health care spending account (HCSA)

save for health

This flexible spending account plan allows you to save and pay for certain eligible health expenses with before-tax dollars.

The Health Care Spending Account (HCSA) is a flexible spending account that allows you to save and pay for your (and your eligible dependents') out-of-pocket health care expenses – like deductibles, office copayments, your share of prescription drug costs, contact lens supplies, and more. Chevron also offers another type of flexible spending account - the Dependent Day Care Spending Account (DCSA) - for your eligible dependents' day care expenses.

The HCSA is different from a health savings account (HSA). The HCSA – a flexible spending account – and a health savings account (HSA) are two very different types of health accounts. While they are similar in some ways, the differences are important to understand. Learn more about the difference between the HCSA and an HSA.

the basics

The Chevron Health Care Spending Account (HCSA) is a flexible spending account plan. A flexible spending account plan is a voluntary option that allows you to pay for certain eligible expenses with before-tax dollars. Each month, you contribute a set amount to your account through before-tax payroll deductions. Then you use the funds in your account to pay for eligible expenses.

Your contributions to flexible spending accounts reduce your taxable income. For this reason, federal tax laws require you to follow certain rules when using the funds in your account. Keep these rules in mind as you plan how much to contribute each year:

  • If you are enrolled in a high deductible health plan (HDHP), you are not eligible to enroll in a health flexible spending account. You may, however, be eligible to contribute to a health savings account (HSA).

  • Plan your contribution goal carefully. Once you've elected an annual contribution amount, you cannot change it unless you experience certain qualifying life event (for example, you have or adopt a child). 

  • Use it or lose it. Meet the plan deadlines. This plan does not have a carry-over feature. The money in your flexible spending account can be used only for eligible expenses incurred between January 1 and December 31 of each year. You have until June 30 of the following year to submit your claims for expenses, but any remaining balance left in your account after the final claim filing deadline will be forfeited. Note: If you enroll mid-year, you can only claim eligible expenses you incurred after the date your coverage began.

  • Only certain expenses are eligible. The money in your account(s) can be used only for eligible expenses. It's important to make sure that any expenses you've planned are reimbursable.

  • Your account has a specific purpose. You cannot use money in a health care flexible spending account to pay for dependent day care expenses. Likewise, you cannot use money in a dependent day care flexible spending account to pay for health care expenses.

  • There are rules regarding your contributions. The IRS limits the amount you can contribute to a flexible spending account, and the limit may change from year-to-year.

  • Be aware of mid-year enrollment. If you enroll, the amount of before-tax contributions you authorize is deducted from your pay in equal amounts throughout the year and credited to your flexible spending account. Keep this in mind if you are enrolling for the first time late in the year because your election will be spread out over fewer pay periods and could be a larger payroll deduction than you planned for. 

You must re-enroll in a flexible spending account every year; coverage is not automatic. If you want to participate, you must re-enroll during open enrollment every year, even if you're already participating. If you don't make an election during open enrollment, you will not have coverage for the next year. Outside of the open enrollment period, you can make changes only within the 31-day deadline after certain qualifying life events.

plan facts at-a-glance

recent plan changes

Things change; be sure you're informed. The documents provided below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD). Be sure to review the SMM for an understanding of important plan updates.

summary plan description (SPD)
The IRS limits the amount you can contribute to a flexible spending account, and the limit may change from year-to-year. You cannot contribute more than the IRS annual limit each year. However, employers are permitted to set an annual limit for their plans that may be less than the IRS annual limit.
 
The employee contribution limit for the HCSA is:
  • $120 is the minimum contribution.
  • $2,700 in 2020 per individual. 
  • Keep in mind this contribution limit applies to all of the contributions you have made to a health flexible spending account plan during the year – including a similar plan through another employer. 
  • However, if your spouse is eligible to make contributions to a health flexible spending account, under IRS rules, each spouse may contribute up to the maximum IRS annual limit to their own health flexible spending account. This applies even if both spouses participate in the same health flexible spending account plan sponsored by the same employer.
Chevron does not contribute to the HCSA.
A special purpose debit card will be issued to you for use on qualified health care expenses only under the Chevron Health Care Spending Account (HCSA)
  • If this is your first time to participate in the HCSA, you will automatically receive a debit card. 
  • No claim forms are required. Swipe your card and the special purpose debit card transfers funds for qualified expenses directly from the available funds in your HCSA.
  • You can only use the card to pay for eligible expenses, up to the amount you elected for the year.
  • Keep your card(s) even if you’ve used your entire account balance; just like your bank debit card they can be reused if you participate again next year. 
  • The expiration date on your card has no connection with your plan's claims deadlines and may be different from the end date for your plan.
  • New cards for existing members will not be reissued, unless your card is set to expire during the year or there's been another plan update that necessitates a new card.
  • The debit card can only be used for purchases inside the United States, so if you incur an expense outside the U.S., you’ll need to submit a claim form (online or by paper) to request reimbursement. 
  • In general, you do not have to submit receipts for reimbursement, but there may be some instances in which substantiation is required. You will be notified if this applies to you. 
  • No matter what, IRS guidelines still require you to save your itemized receipts as part of your tax records
  • When using your card, you are certifying use for qualified health care expenses.
  • Call the claims administrator if you have questions, have lost your cards, or have not received your cards. 
 
