Oregon Administrative Rules
Chapter 101 - OREGON HEALTH AUTHORITY, PUBLIC EMPLOYEES' BENEFIT BOARD
Division 20 - ENROLLMENT RULES
Section 101-020-0065 - Health Flexible Spending Arrangement

(1) An eligible employee may enroll in a pretax Health Care Flexible Spending Account (Health Care FSA). A Health Care FSA is regulated by various federal government regulations. Health Care FSAs can be defined in part by the following categories.

(2) Employees enrolled in a Health Care FSA contribute a pre-tax amount from each month's salary during the plan year. Employees receive reimbursement from the account for qualified incurred health expenses during the plan year by submitting claims.

(3) FSA plans are annual plans, eligible employees must enroll for each plan year in order to participate. FSA plan enrollments do not roll over from one plan year to the next. All plan year FSA enrollments terminate December 31. The period of coverage is the 12 months during PEBB's plan year.

(4) An employee's failure to take an enrollment action is not considered an employee enrollment error. An enrollment action means that the employee during the allowable enrollment times must take an action to enroll, add to, save an active enrollment, or change benefit plan enrollment elections.

(5) The eligible employee is responsible for identifying enrollment errors and maintaining a valid and accurate Health Care flexible spending enrollment. The employee has 30 days from date of their first paycheck with their Health Care FSA enrollment to request a correction. The exception is open enrollment see OAR 101-020-0037(c).

(6) PEBB must review enrollment errors reported by the employee. Corrections if allowable must be consistent with the IRS regulations that govern flexible spending accounts.

(7) The annual employee contribution to the FSA account cannot exceed the allowable federal annual maximum.

(8) FSA accounts have uniform coverage. Uniform coverage means that an employee's maximum contribution amount for the plan year is available at all times while the account is active. The amount available is reduced for prior reimbursements made in the current plan year. Uniform coverage is provided throughout the period of coverage.

(9) Expenses must be incurred by the employee, spouse, the employee's children who have not attained age 27 as of the end of the employee's taxable year, or who are the employee's tax dependents for health coverage purposes.

(10) A grace period for qualified claim and reimbursement extends through March 15 of each new plan year. During the grace period, FSA participants may incur claims against any remaining previous plan year FSA funds up to March 15 in the new plan year. The qualified claim submission deadline for previous plan year account fund reimbursements is March 31 of the new plan year. The 3rd Party Administrator may require additional documentation for a claim to be in accordance with IRS regulations.

(11) FSAs are "use it or lose it" accounts. Any previous plan year funds remaining in the account beyond March 31 of the new plan year forfeit to PEBB plan administration.

(12) Refunds of account funds without a timely claim and reimbursement submission process is not permitted. Fund transfers between the account types is not permitted.

(13) Employees taking an approved protected leave, for example, FMLA/OFLA, CBIW, or Active Military Duty Leave are entitled to continuation of the their Health Care FSA while on the leave.

(14) An employer is not required to continue the benefits of an employee who fails to make required payments while on a protected leave provided notice procedures are followed. Refer to OAR 101-20-0002(7)(d) for employee non-payment notices and benefit termination. If the employer chooses to continue the health coverage of an employee who fails to pay his or her share of the premium or contribution payments, the employer is permitted to recoup the employee's premium.

(15) Employees who terminate FSA participation during the plan year can receive reimbursement for qualified claim expenses incurred while the Health Care FSA coverage was actively in force. No reimbursement is allowed for expenses incurred after the account terminates. Active participation ends the last day of the month that a contribution is received for that month.

(16) OUS and some academic OSPS employees that enroll based on their 9- or 10-month pay contributions are considered actively participating during the months of no contribution. For example, during months of June and July when they are not actively at work.

(17) Final contribution at termination of employment or a leave without pay terminating the FSA:

(18) An eligible employee terminating employment or going on an approved unprotected leave of absence, may continue to participate in the Health Care FSA up to the end of the current plan year through COBRA. There must be a positive FSA account balance and all contributions are paid post tax to the COBRA administrator.

(19) When called to active duty for a period of at least 180 days or for an indefinite period, an employee can request a qualified reservist distribution from a Health Care FSA. The eligible employee must be a member of the Army National Guard of the United States, the Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard of the United States, Air Force Reserve, Coast Guard Reserve, or Reserve Corps of the Public Health Service.

(20) An employee who separates from the employer and returns to work in a benefit eligible position within 12 months is not reinstated in the Health Care FSA. They may enroll within 30 days of their new benefit eligible date.