State of Illinois exible spending
account reference guide
What is a Flexible Spending Account (FSA)?
A Flexible Spending Account is a tax-advantaged account that
allows you to use pre-tax dollars to pay for out-of-pocket eligible
medical care (MCAP) or dependent care (DCAP) expenses. You choose
how much money you want to contribute to an FSA at the beginning
of each plan year and can access these funds throughout the year.
This contribution is subject to certain legal limits.
When enrolling in an FSA, employees designate the amount they
wish to have deducted from each paycheck. The designated amount
is deposited into the employee’s MCAP and/or DCAP account before
any state, federal or social security taxes are withheld, resulting in
reduced taxes and greater disposable income.
Participation Eligibility
In order to be eligible to participate in an FSA, employees must:
• Work full-time or part-time not less than 50%;
• Be eligible to participate in one of the State’s health plans; and
• Be receiving a paycheck from which deductions can be taken.
In addition to the eligibility requirements that apply to all FSA
enrollments (indicated above), a DCAP participant and their spouse
must be unavailable to care for the qualifying individual (child or
adult). Therefore, the following eligibility rule also applies to all
DCAP enrollments.
The employee’s spouse must either be:
(1) gainfully employed;
(2) a full-time student;
(3) disabled and incapable of self-care; or
(4) seeking employment and have income for the year.
Temporary, intermittent and contractual employees, as well as
retirees, are not eligible to participate in the FSA Program.
Additionally, only the expenses of eligible dependents may be
reimbursed. Dependents must qualify under the Internal Revenue
Code in order to be eligible.
Paying for health care has never been easier with a
Flexible Spending Account (FSA) from Optum Financial.
FSA Rules & Regulations
• The IRS requires that all FSA purchases
be veried as eligible expenses.
Sometimes, purchases are automatically
veried when you use your card. Other
times, we will request itemized receipts
or an Explanation of Benets. Always
save your itemized receipts.
• Your unused MCAP funds roll over.
Unused MCAP funds – up to $570 – can
roll over to the next plan year after the
September 30 run-out period ends.
Employees must re-enroll in MCAP for
the new plan year in order to qualify
for the rollover benet.
• FY23 MCAP contributions are limited
by the IRS to $2,850. The limit is per
person; a husband and wife may each
contribute up to the $2,850 limit.
• The IRS also requires that employers
make the full annual MCAP election
available to employees when an eligible
expense occurs, regardless of whether
you have deposited enough to cover
the full amount at that point in time.
For example, you may designate $1,200
per year, equal to a payroll deduction
of $100 a month. You are eligible for
reimbursement up to the full $1,200 in
the rst month, even though you have
only deposited $100 in your account.
Remaining deductions will be taken
from your pay during the rest of the
plan year.
State of Illinois exible spending account reference guide
Page 2
Unused health MCAP funds –
up to $570 – can rollover to the
next plan year.
The IRS recently announced that
employers may allow a rollover up
to $570 of unused health FSA funds
(MCAP funds) to the next plan year
for employees to use on eligible
expenses. We are happy to bring
you this new roll over feature as
just another way we make it easier
for you to get the most out of
your account.
How it Works: Any MCAP funds
you are unable to use by the end of
the plan year – up to $570– can roll
over to the next plan year after the
September 30 run-out period ends.
Employees must re-enroll in MCAP
for the new plan year in order to
qualify for the rollover benet.
Contribution Limits: Carried over
amounts do not count toward your
contribution limit for the following
plan year. In other words, you may
still contribute up to $2,850 a year
whether or not you have a carry-
over from the previous year.
Medical Care Assistance Plan (MCAP)
• Multiple uses. There are hundreds of eligible expenses for your MCAP
funds, including prescriptions, some over-the-counter items, doctor
ofce copays, health insurance deductibles and coinsurance. MCAP
funds may be used for eligible expenses for your spouse or federal
tax dependents. See the list of Eligible Expenses pages in this guide
for more details.
• Easy to access. Funds in the account are easily accessed with the
payment card. Your account balance is available at any time online or
over the phone.
• Tax advantages. Since your contributions are not taxed, you can
reduce your taxable income by the amount you contribute to
your MCAP. You can then use those pretax dollars to pay for eligible
healthcare expenses that would have otherwise been paid with
after-tax dollars.
• Rapid reimbursements. Paying for healthcare expenses is easy when
you use your payment card. If you do not use your card, you can
quickly and easily create your claim online. Once you submit your
receipts, we will reimburse you via check or direct deposit.