Need to order a debit card for your dependent?
  • Login to your HCSA account on the website or through the mobile app.
  • Navigate to your Spending Account Dashboard.
  • Choose your name in the upper right corner, then select Add Family Member.
  • Once the dependent has been added, you will receive a debit card in the mail within 7 to 10 business days.

Only eligible expenses can be reimbursed under the HCSA. These expenses are defined by IRS rules (See IRS Publication 502) and HCSA plan rules.

The HCSA can reimburse health-related charges for you and your eligible federal tax dependents that satisfy all the following requirements:

  • Are not already reimbursed under a health, dental or vision care plan; double dipping is not permitted. In addition, expenses reimbursed under the HCSA may not also be deducted when you file your tax return. 
  • Are the types of expenses that you could claim as a tax deduction. The IRS says that this includes items and services that are meant to "diagnose, cure, mitigate, treat, or prevent illness or disease." Transportation for medical care is also included. 
  • Are incurred during the calendar year while you're a participant in the HCSA. This means the date of service must be within the current plan year while you were an active participant in the plan; it's not the date when you are billed for and consequently pay for the service. 

eligible expenses

You can preview a list of expenses that are generally considered an eligible expense in the HCSA summary plan description. For a complete list of items that may be considered qualified expenses or exclusions under the plan, access your HCSA account online. (Navigate to your Spending Account Dashboard, then choose How It All Works from the navigation.)

Here are some examples of eligible expenses:

  • Your medical plan deductible.
  • Your share of the cost for eligible dental care, including exams, X-rays, and cleanings.
  • Your share of the cost for eligible vision care, including exams, eyeglasses, contact lenses, and laser eye surgery.
  • Certain over-the-counter medicines and drugs that are prescribed by a doctor.
  • Insulin, including over-the-counter insulin.
  • New, as of January 1, 2020: Certain over-the-counter medicines and other products are now considered reimbursable, without a prescription. Read more.

ineligible expenses

You can preview a list of expenses that are generally not an eligible expense in the HCSA summary plan description or by accessing your HCSA account online. (Navigate to your Spending Account Dashboard, then choose How It All Works from the navigation.) 

Some examples of ineligible HCSA expenses include:

  • Cosmetic surgery and procedures, including teeth whitening
  • Herbs, vitamins, and supplements used for general health
  • Insurance premiums
  • Family or marriage counseling
  • Personal use items such as toothpaste, shaving cream, and makeup
  • Prescription drugs imported from another country

As a reminder, ineligible expenses also include:

  • Services that take place before or after your coverage period.
  • Expenses that are reimbursed by another plan or program, including another health plan.
As a reminder, effective January 1, 2020, Anthem Blue Cross has replaced HealthEquity as the claims administrator for the HCSA. Please continue to contact HealthEquity for 2019 account management, and contact Anthem Blue Cross for 2020 account management.
 
Your HCSA contribution is deducted from your pay in equal amounts during the year. However, you can spend the total amount you chose to put in for the year on day one of your plan.  
 
Reimbursement requests must be sent in no later than June 30 of the year after the year in which you incur the expense. Any balance remaining after June 30 will be forfeited. This money is not available for future expenses or a refund.  
 
After you receive eligible health care services, you can request for reimbursement through any of the following methods:
  • Debit Card. Swipe your special purpose debit card and the card transfers funds for qualified expenses directly from the available funds in your HCSA. A claim form or receipts are not required if you use your debit card; however know that there may be some instances in which substantiation is required. You will be notified if this applies to you. 
  • Online Website Account*. Access your HCSA account online at the claims administrator's website.
  • Mobile App*. Use your claims administrator's mobile app to submit a claim with supporting documentation.
  • Paper Form*. Fill out a HCSA claim form and provide supporting documentation as requested on the form.
*The amount of your reimbursement request must be at least $25. If your qualified expenses are less than $25, wait until you incur additional qualified expenses totaling $25 or more to submit a claim.  
 
set up direct deposit
You can set up direct deposit of approved reimbursements to your bank account. Here's how:
  • Online Website Account. Access your HCSA account online at the claims administrator's website. Navigate to your Spending Account Dashboard. From there, go to the Claims tab, then choose Reimbursement Preference.
  • Call Claim Administrator. If you do not have access to the web, you can also call your claim administrator for assistance with this request.
HealthEquity will be available to handle reimbursement requests for eligible 2019 expenses until June 30, 2020. 
 
