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How does an employee make a Health Spending Account claim?

Posted by Alden Hui on January 24, 2020
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In a group plan, there are benefits coordinator(s) and employees. A benefits coordinator is responsible for managing the plan. This includes determining employee benefits limits and classifications. As expected, this role is usually assigned to the owner of the business. Think of benefits coordinators as the managers of the Health Spending Account. The benefits coordinator will also be an employee of the plan as they both manage and use the plan themselves.

When signing up for the plan, the benefits coordinator will determine a fixed amount to be automatically deposited into the Health Spending Account every month. These funds will be taken from their business account.

Employees will be able to make claims and get reimbursed 100% tax-free using the deposited funds inside of the Health Spending Account. Let's look at the claims process for an employee within a group plan:

Note: For a business with no arm's length employees, please read our top 9 FAQ about claims instead.

What is the claim process?

Example: here’s how a claim would work for a $100 medical expense.

Step 1 — Employee pays for $100 medical expense upfront.
Step 2 — Employee logs in to personal HSA account and submits a claim online. Employee keeps original receipt.
Step 3 — Olympia debits Employer funding account $108. (Cost + 8% Admin Fee)
Step 4 — Olympia reimburses employee $100 directly by online banking. The process occurs within 24 hours.

The $100 reimbursement is TAX FREE.
The $100 payment from your corporation is TAX DEDUCTIBLE.

This process (including reimbursement) usually occurs within 2 days (48 hours). 

How are claims funded?

The employer determines the funding amount. Group plans are funded by the employer with a pre-set amount at the start of every month. This means that funding is held inside the Health Spending Account to satisfy any claims submitted by your employees. 

We recommend allocating a sufficient amount at the start of the plan so that employees can be reimbursed immediately after a successful claim.

How much should I give employees in a Health Spending Account? 

  1. Figure out your current (health and dental plan) budget
  2. Add up your total liabilities (classification amount x employees in the classification - for all classifications)
  3. Divide the total liabilities by 12 (months)
  4. Deposit the calculated amount into the HSA at the beginning of each month


When can an employee make their first claim?

Employees are eligible to make a claim as soon as they are added to the plan. Claims may only be made on a going forward basis, that means you can only claim eligible expenses that occur on or after the day you are added to the plan. Before your first claim, you will need to setup a direct deposit with your financial institution to get the tax-free reimbursement.

What is needed to make a claim?

Making a claim is fast, convenient, and secure. Login to your online account or use the Olympia Benefits mobile app. Enter your details from your medical expense receipt, and submit the claim.

How much can employees claim?

The benefit limit is set by the benefits coordinator based on the employee's classification (ex. Manager, Full time, associate, etc).

When will an employee get reimbursed after their claim?

Claims are reviewed and processed within 24 hours. Reimbursements will take 1-2 business days after the review.

Is there a deadline for filing claims?

This depends on your group plan. After the plan year end, the employer chooses the number of extra days (up to 365 days) that an employee has, to claim expenses incurred in the previous plan year.

How far back can employees make claims?

Employees can claim an expense that occurred on or after their effective date (date they were added to the plan).

What happens to unused funds (funds not claimed during the plan year)?

Olympia can give a full refund to the employer at any time. Remember, a deposit for the HSA funding account is not the same as a premium payment to insurance. You can withdraw funding from your HSA account at any time.  

At the plan's year end, remaining funds can be returned to the employer or left for next year’s budget.

 

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Related reading:

Top 53 FAQ about Olympia Health Spending Accounts

Top 24 FAQ about Employee Benefits Package for Small Business

 

Topics: health spending account, online claims, employee benefits