Health Care Flexible Spending Account (HCFSA)

The Health Care Flexible Spending Account (HCFSA) allows you to set aside money to pay for eligible health care expenses with pre-tax dollars. You can only have an HCFSA if you are enrolled in the Standard Plan or if you waive Baker Hughes Medical plan coverage.

Eligible Expenses

Use the account to pay for eligible expenses. Examples include:

• Medical and dental plan deductibles, copays and coinsurance
• Prescription drug copays and coinsurance
• Certain over-the-counter drugs with a prescription
• Vision expenses

Refer to IRS Publication 502 for more information.

Important Details

• You can be reimbursed for eligible expenses before the money is in your account, up to the total amount you elect to contribute for the year. 
• Medical and Prescription Drug claims are submitted automatically. 
• You must file Dental and Vision claims.
• Claims must be incurred during the plan year (January 1 – December 31) and submitted to UHC by March 31 of the following year to be eligible for reimbursement. 
• You will not receive an ID card for the HCFSA.
• Any money you do not use by the end of the year is forfeited.

Contributions

You may contribute a minimum of $60 and a maximum of $2,750 in 2021.

Payroll Deductions

The amount you elect to contribute to your FSA during Annual Enrollment will be deducted from your paycheck. You will not be able to make adjustments to your HCFSA contributions after November 1 of the plan year.

How to File Claims

There are two ways to file your claim: online or paper claim form.

Online Claim Form

If you submit a claim using the online claim form on myuhc.com, UHC will typically reimburse you 2-3 days after the claim is processed. Here’s how to file an online claim form:

• Go go myuhc.com and log in or create an account. (To create an account, click Register Now. You can register using your Social Security Number and date of birth.)
• Once you’re logged in, click Claims & Accounts, then click Submit a Claim.
• Follow the prompts to fill out the form and submit it.

Paper Claim Form

Print the online claim form and then mail or fax it along with your receipts.

Mail to:

Health Care Account Service Center

P.O. Box 981506

El Paso, TX 79998-1506

Fax: 1-915-231-1709

Toll-free fax: 1-866-262-6354

Check the Status of Your Claim

Go to myuhc.com or call UHC at 1-866-743-6549.

Accessing Your Account

If you are currently enrolled in a Baker Hughes UnitedHealthcare (UHC) Medical plan, go to myuhc.com to log in. Click on View Account Balances.

If you are not currently enrolled in a Baker Hughes UHC Medical plan, you will use your Social Security Number and date of birth to create a myuhc.com account. Click on View Account Balances once you are logged in.

You can access your UHC account online from a desktop or laptop computer, tablet, or your mobile phone. Go to myuhc.com and/or download the UnitedHealthcare app to:

• Submit claims via the online claim form
• Track account balances and spending
• Set up direct deposit for reimbursement