Orthodontia services aren't provided the same way as other types of health care. Most of the time, provided they're over a long period of time and may extend beyond the plan year. Orthodontic services tend to be hard to match up with actual costs. As a result, the reimbursement process is different. With Anthem, you have two ways to be reimbursed:
 
entire cost of treatment approach
This method allows you to be reimbursed for the full amount of the orthodontia contract. You can do this only if you paid the full amount during the plan year. To get
reimbursed, send in these items:
  • Completed HCSA claim form.
  • Proof of payment for the entire contract, including start date and expected end date.
  • Proof of payment made during the applicable plan year in which you are requesting reimbursement.
 
monthly approach 
This method allows you to be reimbursed for the first round of treatment (usually called banding fees) and then monthly reimbursement after that. To get reimbursed for banding fees, submit:
  • Completed HCSA claim form.
  • Your treatment plan or itemized statement that includes the start date and the expected end date.
  • Proof of the initial down payment.
After you submit the first reimbursement request, send in these items for monthly reimbursement:
  • Completed HCSA claim form.
  • An itemized statement or monthly coupons from the orthodontist.
  • Proof of the monthly payment.
Contact Anthem directly for more information or to ask questions.

enrollment & participation

If you're eligible to participate, enroll:
If you’re eligible, you can enroll in the Health Care Spending Account at any of the following times: 
Note: If you are eligible to enroll in a flexible spending account mid-year because of a qualifying life event or you’re newly hired, note that enrollments or changes for the current calendar year cannot be processed after December 1 for administrative reasons.  
 
You enroll in this plan for one calendar year at a time
  • You must re-enroll in this plan every year to continue your participation, even if you're already currently participating.
If you enroll in the High Deductible Health Plan (HDHP) or the High Deductible Health Plan Basic (HDHP Basic), you cannot enroll in the HCSA. And if you are enrolled in the Health Care Spending Account (HCSA), you cannot open or contribute to the BenefitWallet health savings account (HSA).
  • This means that if you change to the HDHP or HDHP Basic mid-year due to a qualifying life event, you will not be permitted to open and contribute to the BenefitWallet HSA if you had previously elected to enroll in the HCSA for the calendar year. You'll need to wait until the next year to open and contribute to an HSA.  
  • This means that if you leave an expatriate assignment and want to enroll in the HDHP or HDHP Basic, you will not be permitted to open and contribute to the BenefitWallet HSA if you had previously elected to enroll in the HCSA for the calendar year. You'll need to wait until the next year to open and contribute to an HSA. 

Once you've elected an annual contribution amount, you cannot change it unless you experience certain qualifying life event(s). You can make changes to this coverage only under the following circumstances:

  • During open enrollment. You can re-enroll and change the amount of your annual contribution election during open enrollment. Changes you elect during open enrollment take effect January 1 of the following year.
  • During the first 31 days after a qualifying life event that allows for enrollment or a change in your participation in this plan. The ability to make a change and the kinds of changes you can make vary depending on the type of life event.

If enrolled, your participation will end the date your employment ends. This plan is not available to retirees; however, if you are eligible, you can elect COBRA coverage for the HCSA plan.

if you do not elect COBRA

If you do not elect COBRA coverage for your HCSA (or you're not eligible), your participation ends the date your employment ends

  • You will not be reimbursed for any services received after the date your participation ends
  • You may request reimbursement for eligible expenses incurred during your period of participation by no later than June 30 of the following year.
  • You cannot use your HCSA special purpose debit card after termination from Chevron, regardless of whether or not you choose to elect COBRA coverage for the HCSA. 
  • You must pay for the expense and submit a claim for reimbursement either by using the form, the online tool, or the mobile app. 

COBRA and HCSA

Generally, you can elect COBRA coverage for your HCSA only if your account is underspent – in other words, the cost of coverage for the remainder of the plan year does not exceed the amount of benefits available for the remainder of the plan year. 

