Manage your health flexible spending account (FSA)

Summary

Enrolling, eligible expenses, what happens at the end of the plan year or if you leave the company.

Users Intent

Users Intent

Context Variations

context Variations

Content

This article is for admins who want to set up a health flexible spending account (FSA) program for their teams, and employees who want to enroll in and use their FSA benefits.

A health FSA is a pre-tax benefit account where you can set aside pre-tax dollars to pay for eligible medical expenses.

Health FSAs are pre-funded, which means employees can access their full election amount on the first day of the plan year. Employers collect employee contributions through pre-tax deductions throughout the year to repay the upfront costs.

Health FSA funds also expire if you do not use them by the end of the plan year unless your company offers extension options like a rollover, runout period, or grace period.

To offer a health FSA with Gusto, your company must offer health insurance with Gusto. If your company offers a health FSA through a third party, you can still set up benefit deductions for your team.

Employees: Enroll in your company's health FSA

Here’s what you need to know about enrolling in a health FSA as an employee.

Health FSA enrollment instructions

Learn when you can enroll in a health FSA and how to go about actually enrolling in one.

When you can enroll in a Health FSA

If your employer offers a health FSA and you’re eligible, you can enroll through Gusto:

Enroll in a health FSA

To enroll in or waive enrolling in a health FSA: 

  1. Sign in to your Gusto employee account.
  2. Click Benefits.
    • Alternatively, from your Home page, under Enroll in or waive health benefits, click Lets do it.
    • If you do not see this, you may not be currently eligible to enroll in an FSA. If you’ve experienced a qualifying life event, learn how to change your benefits outside open enrollment
  3. Click Edit enrollees.
  4. Part 1: Who’s covered
    • Make sure all your information is up to date. If it’s not, contact your admin. 
    • Add dependents and their information if needed. Dependents will be added as claimants in the Benefits Card Hub, where you’ll manage your FSA. Remember that while you can add any dependent in this step, you can only use health FSA funds on eligible dependents. Once enrolled, you can add or remove dependents anytime in the Benefits Card Hub.
    • Click Save & continue.
  5. Part 2: Choose Benefits. Next to Health FSA, select Enroll or Waive.
    • To enroll in the health FSA, choose Enroll. To opt out, choose Waive. 
    • If enrolling, answer the questions to determine which health FSA you’re eligible for. Check out the Health FSA overview section to learn the difference between an FSA and a Limited-Purpose FSA. 
    • Enter the amount you’d like to contribute to the health FSA for the plan year. If the policy year is less than 12 months, the IRS prorates the contribution maximum based on the year the plan started and the number of months left in the policy year.
    • Click Save & continue
  6. Part 3: Extra information
    • Answer any questions here and select Save & Continue.
  7. Part 4: Sign forms
    • If applicable, e-sign any forms here. Then click Confirm selections.

Your Gusto Benefits Card will arrive at your mailing address in a plain white envelope before the benefit begins. 

After the benefit’s effective date, you can find your plan details on the Benefits page of your Gusto account. There, you’ll also find your plan document, which explains health FSA rules and how to use your benefits. Payroll deductions will begin on the first payroll of the health FSAs plan year.  

Employees: Use your health FSA (Benefits Card Hub)

Your health FSA gives you flexible options to pay for your medical expenses.

How to use your health FSA funds

There are three ways you can use your health FSA funds on eligible expenses:

  1. Swipe your card at an eligible vendor.
    • Save your receipt. We may email you if the IRS requires more documentation for the transaction.
    • Some vendors do not allow the IRS to verify that your purchase is for an eligible expense. If this happens, the system may deny the transaction at the point of sale. You can pay out of pocket, save your receipt, then submit the health FSA expense for reimbursement.
  2. Pay out of pocket and submit the health FSA expense for reimbursement.
  3. Pay a bill by sending a check directly to the provider.

Eligible expenses

Here’s what makes an expense eligible:

  • The service is eligible — check out the list of eligible expenses.
  • The service happened during the eligible spending period, also known as the policy year.
    • The eligible spending period includes your policy year and the grace period, if your company offers one. You can see your plan details on the Benefits page of your account.
  • The service is not in the future.

When your plan year ends or you leave your company, you may have extra time to submit claims.

Submit a health FSA expense for reimbursement

You can review and manage your expenses in the Benefits Card Hub: Under My Accounts, click FSA.

Add or edit a health FSA reimbursement method

You can choose to be reimbursed by check, direct deposit, Venmo, or PayPal.

To add or edit a reiumbursement method:

  1. Access the Benefits Card Hub.
  2. In the top-right corner, click on your initials.
  3. Click Manage Account.
  4. Click Reimbursement Options.
  5. Choose Add Payment Method.
  6. Fill out the prompts.
Note: Adding a bank account can take 2 – 3 business days to verify.

Health FSA receipt requirements

To make sure your documentation meets IRS criteria, make sure it includes:

  • Provider name
    • The name of the facility or doctor who provided the service, or the name of the store where you purchased the item
  • Patient name
    • The person who received the service or purchased the item
  • Dates of service
    • The date(s) on which someone performed the service or the date of purchase
    • The bill date is not the same as the date of service.
  • Cost of service
    • The amount of the service or item after insurance payments. We will not approve receipts that indicate “estimated insurance payments.”
  • Summary of services received
    • A summary of the service(s) performed or item(s) purchased
Note: Documents changed by hand or in any other way will not be accepted as proof for a claim.