State of Illinois exible spending account reference guide
Page 3
Dependent Care Account Rules
and Regulations
• Unlike the MCAP account,
you must use all of your DCAP
funds by the end of your plan
year, or remaining funds will be
forfeited, according to
IRS regulations.
The FSA calculator in this
guide helps you estimate your
dependent care expenses, so
that you contribute the
right amount.
• According to the IRS, you may
contribute up to $5,000 per year
if you are married and ling
a joint return, or if you are a
single parent. If you are married
and ling separately, you may
contribute up to $2,500 per year
per parent.
• Unlike the MCAP account, you
may only receive reimbursement
from your DCAP account equal
to the amount you have
actually deposited.
Dependent Care Assistance Plan (DCAP)
You may also choose to enroll in the Dependent Care Assistance Plan
(DCAP), which is an alternative to the Dependent Care Tax Credit and
covers dependent and certain elder care expenses while you are at work
(special requirements apply). If you work and have children, a disabled
spouse, or qualifying dependent parents, you know how important it is
to have reliable and affordable care for them while you are at work.
A DCAP account allows you to pay for child and elder care expenses
and get a tax break at the same time. Expenses must be for qualifying
dependents. See IRS Publication 503 Child and Dependent Care
Expenses. Typical expenses under this account include charges for day
care, nursery school, and certain elder care (unless it is for medical care)
for your legal dependents. See the list of Eligible Expenses on page 9 for
more details.
Eligibility Requirements
To be reimbursed through your DCAP Account for child and dependent
care expenses, you must meet the following conditions:
• You must have incurred the expenses in order for you and your
spouse, if married, to work or look for work, unless your spouse was
either a full-time student or was physically or mentally incapable of
self-care.
• You cannot have made the care payments to someone you can claim
as your dependent on your federal tax return or to your child who is
under age 19.
• Your ling status must be single, qualifying widow(er) with a
dependent child, married ling jointly, or married ling separately.
• You and your spouse must maintain a home that you live in for more
than half the year with the qualifying child or dependent.
• Only the custodial parent of divorced or legally-separated parents
can participate in DCAP. The custodial parent is dened by the IRS as
the person who has the child for most nights during the calendar
year. See IRS Publication 503 for more information.
State of Illinois exible spending account reference guide
Page 4
Using Your Flexible Spending Account
We make it easy to access and use your account funds. There are two ways to pay for health care.
Use Your Payment Card: This is the simplest way to pay for health care.
Pay using your payment card and keep your itemized receipt (showing
service description, patient name, service date, provider name, and amount
charged) or Explanation of Benets (EOB) from the insurance vendor as
documentation, since you may be required to substantiate the expense.
Then, sign in to your online account or Optum Financial mobile app to see if
documentation is needed. If so, use the convenient Optum Financial mobile
app to snap a picture of your documentation, use the website to scan a
picture of your documentation, or print the claim submission form and submit
your documentation via fax or mail. Note: Only services rendered during the
current plan year should be charged to the healthcare payment card.
Pay with Personal Funds and Request Reimbursement: Pay using your own personal credit card, cash, or check
and keep your itemized receipt as documentation. Then, log on to your online account or Optum Financial
mobile app to le for reimbursement and upload documentation. Use the convenient Optum Financial mobile
app to snap a picture of your documentation and use the website to scan a picture of your documentation or
print the claim submission form and submit your documentation via fax or mail. You can receive reimbursement
funds via check or direct deposit.
How to Pay at…
• The Doctor, Dentist, Eye Doctor, or Hospital. When you pay for eligible health care expenses at the doctor, dentist,
eye doctor, or hospital, be sure to always present your health insurance ID card rst to ensure proper processing of
your charges.
• Copays. If you are asked to pay a copay, you may pay with your payment card, or you may pay using personal funds
and request reimbursement. State of Illinois copays and deductibles are automatically adjudicated when you use the
payment card, limiting the need for you to submit documentation, but it is always a good idea to save your itemized
receipt and EOB as documentation.
• Additional Charges. If you’re asked to pay additional charges, if possible, do not pay your provider until the claim
is processed by your health plan and you receive your Explanation of Benets (EOB) in the mail. This helps avoid
overpayment. Compare your EOB with the provider bill to verify the amount being charged by your provider is the
same as the patient balance on the EOB. Then, pay using your payment card, or pay using personal funds and request
reimbursement and submit your EOB or itemized provider bill as documentation online, using the mobile app, fax or
postal mail.
• Dependent Day Care Locations. If you have a DCAP account, you will need to pay for your qualied dependent
day care expenses using personal funds and request the reimbursement from your DCAP account. You will need to
submit your itemized receipt as documentation. Remember, whether submitting a receipt or a DCAP Claim Form,
documentation must include the dependent’s name, provider name, service period, payment amount, and the type
of care being provided (i.e. daycare, pre-school, before and after school care).
