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Medical flexible spending arrangement
The Medical Flexible Spending Arrangement (FSA) lets you set aside pretax money from your paycheck to pay for out-of-pocket health care costs. Navia Benefit Solutions processes claims and provides customer service for School Employees Benefits Board (SEBB) subscribers.
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You are eligible if you meet criteria listed in Washington Administrative Code (WAC) 182-31-040. Generally, the Medical Flexible Spending Arrangement (FSA) is available to SEBB employees who are expected to work at least 630 hours during the school year.
School employees hired mid-year may also be eligible for a Medical FSA if they are expected to work at least 17.5 hours a week for six of the last eight weeks of the school year, and are expected to work 630 hours the next school year.
The Medical FSA allows you to set aside pretax money from your paycheck to pay for out-of-pocket health care costs like deductibles, copays, coinsurance, dental, vision, and more. You can use your Medical FSA to pay eligible health care expenses for you, your spouse, or your qualified tax dependents, even if they are not enrolled on your SEBB account.
This SEBB benefit has a grace period, which is a set time in which you spend any leftover funds from last year on eligible expenses. We offer this grace period instead of the option to carry over funds to the next plan year.
The Medical FSA plan year runs from January 1 through December 31 every year. Then, the grace period for that plan year runs from January 1 through March 15. You must incur all expenses for the previous year by March 15, and submit all claims by March 31. Any funds not claimed by March 31 are forfeited to the Health Care Authority. Once the money is forfeited, you will not be able to claim it.
The grace period does not apply if you enroll in a high deductible health plan with a Health Savings Account (HSA) for the next plan year. If you enroll in this type of plan, you must use all your Medical FSA funds and get reimbursed for your claims by December 31, the date before the new plan year begins. If you don’t, neither you nor your employer can contribute to your HSA until April 1.
During open enrollment, you will enroll in the SEBB Medical FSA on the Navia Benefit Solutions website. Paper enrollment forms will also be available to mail, fax, or email to Navia Benefit Solutions for processing.
You must enroll in a Medical FSA for each plan year you want to participate because your enrollment does not automatically continue year to year. If you want to enroll, make sure to elect this benefit again during each SEBB Program annual open enrollment.
IRS rules set the maximum you may contribute to a Medical FSA for each plan year.
- For 2020, you can contribute a minimum of $240 up to a maximum of $2,700 annually.
- For 2021, you can contribute a minimum of $240 up to a maximum of $2,750 annually.
To figure out how much you want to contribute, estimate your expenses for the plan year (January 1 through December 31) and enroll in a Medical FSA for that amount. Divide that amount by the number of paychecks you will receive that year to find out how much will be deducted each pay period.
You can start submitting reimbursement claims for eligible expenses on or after the first day of the plan year, January 1. The full amount you set aside for your annual Medical FSA contribution is available to spend on January 1. You may submit claims for services as often as you like, but not until after the services have been provided.
You cannot have a Medical FSA and a health savings account (HSA) at the same time. If you enroll in a high-deductible health plan (HDHP) with an HSA for 2021, you must spend all your funds and have all claims paid by December 31, 2020. If you do not, neither you nor your employer can contribute to your HSA until April 1, 2021.
When your SEBB insurance coverage ends or you go on unpaid leave that is not approved under the Family and Medical Leave Act (FMLA) or military leave, you are no longer eligible to contribute to your Medical Flexible Spending Arrangement. Eligibility ends on the last day of the month of loss of coverage or unapproved leave. You will be able to claim expenses incurred while employed, only up to your available funds, unless you are eligible to continue your Medical FSA coverage under SEBB Continuation Coverage (COBRA) or SEBB Continuation Coverage (Unpaid Leave), through Navia Benefit Solutions. Claims may be submitted up to your account balance and must be submitted to Navia Benefit Solutions by March 31 of the following plan year.