Submit a health FSA expense for reimbursement

If you paid out of pocket for an eligible expense, you may submit it for reimbursement as long as the service occurred during your coverage period, and the final date to submit claims has not passed. 

To submit a health FSA expense for reimbursement:

  1. Access the Benefits Card Hub.
  2. Choose Reimburse Me.
  3. Upload your receipt, bill, or explanation of benefits (EOB).
  4. Review the information on the next page. If everything looks correct, submit the request. If anything needs to be corrected, you can edit the field directly.
  5. Choose your reimbursement method and submit the request.

If we can validate the information right away, we’ll approve your claim on the spot. If we need more review time, you’ll get an email when we process the claim. This typically takes 3 – 5 business days.

Get reimbursed

If we approve your claim, we’ll reimburse you using the reimbursement method you’ve chosen:

  • Check: We’ll mail a check to your home address in a plain envelope. If you have not cashed the check, you can still update your reimbursement method to direct deposit, Venmo, or PayPal in the Benefits Card Hub.
  • Direct deposit: Your chosen bank account will get the Automated Clearing House (ACH) within 1 – 3 days. It will appear on your bank statement as “Gusto PayClaim.”
  • Venmo/PayPal: Well send payment instantly from Elevate to your Venmo or PayPal account. You’ll pay a fee of $1 per transaction for this service. 

Submit an expense for reimbursement after leaving your company

If your benefit has a runout period, you may have extra time to submit claims for qualifying expenses you had during your employment. You can confirm your last day to submit an expense in the Benefits Card Hub.

If you did not register for the Benefits Card Hub during your employment, we can help. To contact us, sign in to your Gusto account and click the help icon Speech bubble icon with a question mark inside in the top-right corner of the page.

Pay a health FSA bill directly

If you receive a bill for an eligible expense, you can pay it via check directly from your associated pre-tax benefit account.

If you’ve already paid the bill and want to be reimbursed, go to the header above titled “Submit a health FSA expense for reimbursement.”

To pay a bill directly:

  1. Access the Benefits Card Hub.
  2. Choose Pay a bill.
  3. Upload your receipt.
  4. Review the information on the next page. If all looks correct, submit the request.

If we can identify all the required information in the receipt, we’ll automatically approve your claim and pay the provider by check. If not, we’ll manually review the claim within 3 - 5 business days. You’ll get an email once we’ve reviewed and processed the claim.

Important: Checks expire after 180 days. If a check is about to expire, you’ll receive an email. If we sent the check to your provider, contact them first about the payment.
Resolve a health FSA expense that requires action

The IRS requires that we validate the eligibility of each health FSA expense. We’ll email you if an expense requires more information to complete this validation. You’ll also see it as a notification on your Benefits Card Hub homepage.

To resolve an expense requiring action: 

  1. Access the Benefits Card Hub.
  2. Click Expense Details.
  3. Filter for the status Needs help.
  4. Click the expense that needs help.
  5. You’ll see a note that provides more detail on what we need. If we need more documentation, you can upload the documentation it directly.

We’ll review your documentation and email you with an update within 3 – 5 business days.

Here’s what your documentation should include:

  • Provider name
    • The name of the facility or doctor who provided the service, or the name of the store where you purchased the item
  • Patient name
    • The person who received the service or purchased the item
  • Dates of service
    • The date(s) on which someone performed the service or the date of purchase
    • The bill date is not the same as the date of service.
  • Cost of service
    • The amount of the service or item after insurance payments. We will not approve receipts that indicate “estimated insurance payments.”
  • Summary of services received
    • A summary of the service(s) performed or item(s) purchased
Note: Documents changed by hand or in any other way will not be accepted as proof for a claim.
Pay back an ineligible expense

We’ll email you if you used your Gusto Benefits Card on an ineligible expense. To make sure you’re using the account’s funds according to IRS standards, you should resolve this expense before the account expires. 

To resolve an ineligible expense, you can either pay it back within the Benefits Card Hub or by mailing a check.

Option 1: Pay the expense back via the Benefits Card Hub

If a repayment is required, go to your Benefits Card Hub and find the expense that was ineligible and shows a balance due. You'll have the option to repay it using your connected bank account. 

Option 2: Pay the expense back via check

Mail a check for the amount of the transaction to:

  • Elevate HCS
  • PO Box 875050
  • Kansas City, MO 64187-5050

Solution Properties

Keywords
health fsa employee fsa
Solution ID
109764745100000
Last Modified Date
10/17/2025 11:13:38 AM
Attributes
Gusto Attributes
  • Role: Employees
  • Category: Benefits
  • Plan type: Core; Complete; Concierge
  • Who brokers my benefits?: Gusto
Taxonomy
  • Employees and managers > Benefits > Tax advantaged accounts
  • Employers and admins > Benefits > Tax advantaged accounts
Collections
  • Admins
  • External
  • Support Agent
  • US employees
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