TIP: Set up direct deposit online to receive quicker reimbursements.
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State of Illinois exible spending account reference guide
Page 5
Use Your Card at
Approved Merchants
Your card has been programmed
to work only at merchant locations
that are designated as health care
merchants based on their Merchant
Category Code (MCC).
Examples of qualied merchants
include pharmacies, doctor’s ofces
and hospitals. The card should
only be used to pay for eligible
medical expenses, and you should
always save your receipts showing
the member responsibility after
insurance has paid or an insurance
Explanation of Benets (EOB).
You will not be able to use
your payment card at locations
that are not approved
health care merchants. Visit
sig-is.org/card-holders/store-
locator for a list of approved
merchants.
For qualied purchases at locations
that are not approved health care
merchants, you can pay with other
means, then submit a request for
reimbursement through your
online account.
Using Your Payment Card
We provide a convenient payment card to access account funds. You will
receive this card in the mail.
Below are four tips to make using your payment card simple and easy.
Pay for Eligible Expenses with Your Card. Pay for eligible products
and services directly at approved merchants (see sidebar). The
money comes right out of your health care account. Provide your
card to a qualied merchant or provider, and they will swipe your
card like any other credit or debit card to pay for your purchase. If
asked, select “credit,” to use it without a personal identication
number (PIN), or “debit” to use a PIN. There is a preset PIN
associated with your card, which is the last 4 digits of your card
number. To select a different PIN, call 888.999.0121.
Get Your Balance. By frequently checking your account balance
online or on the mobile app, you will have a good idea of the
amount of funds available in your account. When you swipe your
payment card, the system ensures your MCAP account is active and
has sufcient funds in your account for the full amount. If not, the
transaction will be denied. You can swipe the card for the amount
left in your account and pay the difference with another form
of payment.
Know What’s Eligible. Familiarize yourself with what expenses are
eligible using the list of eligible expenses in this guide, your online
account, or your employer’s plan documents. Examples of eligible
expenses are doctors’ visits, prescription drugs and many over-the-
counter medications (with a prescription). If you use the card for
ineligible expenses, you may be asked to write a personal check to
refund the plan.
Save Your Itemized Receipts. Although your payment card
eliminates the need to le paper claims, the IRS requires that your
charges be veried. Always save your itemized receipts in case they
are required to conrm a purchase or for tax purposes.
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State of Illinois exible spending account reference guide
Page 6
Using Your Account
Online Account Features
Our online participant portal puts account information and health
education tools at your ngertips.
• Get account balance
• View payment card charges
• Enter a request for reimbursement
• View reimbursement requests
• Read important messages
• View reimbursement schedule
• Use helpful tools
• Find answers to frequently asked questions
Mobile App
We offer a secure, interactive mobile application for Android
and iOS devices.
• View account balance, account alerts and transaction history
• View all claims, claims requiring action, and claims details
• Submit a new claim
• Receive important account alerts
• Tap to call Customer Service
• Upload claim documentation – quick and easy way to submit receipts
using your device’s camera.
Mobile Alerts and Two-Way Texting
Our Mobile Alerts feature lets you access account information at any time
using text messaging. Simply opt into the service online. You may also opt
into a text alert service that lets you know immediately after you use your
payment card if that purchase requires additional documentation. This
way, you always know when to save your itemized receipts.
Mobile Browser
We also offer a streamlined version of your online account that allows
you to access your most important account information including account
balances, transaction history, claim summaries, claim details and FAQs, all
on your smartphone without having to download our mobile app.
Where to Begin
• Go to optumnancial.com.
• Select the log in link from the
upper right hand corner.
• Sign in with your user name
and password.
• If it is your rst time visiting
the site, choose New User
Registration to select your name
and password.
Enter a New Claim
If you pay for an expense using
personal funds (not your payment
card), you will need to enter a
claim for reimbursement. Entering
a new claim is easy.
• Sign in to your online account or
mobile app.
• Click to add a new request for
payment or reimbursement.
• Enter the required information
about your expense.
• Follow the instructions to
submit your documentation via
upload, fax, or postal mail.
Learn more about the Optum Financial mobile app.
State of Illinois exible spending account reference guide
Page 7
Step 1: Estimate Health Care Expenses
Your MCAP can cover medical, dental, or vision expenses
that you would otherwise pay using personal funds.
Enter the annual amounts you spend on each expense
to see how much you should contribute.
