One of the more immediate reforms in the Patient Protection and Affordable Care Act (Affordable Care Act) is the requirement that affects Flexible Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements. Starting January 1, 2011 all OTC (Over The Counter) items eligible for reimbursement must be accompanied by a doctor's prescription and a reimbursement request (claim form). They may no longer be purchased using the benefits card.
When does this change go into effect?
This change will go into effect January 1, 2011 and will apply to the taxable year. This means that both calendar year and off plan year FSA's and HRA's will have the change at the same time.
What if my plan year runs from October 1, 2010 through September 30, 2011? Can I get reimbursed for OTC items through the end of my plan year?
No. Eligibility for OTC items ends on December 31, 2010 regardless of plan end date. However, you may still use remaining funds for all other eligible expenses until the end of your plan year.
I am a diabetic. Will I need a doctor's prescription to get reimbursed for my insulin after December 31, 2010?
No. Insulin that is currently purchased over-the-counter without a prescription will still be eligible for reimbursement. However, the benefits card will no longer be accepted as payment after December 31, 2010, and a manual claim form will be required for reimbursement.
Will I still be able to use my benefits card to get reimbursed for my regular prescription medications?
Yes, prescription drug reimbursement will not be affected by this change and you can still use your card.
If I do get a doctor's prescription for an OTC, can I still use my benefits card to get reimbursed?
No. The benefits card may no longer be used as payment for any OTC items. However, you may use another form of payment then submit a reimbursement request along with the doctor's prescription. You can then mail, email, or FAX your receipt and prescription along with a completed claim form to us. All claims are generally processed in 48-72 hours of receipt.
What if I purchase an OTC item December 31 of 2010 but do not submit the expense until March 2011?
You will still be reimbursed for OTC items purchased prior to January 1, 2011. The new rule only affects those items purchased after January 1, 2011.
What are some of the OTC items that will no longer be eligible for reimbursement without a doctor's prescription under the new legislation?
The items no longer eligible for reimbursement under the new law will include item categories such as cough medicines, pain relievers, acid controllers, and allergy medications, to name a few. A complete list of items being affected by this change has not been made available yet. If a list is made available we will pass along to you.
Does this affect purchases with my benefits card for any other type of expenses?
This legislation will not affect expenses related to doctor's office co-pays, dental co-pays, orthodontia, vision exams, eye glasses, and more. Participants will continue to enjoy the convenience of eliminating up-front and out-of-pocket costs with your benefits card or by manually filing claims.