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Office of Labor Relations


Employee Asst Pgrm Flex SpendingMgmt Benefits VDC Program

FSA Videos
Worksheets and Calculators
DeCAP
HCFSA
MSC Health Benefits Buy-Out Waiver
MSC Premium Conversion
FSA Forms and Downloads
FSA Frequently Asked Questions
Email FSA

FSA Videos

Worksheets and Calculators

DeCAP

HCFSA

MSC Health Benefits Buy-Out Waiver

MSC Premium Conversion

FSA Forms and Downloads

FSA Frequently Asked Questions

Email FSA


Please note that the goal amount indicated in this video is effective for Plan Year 2025.

Health Care Flexible Spending Account

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About HCFSA

The Health Care Flexible Spending Account (HCFSA) Program allows City employees to pay for eligible out-of-pocket health care expenses on a pre-tax basis, with deductions taken directly from salary. Below, find out how the plan works and how you can benefit.

Eligibility

Employees eligible to participate in the HCFSA Program must be covered by: Read More

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New York City health insurance, and the Citywide contract, or the Management Benefits Fund.

Agencies include:

Mayoralty

NYC Health + Hospitals (H+H)

Housing Authority

City University of New York (CUNY)

School Construction Authority (SCA)

Department of Education (DOE)

Employees of cultural institutions, libraries and DOE charter schools may be offered an HCFSA Program through their individual institutions. Please contact your Benefits Manager for additional information.

Annual Open Enrollment Period

Each year, the Open Enrollment Period for the following calendar year will generally be held from September to November. New employees may enroll within 30 days after becoming eligible to receive City health benefits. Read More

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Elections will be effective January 1st, or the date of your first payroll deduction if you become eligible after the beginning of the Plan Year. Newly eligible employees may participate as soon as they become eligible for City of New York health benefits.

To participate, newly eligible employees must submit a Flexible Spending Accounts (FSA) Program Enrollment/Change Form with documentation within 30 days after becoming eligible for City of New York health benefits. Your annual election will be prorated over the remaining pay periods.

Important: Enrollment is not automatic from year to year. You must re-enroll each year during the annual Open Enrollment Period.

How to Enroll

To enroll in the HCFSA Program, you must obtain an FSA Enrollment/Change Form from either this site, the FSA Program's Administrative Office, or from your agency's benefits office. Read More

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If you do not enroll in the HCFSA Program within 30 days after becoming eligible, you must wait until the next annual Open Enrollment Period before you can enroll.

Visit the Forms and Downloads page for a Program Brochure and Enrollment Form.

Completed forms must be returned during the annual Open Enrollment Period electronically to: http://nyc-fsa.leapfile.net

Should you require assistance in completing the Enrollment/Change Form, please email the FSA Administrative Office.

Eligible Expenses

Find out which expenses qualify under the HCFSA Program. Read More

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You may reduce your taxable income by the amount you contribute to your HCFSA account for eligible health care expenses. These expenses must meet the following requirements:

Eligible Health Care Expense: An expense that has been incurred by the participant or eligible health care recipient (see below) during the Plan Year and that is eligible for reimbursement under the terms of HCFSA.

You may also submit claims for any over-the-counter (OTC) drugs that diagnose, cure, treat, prevent, or mitigate ailments. You only need to obtain a prescription for sunscreens, nutritional supplements and vitamins. Cosmetic items, sundries and toiletries are not eligible.

For example, aspirin and cold medicine are eligible, but toothpaste and shampoo are not eligible, even with a prescription.

You must submit a claim form, and an itemized receipt for any and all OTC drugs.

Qualifying Health Care Expense: An expense incurred for an eligible medical service that is for you or an eligible health care recipient (see below);

Permitted under the Internal Revenue Code;

Medically necessary;

Not reimbursable by your health insurance and/or Welfare Fund; and

Not for the payment of health insurance premiums.

Eligible Health Care Recipient:

The participant;

The participant's spouse; or

The participant's eligible dependent, including an adult child, through the end of the Plan Year in which the child turns age 26.

Your enrollment covers you and all of your eligible health care recipients, if any, for the entire Plan Year and Grace Period or any remaining portion of the Plan Year. All of your eligible dependents must be listed on your Enrollment/Change Form in order to receive reimbursement under HCFSA.

