Health Care Spending Account

The Health Care Spending Account (HCSA) allows you to pay for eligible health-related expenses using pre-tax dollars. That’s because you can use the pre-tax dollars that are deducted from your paycheck towards expenses like copays and coinsurance that you may now be paying for out-of-pocket.

You can contribute between $100 and $3,400 for 2026. The maximum contribution may change each year based on IRS limits. Here’s the best part: the full amount you choose to contribute is available from Jan. 1. So even if payday hasn’t hit yet, your HCSA funds are ready when you need them.

Please Note: the maximum contribution may change each year based on IRS limits.

The HCSA is open to New York State employees of Executive Branch state agencies, the State University of New York, the Legislature, and the Unified Court System.
•All negotiating units in the Unified Court System are eligible to participate.
•Employees of the Roswell Park Comprehensive Cancer Center, NYS Energy Research and Development Authority (NYSERDA), New York Liquidation Bureau, and Environmental Facilities Corporation (EFC) are also eligible to participate.

Employees who wish to enroll in the HCSA must also:
•Work at least half-time
•Be permanently employed or expect to be employed for the entire calendar year in which they plan to enroll in the HCSA (employees
who work on a semester or school year basis are also eligible)
•Meet the eligibility criteria for enrollment in the New York State Health Insurance Program (NYSHIP) and
•If an Executive Branch employee, be either M/C or represented by CSEA, PEF, UUP, NYSCOPBA, Council 82, PBANYS, DC-37, PBA, or NYSPIA.

Who is Not Eligible to Enroll?
•GSEU-represented, casual, seasonal, session, per diem, fee basis employees, and retirees are not eligible to participate in the HCSA.

What Expenses Are Covered?
To be reimbursed through your HCSA, expenses must be for medically necessary health care services and must be incurred during your plan year (or within your coverage period if you enrolled mid-year).
To be eligible for reimbursement, a health care expense must be:
•For you or an eligible dependent
•Permitted under the Internal Revenue Code
•Medically necessary
•Not reimbursed by your health insurance or any other benefit plan, nor will you seek reimbursement from such plans
Just remember—you can get reimbursed once the service happens—you don’t need to wait until you get the bill or make the payment.

When Letter of Medical Necessity (LOMN) Is Required
These expenses aren’t automatically covered— they’re only eligible if they’re used to treat a diagnosed medical condition. You’ll need a LOMN from your doctor that includes the reason for the treatment, the diagnosis, when it started, and their signature. These services include:
•Massage treatments
•Nursing services for case of a special medical ailment
•Orthopedic shoes (excess cost of ordinary shoes)
•Oxygen equipment and oxygen support hose
•Veneers
•Vitamins & dietary supplements
•Wigs (for mental health condition of individual who loses hair because of a disease)

Who Is Covered by Your HCSA?
Use your HCSA to cover eligible expenses for:
•Yourself
•Your spouse
•Your qualifying child
•Your qualifying relative

Special Rule for Divorced Parents
If you share custody, a child is treated as a dependent of both parents for HCSA purposes—so either parent can be reimbursed for the child’s eligible expenses.
Contribution Limits: You and Your Spouse
The HCSA limit is per employee, so if you have a spouse with an FSA, they can contribute up to $3,300 in their account as well, even if you both work for the State of New York.

Transferring Funds
•Funds cannot be transferred between FSAs.
•You cannot pay a DCAA expense from your HCSA or vice-versa.
•You cannot transfer funds to your spouse’s
FSA or an FSA you may have in the upcoming plan year.

Over-The- Counter Drugs
Over-the-counter (OTC) drug costs are reimbursable through the HCSA as long as the items are used to treat a medical condition or illness. Certain OTC costs such as vitamins and dietary supplements are not reimbursable unless they are recommended by a doctor for a medical condition. General purpose items such as toothpaste and lip balm are not eligible expenses.

Requiring LOMN

The following expenses are eligible only when incurred to treat a diagnosed medical condition. Such expenses require a LOMN from your physician.