Ofce visit copays
Chiropractic services
Psychiatric services
Medical supplies and equipment
Laboratory or x-ray charges
Surgical or outpatient procedures
Hospitalization expenses
Prescription drugs
Eligible over-the-counter items
Other medical expenses
Dental deductible
Dental preventative visits
Orthodontia expenses
Other dental expenses
Vision exam
Glasses, contact lenses, supplies
Other vision expenses
Other health care expenses
Annual MCAP Election*
*Not to exceed IRS limits.
Step 2: Estimate Dependent Care Expenses
A Dependent Care Account can cover costs for the care
of your eligible dependents while you work. Enter the
amounts you spend on each expense to see how much you
should contribute to your Dependent Care Account.
Day care center
Au pair or in home care
Nursery school
Before school care
After school care
Elder care (if qualifying)
Other dependent care expenses
Annual Dependent Care Election*
Step 3: Calculate Tax Savings
Enter your total election amount and multiply it
by your tax rate to estimate your tax savings.
Annual Elections
(MCAP+ Dependent Care)
x Tax Rate
(from table below)
= Annual Tax Savings
(Annual Elections x Tax Rate)
Table
Annual Heads of Households Estimated Tax Rate**
Tax Rate
$54,201 - $86,350 22%
$86,351 - $164,900 24%
**Tax rates based on only using the federal tax rate in the
modeling and excluding state, social security, and payroll tax
as those can vary based on the individual.
Sources: Internal Revenue Services.
Flexible Spending Account Calculator
While there’s no such thing as free money, an FSA can help your money go a lot further. Use this worksheet to see how
much you can save.
State of Illinois exible spending account reference guide
Page 8
Eligible MCAP Expense Examples
There are hundreds of eligible expenses for your MCAP funds, including prescriptions, some over-the-counter items,
health insurance deductibles, and coinsurance. MCAP funds may even be used for eligible expenses for your spouse or
tax dependents.
Ineligible Expense Examples
These items are never eligible for tax-free purchase with MCAP funds.
• Acupuncture
• Alcoholism treatment
• Ambulance
• Articial limb
• Automobile modications for a
physically handicapped person
• Birth control pills
• Blood pressure monitoring
device
• Braille books & magazines
(above the cost of regular
printed material)
• Chiropractic care
• Contact lenses & related
materials
• Crutches
• Dental treatment
• Dentures
• Diagnostic services
• Drug addiction treatment
• Eye examination
• Eye glasses & related materials
• Fertility treatment
• Flu shot
• Guide dog or other animal aide
• Hearing aids
• Hospital services
• Immunization
• Insulin
• Laboratory fees
• Laser eye surgery
• Medical testing device
• Nursing services
• Obstetrical expenses
• Organ transplant
• Orthodontia (not for
cosmetic reasons)
• Over-the-counter treatments
(certain approved items)
• Oxygen
• Physical exam
• Physical therapy
• Prescription drugs
• Psychiatric care
• Smoking cessation program
• Surgery
• Transportation for medical care
• Weight loss program necessary
to treat a specic medical
condition
• Wheelchair
• Cobra premiums
• Concierge service fees (billed for
future services; no treatment
actually provided)
• Cosmetics, wrinkle creams
and cosmetic surgery
• Exercise equipment
• Fitness programs
• Hair transplants
• Household help
• Illegal operations and treatments
• Insurance premiums
• Long-term care premiums
• Maternity clothes
• Retiree medical insurance
premiums
• Teeth whitening
IMPORTANT: Only eligible medical expenses NOT covered under any other health,
dental or vision plan are eligible to be paid or reimbursed from your MCAP.
State of Illinois exible spending account reference guide
Page 9
Eligible Dependent Care Account
Expense Examples
Dependent Care Account funds cover care costs for your eligible
dependents to enable you to work.
• Before school or after school care (other than tuition)
• Qualifying custodial care for dependent adults
• Licensed day care centers
• Nursery schools or pre-schools
• Placement fees for a dependent care provider, such as an au pair
• Child care at a day camp, nursery school, or by a private sitter
• Late pick-up fees
• Summer or holiday day camps
Ineligible Dependent Care Account
Expense Examples
These items are not eligible for tax-free purchase with Dependent
Care Account funds.
• Expenses for non-disabled children 13 and older
• Educational expenses including kindergarten or private school
tuition fees
• Amounts paid for food, clothing, sports lessons, eld trips,
and entertainment
• Overnight camp expenses
• Registration fees
• Transportation expenses
• Late payment fees
• Payment for services not yet provided (payment in advance)
Dependent Care
Accounts reimburse
for dependent care
expenses incurred
during working hours.
