Plan Information for Health Care FSA benefits
| Overview |
Contribute pre-tax dollars to the Health Care FSA to pay for eligible out-of-pocket medical, dental, prescription drug,
orthodontia, and vision expenses incurred by you and your qualified dependents, such as copayments, deductibles, prescription medications, prescription eyewear, and certain over-the-counter items, that are not covered by your medical or dental plan. The Flexible Spending Accounts are managed
by ASIFlex.
You can use this account to pay these expenses for yourself and your eligible tax dependents, even if they are not
covered by your State of New Hampshire health care plan.
The State of New Hampshire limit for the amount of pre-tax money that you may contribute to your Health Care FSA is $3,050 for the 2023 and 2024 plan years.
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| Who is Eligible? |
Health Care Flexible Spending Account benefits are available to all State of New Hampshire employees who work a minimum of 30 hours per week. Newly hired employees have a 45 day window in which to apply for this benefit. |
| How to Enroll |
Elect to participate within 45 days of being newly hired; during the annual open
enrollment period; or within 30 days of a qualifying life event (such as marriage,
birth of a child, etc.), by completing an
FSA Enrollment/Change Form
and submitting it to your agency benefit representative within the specified time period.
Important Note: FSA enrollments do not auto-renew and a new election
must be made EVERY year during Open Enrollment.
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| How it Works |
- Determine the amount of unreimbursed eligible health care - medical, prescription drug, dental, orthodontia and vision - expenses you (and where applicable, your eligible family members) will likely incur during the plan year. Use ASIFlex's Tax Savings Estimator/Calculator or Paper Worksheet.
Keep in mind the State of New Hampshire limit for the amount of pre-tax money that you may contribute to your Health Care FSA is $3,050 for the 2023 and 2024 plan years. Review ASIFlex's listing of Eligible Expenses.
- Elect to have the State of New Hampshire withhold an annual amount which will be withheld in equal amounts from your pay on a pre-tax basis for reimbursement of these expenses. Elect wisely as any unused funds will only carry over until March 15 of the next plan year. Payment can be made directly to providers using your ASIFlex debit card. Click here for some Tips on How to Use the ASIFlex Debit Card.
- Any remaining unused dollars prior to March 15 of the next plan year will be forfeited. You have until April 30 of the next plan year to submit claims incurred through March 15 for reimbursement. You can logon to the ASIFlex website to view your account balance at any time.
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| When Can I Access My FSA |
The effective date of coverage for a newly hired employee will be the 1st day of the month following completion of one full month of employment. Your newly elected annual amount upon Open Enrollment will be available on January 1st of the new plan year. |
| How to Submit Claims? |
You have four options for submitting your Health Care FSA claims:
- Pay for eligible health care expenses directly using your ASIFlex FSA debit card. Click here for an ASIFlex Debit Card FAQ.
- Submit your claim online through ASIFlex, State of New Hampshire's FSA administrator.
- Submit claims using ASIFlex's free mobile app.
- Complete a Flexible Spending Account (FSA) Claim Form and submit a receipt for each expense incurred. Fax or mail your completed claim form to:
FAX: 1-877-879-9038
Mail To:
ASIFlex
PO Box 6044
Colombia, MO 65205-6044
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| Summary Plan Description (SPD) |
Flexible Spending Summary Plan Description |