Mileage is reimbursable as long as a receipt, statement or bill validating your doctor visit is submitted with your claim requesting mileage reimbursement. The standard mileage rate for use of an automobile to obtain medically necessary health care (as described in IRS Code Section 213) is $0.21 for travel that takes place from 1/1/25 through 12/31/26. To submit your claim for mileage to a health care appointment or pharmacy, calculate the mileage on the actual bill/receipt detailing the following: roundtrip mileage multiplied by $0.21. Make sure to include the name of the health care provider or pharmacy on the claim form.

You may be able to include up to $50 for each night for each person. You can include lodging for a person traveling with the person receiving the medical care. For example, if a parent is traveling with a sick child, up to $100 per night can be included as a medical expense for lodging. Meals aren't included.

Eligible Travel Reimbursement

 • Bus, taxi, train, or plane fares or ambulance service.

 • Transportation expenses of a parent who must go with a child who needs medical care.

 • Transportation expenses of a nurse or other person who can give injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone.

• Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as a part of treatment. 

• Out-of-pocket expenses, such as the cost of gas and oil.

• Parking fees and tolls.

Ineligible Travel Reimbursement

 • Going to and from work, even if your condition requires an unusual means of transportation. 

• Travel for purely personal reasons to another city for an operation or other medical care. 

• Travel that is merely for the general improvement of one's health. 

• The costs of operating a specially equipped car for other than medical reasons.

• Depreciation, insurance, general repair, or maintenance expenses.

Qualifying Life Event (QLE)
In general, you must enroll during the open enrollment period if you would like to contribute to an FSA. Once you are enrolled in the FSA, your election amount is locked in and your pre-tax deductions will continue throughout the plan year. However, if you experience an eligible QLE during the plan year, you may be permitted to enroll or adjust your contribution amount, if consistent with the event. QLE elections must be submitted within 60 calendar days of the event, but as soon as possible to prevent unwanted, non-refundable deductions.

Please Note: QLE elections will be accepted during the plan year from January 2–October 31, 2026, for events that occur on or before October 31, 2026. QLE applications submitted after October 31, 2026, cannot be processed in time for the last deduction of the year.

Your period of coverage will begin on the date of your qualifying event or the date your QLE election is received, whichever is later. You will be able to submit claims for eligible expenses incurred on or after that date through December 31, 2026.

To Submit a QLE or New Hire Application: 

1. Login or register your Bentek account at https://app.mybentek.com/nysfsa.
2. From Employee Home, click on Life Events
3. Click on (+) Life Events, then select the applicable event from the drop down and follow instructions to submit your event.

What Happens After a QLE Election?
No need to upload extra documentation—just be sure to keep legal records for your own files in case of an IRS audit. You can disregard this message in Bentek. Following approval of your QLE, payroll changes and any updated deductions will be applied in the first pay period per your agency’s payroll schedule. If your QLE does not occur for any reason, login to your online account to change or cancel your QLE.

QLE enrollments will be accepted during the plan year between January 1–October 31. If you have questions, contact the FSA administrator at 800-358-7202.

Leave Without Pay or Termination
If you retire, leave state employment, go on leave without pay, or otherwise stop contributing to your account, your deductions will stop. Your coverage will end. You will still be able to submit claims for expenses that occur on or before the last day of the month of your final paycheck deduction.

Leave With Pay
Payroll deductions will continue for participants on sick leave, sick leave at half-pay, and vacation provided there are sufficient funds in the paycheck. Deductions will not continue for employees receiving short- or long-term disability benefits through the Income Protection Plan (IPP). Some situations may be considered eligible qualifying events

If you have a question about your situation, contact the FSA administrator at 800-358-7202.

Returning to Payroll
If you return to the payroll during the same plan year, you can re-enroll by submitting a QLE election within 60 calendar days of your return to the payroll.