Flexible spending accounts (FSAs) are administered on behalf of your plan sponsor by Optum Financial, Inc. and are subject to eligibility and restrictions.
Please contact a legal or tax professional for advice on eligibility, tax treatment, and restrictions. Please contact your plan administrator with questions
about enrollment or plan restrictions. Federal and state laws and regulations and the design of your plan are subject to change.
This guide does not constitute tax advice. For more assistance, please contact your tax advisor. You can also nd more information in IRS Publication 969
at http://www.irs.gov/pub/irs-pdf/p969.pdf. Your state might have different tax rules. Always refer to your state’s tax guidance regarding FSA taxation.
© 2022 Optum, Inc. All rights reserved. WF7283995 219297-042022 OHC
How much can I contribute to my accounts?
For Fiscal Year 2023 (FY23), the IRS limits MCAP contributions to
$2,850 each year. The limit is per person; a husband and wife may
each contribute up to the $2,850 limit. The limit may be increased
periodically by the IRS.
The IRS limits DCAP contributions to $5,000 per year if you are
married and ling a joint return, or if you are a single parent. If
you are married and ling separately, you may contribute up to
$2,500 per year per parent.
How can I nd out my account balance and review transactions?
• Visit optumnancial.com to sign in to your online account.
If it is your rst time visiting the site, click on the “Register”
button to select your user name and password.
• Use the mobile app, Optum Financial.
• Customer Service is available 24 hours a day, seven days a week
at 1-888/469-3363.
How will I be able to access my MCAP funds?
You will receive a payment card to access your MCAP funds. You
can also pay for eligible expenses with any other form of payment
and request a withdrawal from your account.
When can I request reimbursement from my MCAP?
You will have access to the funds in your account on the rst day
of your plan effective date.
How will I receive my reimbursements?
You are eligible to receive funds by check or direct deposit. For
quicker reimbursements, sign up for direct deposit in your account
at optumnancial.com.
How much can I roll over to the next scal year for my
MCAP account?
Employees must re-enroll in MCAP for the new plan year in order
to qualify for the rollover benet. You can roll over up to $550 of
unused funds from FY22 to the next scal year and still be able to
enroll up to the maximum withholding of $2,850 for FY23.
Can I use my MCAP card for FY23 expenses after June 30?
No, only FY23 amounts are available on the health care card
during July, August and September of 2022. You may submit
manual receipts during July, August and September 2022, for
eligible FY22 expenses incurred from July 1, 2021 through
June 30, 2022.
Who do I contact if I am not sure if a product or service
will be covered under MCAP or DCAP?
This Reference Guide offers examples of products and services
that are, or are not, covered under an FSA. Contact Customer Care
at 888-469-3363 for more assistance.
What happens if I have $700 in my FY22 MCAP on June 30?
You may turn in FY22 receipts during the run-out period of July
1 through September 30, 2022. After September 30, and if you
have enrolled for FY23, up to $550 of the leftover FY22 funds will
be rolled over and the card will be funded with this amount on or
after October 1, 2022.
What happens if I use my account for a non-eligible expense?
If you le a manual request for reimbursement, the request will
be denied. If you used your payment card and the expense is
deemed ineligible, you will be required to reimburse your account
for that transaction.
How will I know if I need to submit an itemized receipt?
You can review if your claim requires receipts online by signing in
to your account. You need to submit receipts if you see a notice.
If a receipt or EOB is needed, you will also be notied by email
or letter within a week of your payment card swipe. You should
always save your receipts and EOBs even if you have not received
such a notice.
What if I don’t submit an itemized receipt?
You must provide an itemized receipt or EOB within the time
requested, or the transaction will be deemed ineligible and
you will be required to repay your account. If you fail to submit
required documentation within 60 days, your payment card will
be suspended. The card will remain suspended until the money
is paid back or until another claim of equal or greater value is
substituted (substitute claim must be submitted online or mobile
with sufcient documentation).
Where can I use my MCAP payment card?
Your payment card can be used nationwide at qualied
merchants, including pharmacies, doctors’ ofces, vision centers,
and hospitals. Visit sig-is.org/card-holders/store-locator for a list
of approved merchants. Your card should only be used to pay for
medical expenses eligible under your plan, and you should always
save your receipts and EOBs.
Do I need to keep my receipts when I use my MCAP card?
YES. We may request documentation any time you use your
payment card, so always hold on to your itemized receipts or your
Explanation of Benets (EOB). Receipts must contain the date of
service, name and address of service provider, description of the
service provided, amount charged, and name of person receiving
the service. Non-itemized cash register tapes, credit card receipts
and cancelled checks alone do not provide proper substantiation.
Frequently Asked Questions
