Health Benefits

Health Care Spending Account (HCSA)

(effective July 1, 2023)
This benefit provides an entitlement of $500 per year per Member, regardless of whether the Member has single or dependent coverage under the Plan.

The Member’s initial entitlement will be prorated to the month they qualify for coverage. For example, if the Member qualifies for coverage July 1st, the initial entitlement will be $250 for the balance of that calendar year. These funds are available to claim any unpaid portion of eligible benefits that are not reimbursed in full under the Plan and after coordinating benefits with a spouse’s benefit plan, where applicable. Provided the Member remains eligible for coverage under the Plan, an additional $500 will be contributed to their HCSA account on January 1st of each subsequent year.

Funds are available in the HCSA for 12 months from the end of the calendar year in which they were contributed. If the Member does not fully claim a current year’s HCSA entitlement, the balance of the entitlement contributed that year will be carried forward into the next calendar year to be used for expenses incurred in that new calendar year and will be forfeited at the end of the carry-forward year. For example, any unclaimed entitlement earned in 2023 will be carried forward into 2024 and will be forfeited (expire) December 31, 2024 if any portion remains unclaimed. The funds contributed in 2024 will be available until December 31, 2025.

Members can view their available balance in the D.A. Townley My Claims portal or mobile app or call D.A. Townley’s claims department for assistance.

Expenses incurred during a calendar year must be reimbursed using that same calendar year’s entitlement (or the previous year’s entitlement if the funds were carried forward, where applicable). No unpaid portion of a HCSA claim may be carried into the next year for further reimbursement. For example, if a $400 expense were incurred in November 2023, any available 2023 entitlement would be applied to this claim and the 2024 entitlement could not be used to pay the balance. This claim would be considered closed.

Upon termination of coverage, the Member has 30 days to submit any eligible expenses to the Plan, provided they were incurred while the Member was eligible for HCSA coverage. Any unclaimed entitlements following termination will be forfeited. If the Member requalifies for coverage later that same year, any forfeited entitlement from that same year will be reinstated but can only be used to reimburse eligible expenses that were incurred while the Member was eligible for coverage. If the Member already claimed their HCSA entitlement prior to coverage terminating, the Member must wait until the next new calendar year for a new entitlement, provided they remain eligible for benefits.

How to File a Claim (HCSA)

The HCSA is the final payer of expenses so all expenses must first be claimed under a Member’s regular benefits and any benefits they may have through a spouse’s benefit plan before they may be claimed under the HCSA benefit. Claims can be submitted using the D.A. Townley My Claims portal or mobile app. You can also indicate clearly on your regular benefits claim form that you want any unpaid balance applied to your HCSA. It is important to clearly indicate this on the claim form so that the adjudicator will notice it.

Members have 60 days at the beginning of a new calendar year to submit eligible expenses that were incurred in the previous year. These expenses will be paid from any entitlement balance that was available at the end of the previous year. Claims incurred during the previous year, which are received after February 28th, will be returned unpaid.

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