If you leave and return to the payroll, you may re-enroll, but only for the same election amount that you had at the time you left the payroll. However, you will have two separate periods of coverage from which expenses can be incurred and reimbursed. You will not be reimbursed for health care services during the time period when you were not contributing to your account.

If you leave and return to payroll within 30 calendar days and have missed a deduction, please contact [email protected] within 14 calendar days of your return to payroll date to reinstate your HCSA.

What To Do at Tax Time
When you receive your W-2, the salary reported in Box 1 will already be reduced to reflect your HCSA contributions. You are not required to file any tax form to report your HCSA contributions

Please consult your tax preparer, tax attorney, or accountant if you have any questions regarding your filing requirements.

Extended Coverage Options
Pre-Pay: This option is only available to you during Open Enrollment. You can contribute your full annual election before you leave the payroll, which will allow you to use your account for expenses incurred after you leave. During open enrollment, make sure to indicate the number of paychecks you expect to receive prior to your official termination from the NYS payroll.

Continuation of Coverage: You continue to contribute to the HCSA after you leave the payroll by making after-tax payments directly to the FSA administrator; you will be able to submit claims for services that occur after you leave NYS. The FSA administrator will send you a notice to elect continuation of coverage that you must sign and return by the specified deadline.

Does the HCSA replace my medical plan?
No. This program offers you a way to pay for eligible out-of-pocket health care costs with pre-tax money. You cannot submit expenses for which you have received or will seek reimbursement from your health care plan or other source. You should first submit your claims to your health insurance plan. Once you know how much of your cost is covered, then submit any remaining eligible expenses to the HCSA for reimbursement.

Am I required to participate in the New York State Health Insurance Program (NYSHIP) in order to enroll in the HCSA?
No, you are not required to participate in NYSHIP to enroll in the HCSA. 

If my spouse or I have health insurance coverage elsewhere, can I still enroll in or use the HCSA to pay for my family’s expenses?
Yes. You can participate in the HCSA even if you are not enrolled in NYSHIP.

If my spouse and I are state employees, can we both enroll in the HCSA?
Yes. Any eligible state employee may enroll in the HCSA. However, if both spouses enroll, each health care expense can only be reimbursed once.

Whose expenses are eligible for reimbursement under the HCSA program?
The HCSA may be used to reimburse health care expenses for you, your spouse, and anyone who is defined as a qualifying child or qualifying relative by the Internal Revenue Code.

Are my domestic partner’s health care expenses eligible for reimbursement from my HCSA?
According to the IRS, health care expenses for a domestic partner can be reimbursed through the HCSA if the domestic partner qualifies as a dependent under the Internal Revenue Code.

Can expenses that are reimbursed by the HCSA be deducted on my tax return as a medical expense?
No, because you have already received reimbursement with tax-free dollars. Only expenses that are not reimbursed through an insurance plan, some other source, or the HCSA may be deducted on your income tax return.

What happens if my medical expenses change during the plan year? Can I increase or decrease my HCSA contributions?
No. Per Internal Revenue Service (IRS) rules, a change in medical expenses is not a qualifying event that would allow you to change your HCSA election amount. So, if you incur more medical expenses during the plan year you cannot increase your HCSA contributions. If your medical expenses are less than you had planned, you cannot reduce your HCSA contributions.

If I have an eligible change in status, can I increase or decrease my HCSA amount?
Yes, however your change must be consistent with the event. The IRS requires that the FSA administrator treat the periods prior to and subsequent to the change as two separate periods of coverage for reimbursement purposes.

If I was not eligible to enroll in the HCSA during the open enrollment period, but gain eligibility during the plan year, can I enroll mid-year?
No. A change in eligibility is not a change in status event that would allow you to enroll during the plan year.

What happens if I retire, terminate employment with the State, or take an unpaid leave of absence during the year?
Your coverage will end once you leave the payroll and stop contributing to your account, unless you plan ahead during open enrollment. You can contribute your full annual election before you leave the payroll, which will allow you to use your account for expenses incurred after you leave.

