PO Box 622337
Hours of Operation
24 hours / 7 days a week
|Important Forms & Documents
The City of Mesa has contracted with a third party administrator ConnectYourCare (CYC), to deliver our Flexible Spending Account (FSA) program. Members may contact CYC customer service 24 hours a day 7 days a week via phone or by visiting the member portal. The portal can be used to view the status of your claims submissions, account balances and a host of helpful health and dependent care related information.
FSA Contact Information/Claims Address:
|FSA Plan administered by:||ConnectYourCare (CYC)|
|Address:||PO BOX 622337, Orlando, FL 32862-2337|
|Customer Service Number:||1.844.226.1872|
FLEXIBLE SPENDING ACCOUNT (FSA) Highlights:
The City of Mesa Flexible Spending Plan offers you the opportunity to set aside pre-tax dollars from your paycheck to pay for either health care or dependent care (child or elder care) expenses that would normally be paid out of pocket. Enrolling in the flexible spending account program reduces your taxable income.
When enrolling in the Flexible Spending Account(s), especially for the first time, estimate eligible expenses carefully. This is a use it or lose it program. However, there is a $500 Rollover plan feature on the health care FSA which allows you to roll over up to $500 of your unclaimed balance to the following plan year in addition to the amount you will elect for that plan year. This $500 will not be subject to the "use-it-or-lose-it" rule from year to year. However, balances in excess of $500 will be.
Any money left in the account after the 90-day deadline (January 1 thru March 31) will be forfeited to the Employee Benefit Trust Fund.
Note that IRS regulations require re-enrollment into the FSA each year during Open Enrollment. If you intend to participate and contribute towards a health and/or dependent care FSA for the following calendar year, you MUST enroll during Open Enrollment otherwise your elections will default to $0 starting on January 1.
Participants may not seek reimbursement for health care or dependent care (child/elder care) expenses for Committed Partner or Committed Partner children/elders under FSA accounts.
Health Flexible Spending Account
The Health Flex plan allows you to set aside up to $2,650 pre-tax from your paycheck to pay for eligible out-of-pocket health care expenses that are not covered by your insurance. It covers not just your medical expenses, but also the expenses of your spouse and dependents. Depending on your tax bracket, you may save up to 30% or more in taxes.
Examples of reimbursable expenses include:
- Certain items not covered by insurance
The following example illustrates how an employee who earns $35,000 a year with $1,500 in eligible health care expenses could save money using an FSA:
|Pre-Tax Contribution to FSA
|| - $1,500
|| - $0
|| = $33,500
|| = $35,000
|Federal Income & Social Security Taxes
|| - $7,362
|| - $7,852
|After-Tax Dollars Spent on Eligible Expenses
|| - $0
|| - $1,500
|| = $26,138
|| = $25,648
|Tax Savings with FSA
*Actual savings will vary based on the individual tax situation
Dependent Care Flexible Spending Account
The Dependent Care Flex Plan allows participants to set aside up to $5,000 per household to pay for eligible child or elder care services that are needed so that the participant and spouse (if applicable) can work. Once a qualifying child care expense is incurred, the receipts may be submitted to CYC for reimbursement from the dependent care account. All claims will be reviewed for eligibility and accuracy. Reimbursements made from this account will be equal to the amount of the claim, but not more than the current balance in the dependent care account. This account is for daycare expenses ONLY. Dependent medical/dental/vision expenses are not reimbursable through the dependent care flex account.
Examples of dependent care arrangements which qualify include:
- A Dependent (Day) Care Center, provided it complies with applicable state and local laws if care is provided by a facility for more than six individuals
- An educational institution for pre-school children
- For school-age children (Kindergarten through age 12), only expenses for before and after school care are eligible. Tuition fees do not apply
- An "individual" who provides care inside or outside your home (who is not your spouse, child under age 19 or anyone you claim as a dependent for federal income tax purposes).
How do I register online with CYC?Registering your account at CYC is easy. Simply follow these steps to register:
- Go to www.connectyourcare.com
- Click the "NEW USER" button on the top right of your screen
- Enter the information as applicable. Please note, simply enter your 9-digit SSN (no dashes "-") when entering your social security number.
Can I use my health care debit card to pay for services incurred in the previous plan year?No. If the current plan year has expired, you should file claims manually. A debit card transaction is processed with an assumed date of service equal to the date of the card swipe; therefore it would pull money from the current plan year instead of the previous plan year. Keep this in mind if you receive services or have expenses towards the end of a plan year and are waiting for the EOB from your insurance company.
I used my debit card at the doctor's or dentist's office, a qualified merchant, but I was still required to submit substantiation - why?While most procedures performed in a doctor's or dentist's office are eligible expenses, some procedures are not. For example, some dentists perform teeth whitening, which is not eligible. Or the date of service may have been from a prior year. Therefore, the IRS requires that CYC receive documentation to identify the service performed is an eligible expense.
What if I don't submit substantiation for my claim?
You must provide substantiation within the time-frame requested or the transaction will be deemed ineligible, and you will be required to refund the amount of the transaction. If you fail to submit required substantiation, your payment card will be temporarily suspended until you refund the ineligible amount. If you fail to reimburse the account, the amount of the ineligible expense(s) may be added to your taxable wages. Make sure to keep your receipts in case IRS requires you to present them for verification during tax return.
The following table illustrates the timeline for substantiation requirements.
ConnectYourCare Action Amount of Days Initial email/letter sent to the member stating substantiation will be required Within 90 Days A second notification letter sent if no acceptable substantiation is provided 30 Days After A third notification letter sent if no acceptable substantiation is provided with a warning that Debit Card suspension will occur in two weeks 15 Days After Debit Card gets suspended 15 Days After
What information needs to be included for substantiation of claims?
An Explanation of Benefits (EOB) provides all the necessary information required to substantiate your claim. If an EOB is not available, your substantiation MUST include the following information:
1. Name of patient
2. Date of service
3. Name and address of service provider/merchant
4. Description of the service or expense provided
5. Amount charged
I received a notification stating I need to submit substantiation for a claim...now what?
If substantiation for a claim is required, you will receive a notification from CYC requesting “supporting documentation” to substantiate your debit card Health FSA usage. DO NOT IGNORE IT. Follow up and submit all the required documentation as soon as possible, but definitely within any time frames specified on the documentation request. If you believe you have already submitted documentation to substantiate your claim in response to a previous notification, and you continue to receive the same notice for that claim, this does not mean that CYC has overlooked your previous submission. It could mean:
a. You really did not submit the documentation
b. You submitted documentation, but ALL OF THE IRS REQUIRED DETAILS were NOT included, or
c. You submitted documentation for another service unrelated to the claim that is causing the substantiation request.
If this happens to you, we suggest that you call CYC Customer Service immediately at 1.844.226.1872. A CYC Customer Representative can assist you in clarifying and confirming the exact details that may have been missing in your initial submission and help you resolve your substantiation requirements.
The most common problem that arises is “all the IRS required details were not provided”. For example, a cash register or credit card receipt (even one you get from a doctor’s office) is unlikely to have all the information you need to satisfy IRS guidelines – and CYC and our City Health FSA Plan are obligated to follow these IRS guidelines. Needed data includes: name of patient, date of service, provider details, service descriptions, billed charges, your out-of-pocket liability etc. – all of which is contained on an Explanation of Benefits document but may not be all inclusive on a receipt, statement, invoice or other documentation.
How does Orthodontia (braces) reimbursements work?
How does the $500 rollover feature work after the new year?
What is the $500 rollover feature?
What are examples of eligible dependent care expenses?
What are examples of eligible health FSA expenses?
How do I submit FSA claims?