Flexible Spending Accounts – Are Urgent Care Services Covered?

What is a flexible spending account?

Most companies will offer open enrollment for insurance benefits to their employees in the fall. During open enrollment, employees can make changes to their health insurance or life insurance coverages. However, many employees may neglect to acknowledge the benefits of a flexible spending account, which many employers offer.

A flexible spending account has many names including ” health savings account,” “flex-plan,” and “reimbursement account.” Regardless of the name, an FSA is a health care benefit that many employers offer in conjunction with a health insurance plan. The FSA is a pre-tax funding account that is available to employees who are enrolled in a high-deductible plan. During open enrollment, an employee can specify the dollar amount they wish to set aside for their FSA, and the payments are deducted from their paycheck prior to taxation.

For 2014, employees will be able to elect up to $3,300 for a covered individual or $6,550 for a covered family into their FSA’s. Money from an FSA can be used to pay for health costs like copayments for doctor visits, prescription medications, medical equiptment, and procedures.

Are Urgent Care Copayments Covered by FSA?

In a word: yes.

Co-payments for urgent care services in Houston are eligible for reimbursement from an FSA. Family members who are covered by the employee’s health insurance should also be covered by that employee’s FSA funds.

For example: Mary, an employee of a medium-sized company, has health insurance PPO which covers up to 80% of her urgent care and hospital expenses. She is then responsible for the remaining 20% until she reaches her deductible. After work on Thursday, Mary received a call from her husband that their daughter is experiencing fever and a lot of pain in her ear, and she may have an ear infection. Their daughter’s pediatrician’s office is closed for the evening, so Mary opts to take their daughter to the nearest urgent care center to have her treated as soon as possible.

Mary knows that she can afford the co-payment at the urgent care center because she has about $3,000 available to her in her FSA to cover costs. Even though she is nearing the end of her pay period, Mary is able to cover the costs of her daughter’s health care through her FSA.

Fall/Open Enrollment is the best time to inquire about FSA benefits with your employer’s Human Resources department. Having money put away into a lump sum may be a fit for your family’s needs, and it can make a significant difference when minor emergencies that require urgent care services arise.