When you enroll, make sure to indicate the number of paychecks you expect to receive before you leave the payroll. If you are unable to plan ahead, you may still continue to participate in the HCSA by making after-tax COBRA payments directly to the FSA administrator. 

I am an adjunct professor at a state university, and don’t expect to receive paychecks during the summer months. Will that affect my participation in the HCSA?
Yes. If you are an adjunct employee and leave the payroll at the end of the spring semester, your coverage will end once you stop contributing to your account. However, you can plan ahead during the open enrollment period. In your enrollment application, select fewer payrolls to complete your contributions by the end of the spring semester. Your coverage will then continue uninterrupted after you leave the payroll.

What happens to the money in my account if I leave state service during the plan year? Can I use it after I leave?
If you retire, leave state employment, go on leave without pay, or otherwise stop contributing to your account, the money in your account can only be used for services that occurred before you left the payroll. However, if you continue to contribute to the HCSA after you leave the payroll by making after-tax payments directly to the FSA administrator, or if you pre-pay the balance of your annual election before leaving the payroll, you will be able to submit claims for services that occur after you leave your state job.

Can I request reimbursement from the HCSA for services I receive before the plan year begins if I am not billed until after the plan year starts?
No. According to IRS rules, a qualified expense is “incurred” at the time the service is provided, not when you are billed (or charged) or actually pay for the service. Therefore, reimbursements made during a plan year are only for eligible medical services received during that same plan year.

Can health care services that require upfront payment to the provider be reimbursed from the HCSA in a single plan year, even if the health care is delivered over several plan years?
No. IRS regulations do not allow medical expenses to be reimbursed through the HCSA until they have been incurred. Expenses are not incurred until treatment is provided, regardless of when you pay the provider.

How do I know if my child’s orthodontia will be reimbursed? How are orthodontic costs reimbursed if I pay my provider on a monthly payment plan?
Orthodontic expenses are a reimbursable expense. At the beginning of the plan year in which you first request reimbursement for these costs, you must submit a copy of the service contract between you and the orthodontist describing the payment arrangement/schedule.

Orthodontia costs that are paid on a monthly payment plan will be reimbursed after each monthly payment is due. However, if you pre-pay the entire cost of orthodontia treatment up front, you will only be reimbursed in a particular plan year for the value of the services that will be provided during that plan year. You must submit a claim for the pro-rated monthly amount on or after the beginning of each month of service, since you will not be reimbursed automatically.

Are dental implants reimbursable?
Yes. Dental implants are reimbursable as long as they are not a cosmetic treatment.

Will the HCSA reimburse the cost of my prescription drug, even if my insurance plan won’t pay for part of it?
Any prescription drug can be reimbursed as long as it is used to treat a medical condition. Prescription drugs that are primarily used for cosmetic purposes can’t be reimbursed.

Can over-the-counter drugs, herbal medicines, and homeopathic remedies be reimbursed if my doctor or medical provider prescribes them to treat my medical condition?
OTC drugs, medicines, and biologicals are eligible for reimbursement under the HCSA. Dietary supplements and vitamins are reimbursable if recommended by a doctor to treat a medical condition. You will need to submit a letter of medical need written by your doctor with your claim. However, herbal medicines and homeopathic remedies are not reimbursable under the HCSA.

Can travel expenses related to my medical care be reimbursed through my HCSA?
Yes. The IRS permits you to be reimbursed for amounts paid for transportation primarily for, and essential to, medical care. You can receive reimbursement for car mileage (.21 cents per mile in 2024), parking fees, tolls, subways, buses, trains, air travel, and lodging if the costs are incurred primarily to receive medical care.

Will the plan pay for upgrades to my prescription glasses?
Yes. You can be reimbursed for the cost of upgrades or add-ons (such as scratch-resistant coating) to your prescription lenses and frames. There is no limit on dollar amounts of the upgrades or add-ons. Non-prescription glasses, warranties, and sunglasses are not reimbursable.