Iowa Administrative Code › Agency 11 - Administrative Services Department › Title IV - Human Resources › Chapter 64 - Benefits › Rule 11-64.13 - Health Flexible Spending Account

Current through Register Vol. 47, No. 3, July 24, 2024
The director administers the health flexible spending
				  account plan for employees of the state of Iowa. The program is permitted under
				  IRC Section 125. Administration of the plan shall comply with all applicable
				  federal regulations and the Plan Document. To the extent that the provisions of
				  the Plan Document or administrative rule conflict with IRC Section 125, the
				  provisions of IRC Section 125 shall govern. For purposes of this rule, the plan
				  year is a calendar year.
(1)
Employee eligibility.
All nontemporary employees who work at
				least 1040 hours per calendar year are eligible to participate in the health
				flexible spending account plan. Temporary employees are not eligible to
				participate in this plan.
(2)
Enrollment.
An open enrollment period, as designated by the
				director, shall be held for employees who wish to participate in the plan. New
				employees may enroll within 30 calendar days following their date of hire.
				Employees also may enroll or change their existing health flexible spending
				account salary reduction amounts during the plan year, provided they have a
				qualifying change in status as defined in the Plan Document, and as permitted
				under IRC Section 125. To continue participation, employees shall reenroll each
				year during the open enrollment period.
(3)
Modification or termination of
				participation in the plan.
An employee may modify or terminate
				participation in the plan, provided the employee has a qualifying change in
				status as defined in the Plan Document, and as permitted under IRC Section 125.
				Employees who have terminated state employment and are rehired within 30 days
				must resume their participation in the plan. Employees who terminate state
				employment and are rehired more than 30 days after termination may reenroll in
				the plan.
(4)
Continuation
				of coverage.
The health flexible spending account plan shall provide
				the opportunity to continue coverage as required by applicable state and
				federal laws.
(5)
Eligible
				health care expenses.
The types of expenses eligible for reimbursement
				shall be consistent with medical expenses as defined under IRC Section
				213.
(6)
Acceptable proof
				of eligible expense.
Only those expenses for which appropriate
				documentation is submitted shall be eligible for reimbursement. Such
				documentation shall include the date upon which the expense was incurred;
				sufficient evidence that the expense is an eligible health care expense;
				evidence that the expense has been incurred and will not be reimbursed under an
				otherwise qualified health plan authorized by IRC Sections 105 and 106; and the
				amount of such expense.
(7)
Appeal process.
In the event that a participant disagrees with
				a determination as to reimbursement from the health flexible spending account
				plan, a formal appeals mechanism is hereby provided. The participant may submit
				a formal appeal in writing to the director (or designee). Such appeal must be
				accompanied by a previous written request for favorable consideration to the
				designated administrator of the plan, along with evidence as to an unfavorable
				determination in response to this request. Upon receipt of a qualified appeal,
				the director (or designee) shall provide a written determination within 30 days
				of receipt. Such determination shall be final and binding. This appeal process
				is not a contested case proceeding as defined by Iowa Code chapter
				17A.
(8)
Third-party
				administrator.
The director may contract with a third-party
				administrator to perform such actions as are reasonably necessary to administer
				the health flexible spending account plan.