on or before the claims filing deadline for the plan year.
The portion (if any) of your flexible spending account contribution that is unused by the end of the plan year that the IRS requires you lose after your plan year ends and your claims filing deadline passes. Your plan may have optional carryover or grace period provisions in place to help prevent forfeitures. Check your plan document for specific information about your plan.
COBRA is optional temporary continuation coverage of a company-sponsored group plan when you, a spouse, or dependent(s) experience a loss of coverage due to certain COBRA qualified events including, but not limited to, a termination of employment, divorce, death of covered employee, or loss of dependency status. Your Employer would be required by law to offer COBRA if your plan is subject to COBRA and your loss of coverage was due to a COBRA qualifying event.
Your employer's 12-month benefit plan period. This may coincide with the calendar year, or be a different 12-month period specified by your employer in your plan document.
Claims Filing Deadline
A date, specified by your FSA plan document, by which all reimbursment claims for the plan year must be submitted to Flores in order for your claim to be processed. Claims received after the claims filing deadline for your plan cannot be processed.
When you incur a service, this is the portion of your provider's fee that will be considered by insurance. Portions of the fee in excess of this total may either be discounted by the provider, or not covered by insurance.
The date on which your coverage begins. Services incurred prior to your effective date are not eligible for reimbursement.
The date on which you become eligible for benefits with your employer.
The period that occurs annually in which you are allowed to make changes to your benefit plan selections with your employer for the upcoming plan year.
Explanation of Benefits (EOB)
A statement provided by insurance after a claim is submitted by you or your provider for a service you or a covered spouse or dependent incurred. The EOB will specify the amount billed by the provider, the portion paid by insurance, and any portions due from you that should be paid to the provider.
High Deductible Health Plan (HDHP)
A health plan with a high deductible cost-share requirement. To participate in an HSA, you must be enrolled in an HSA-qualified high deductible health plan. For 2020, the IRS specifies that the minimum statutory deductible requirement for HSA participation is $1,400 if you are enrolled in individual coverage and $2,800 if you are enrolled in family coverage. Please check with the insurance carrier to be sure the plan is an HSA-qualified high deductible health plan.
A provider who contracts with an insurance company to provide reduced rates for their services.
The total portion, including any deductibles, co-payments, co-insurance, or other non-covered amounts, you are responsible for to the provider for a service.
A provider who does not contract with an insurance company. Out-of-pocket costs may be higher when you choose an out-of-network provider.
Amounts that are shielded from federal, state and FICA income taxation when you participate in a tax-advantaged account option like a HCFSA, DCFSA or HSA.
Initial Notice (or General Notice)
When you become covered by an employer-sponsored health plan, you will receive a notice of your COBRA rights if your employer is subject to COBRA requirements. This document will review your COBRA rights that you will have should you terminate employment or no lose eligibility for benefts with your employer.
COBRA Qualifying Event Notice
When you, a spouse, or a qualified dependent experiences a loss of employer-sponsored group health plan coverage due to certain qualifying events, you will receive a COBRA Qualifying Event Notice explaining your option to elect temporary continuation coverage of your group health plan coverage(s). This notice will include a COBRA Election Form that should be returned by fax or mail, or submitted online at flores247.com, by the specified deadline in order to elect COBRA.
COBRA Qualified Beneficiary
A qualified beneficiary is an individual who is a covered employee, the employee's spouse, and the employee's dependent children who are covered under the group health plan on the day before a qualifying event.
The monthly cost of the plans you elect to continue under COBRA. COBRA premiums have strict payment deadlines. Your coverage will be terminated due to non-payment if payment is not received by the monthly deadline and exceptions cannot be made.