IRS Publication 502, Medical and Dental Expenses
(Please note that Publication 502 is only used for reference.)

Annual Contribution Limit for 2025

Find out how much you can set aside annually. Read More

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Minimum: $260

Maximum*: $3,300
* The maximum may be less in certain cases; e.g. highly compensated employees.

The amount you elect to contribute to your HCFSA account is a before-tax salary reduction. This includes a maximum annual administrative fee of up to $48.

Claims, Reimbursements and Statements

To request reimbursement for eligible health care expenses under HCFSA, you must complete an HCFSA Claim Form and provide proper documentation.

Filing a claim is easy. Here's How

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List each expense and claimant separately on the Claim Form;

Attach an Explanation of Benefits (EOB) statement from the health insurance carrier for medical expenses and from the Welfare Fund/Union for dental, vision, and/or hearing expenses showing the unreimbursed balance;

Attach copies of receipts or billing statements from the provider. The receipts and billing statements must include:

The name of the recipient for whom service was provided;

The amount charged for each service;

The type of service and date of service; and

If submitting a claim for OTC drugs, attach a copy of product box if the receipt does not indicate the name of the drug.

Note: Medical care must be for expenses to diagnose, cure, mitigate, treat or prevent disease, or to affect any structure or function of the human body.

While eligible health care expenses of any amount up to your Plan Year goal amount are reimbursable, you must accumulate claims totaling at least $50 before submitting a Claim Form, unless your account balance is less than $50.

All completed Claim Forms must be submitted via secure mail electronically to: https://nyc-fsa.leapfile.net and received by the 25th day of the month in order to be processed for that month. You will only be reimbursed for health-related expenses that are provided during the applicable Plan Year or Grace Period.

Note: No reimbursement can be made prior to the service actually being provided. Claims should be submitted in a timely manner.

A Grace Period is provided, from January 1 through March 15 following the close of the Plan Year, during which you may submit claims for eligible health care expenses incurred during the Grace Period using the remaining balance in your previous year's account, if any.

A Claims Run-Out Period is provided, from January 1st through May 31st following the close of the Plan Year's Grace Period, to submit claims for services performed during the previous Plan Year or Grace Period.

HCFSA Claims Denial

If, for any reason, it is necessary for the FSA Administrative Office to deny a claim, you will receive a denial letter stating the reason for denial.

You may appeal the denial by filing a written appeal with the Appeals Panel within 60 days after your receipt of the denial notice. The Appeals Panel will review your claim and make a determination within 60 days after receipt of your written notice for appeal, unless an extension of time is required. You will receive notice of the extension period within 60 days after the receipt of your written notice of appeal. The extension period may last for up to 60 days.

HCFSA Reimbursements

Reimbursement for approved claims received by the 15th day of the month will be automatically deposited into the account you indicate on your Enrollment/Change Form or Direct Deposit Form by the close of the month. Claims will be reimbursed up to the total amount of your election, less the maximum administrative fee of up to $4.00 per month (up to $48.00 per Plan Year) and any claims previously reimbursed, regardless of the current balance in your account.

Note: Payments will be made directly to you, not to the service provider.

HCFSA Account Statements

Every calendar quarter, you will receive a statement indicating all monthly contributions to your account, processed claims, a maximum account administrative fee of up to $4.00 per month, and your available balance. If you are receiving reimbursement through direct deposit, you will still receive a monthly claims payment statement.

After the Claims Run-Out Period, you will receive an annual statement that reflects the total amount contributed to and reimbursed from your account for the Plan Year.

In addition, the amount you contributed to HCFSA will be reflected on your Form W-2, which you receive from your employer. For federal tax purposes your gross income will reflect the adjusted amount.

Note: You must add back the amount listed as IRC 125 on your Form W-2 to your state/city gross wages.

Calculate your Potential Savings Under the HCFSA Program

Download FSA Program Forms and Brochures

Learn more about your W-2 Wage and Tax Statement from the Office of Payroll Administration

Learn more about Social Security from the Office of Payroll Administration

Have a Question? See the HCFSA FAQs