  • If you are eligible for and elect COBRA coverage for your HCSA, your participation will continue on an after-tax basis through the end of the year
  • If you choose to continue participation, it must be at the same contribution rate as when you were an active employee. 
  • This means your cost will be your monthly election amount plus the 2% administrative fee
  • If you elect HCSA through COBRA coverage, you can continue to use the funds in your account through the end of the year in which you left Chevron. You have until June 30 of the following year to request reimbursement of eligible expenses.
  • You cannot use your HCSA special purpose debit card after termination from Chevron, regardless of whether or not you choose to elect COBRA coverage for the HCSA. 

who's eligible to participate

Except as described below, you’re generally eligible for this Plan if you’re considered by Chevron to be a common-law employee of Chevron Corporation or one of its subsidiaries that it has designated to participate in the Omnibus Health Care Plan and you meet all of the following qualifications:

  • You’re paid on the U.S. payroll of Chevron Corporation or a participating company.
  • You’re assigned to a regular work schedule (unless you’re on a family leave, disability leave,  short union business leave, furlough leave, military service leave or leave with pay) of at least 40 hours a week, or at least 20 hours a week if such schedule is an approved part-time work schedule under the corporation’s part-time employment guidelines.
  • If you’re a casual employee, you’ve worked (or are expected to work) a regular work schedule for more than four consecutive months.
  • If you’re designated by Chevron as a seasonal employee, you’re not on a leave of absence.
  • You’re in a class of employees designated by Chevron as eligible for participation in the plan. 
However, you’re still not eligible if any of the following applies to you:
  • You’re not on the Chevron U.S. payroll, or you’re compensated for services to Chevron by an  entity other than Chevron — even if, at any time and for any reason, you’re deemed to be a  Chevron employee.
  • You’re a leased employee or would be a leased employee if you had provided services to Chevron for a longer period of time.
  • You enter into a written agreement with Chevron that provides that you won’t be eligible.
  • You’re not regarded by Chevron as its common-law employee and for that reason it doesn’t withhold employment taxes with respect to you — even if you are later determined to have been Chevron’s common-law employee.
  • You’re a member of a collective bargaining unit (unless eligibility to participate has been negotiated with Chevron).
  • You’re a professional intern. 
You cannot participate in the Heath Care Spending Account (HCSA) at the same time you participate in a high deductible health plan, including the Chevron High Deductible Health Plan (HDHP) or the Chevron High Deductible Health Plan Basic (HDHP Basic). Likewise, if you are enrolled in the HCSA, you cannot open or contribute to a health savings account (HSA). For example, this means that if you change to the HDHP or HDHP Basic (and drop your HCSA coverage) mid-year due to a qualifying life event, or if you leave an expatriate assignment and want to enroll in the HDHP or HDHP Basic, you cannot open and contribute to an HSA if you have already elected to enroll in the HCSA during the current calendar year.
 
You may become eligible for different benefits at different times. Participation and coverage do not always begin when eligibility begins. Chevron Corporation, in its sole discretion, determines your status as an eligible employee and whether you’re eligible for the plan. Subject to the plan’s administrative review procedures, Chevron Corporation’s determination is conclusive and binding.  If you have questions about your eligibility for this plan, you should contact the Chevron Human Resources Service Center.
Under the Health Care Spending Account, an eligible dependent whose expenses can be reimbursed includes any person you can declare as a dependent on your federal income tax return for the year. 
  • This person does not have to be enrolled as a dependent under any company-sponsored benefit plan. 
  • When you enroll in this plan, you do not make an election to enroll your dependent(s) for coverage. 
  • The dependent verification process does not apply to this plan.
Note: Federal tax law does not permit you to claim expenses for your domestic partner or your domestic partner’s children, unless they qualify as dependents on your federal income tax return for the year. 

contact information

The HR Service Center manages your enrollment in and eligibility for this benefit plan. For all other questions regarding your coverage, contact the claims administrator. A claims administrator manages the administration of your plan — for example, claims, account balances, ID cards, what's covered and what's not, provider networks, phone numbers, the administrator's website or mobile app, and more. 

health care spending account (HCSA)
  • Plan Type  Flexible Spending Account Plan
  • Eligibility  U.S. Payroll Employees
  • Claims Administrator  Anthem Blue Cross is the claims administrator effective January 1, 2020. Contact HealthEquity for assistance with the 2019 HCSA. 
  • Group Number  N/A
  • Phone (Inside U.S.) 1-844-627-1632
  • Phone (Outside U.S.) 1-844-627-1632
  • Website  anthem.com/ca
  • Mobile App   Sydney Health app from Apple App Store or Google Play
  • Email  N/A
  • Claim Form  Forms Library
  • Address  Anthem Blue Cross FSA Claims  | PO Box 161606  | Altamonte Springs, FL 32716

2019 health care spending account (HCSA)
  • Plan Type  Flexible Spending Account Plan
  • Eligibility  U.S. Payroll Employees
  • Claims Administrator  HealthEquity can assist with or handle claims for the 2019 HCSA only up through June 30, 2020. Contact Anthem Blue Cross for assistance with the 2020 HCSA. 
  • Group Number  N/A
  • Phone (Inside U.S.) 1-866-346-5800
  • Phone (Outside U.S.) 1-866-346-5800
  • Website  healthequity.com/chevron
  • Mobile App  HealthEquity mobile app
  • Email  memberservices@healthequity.com
  • Claim Form  Forms Library
  • Address  HealthEquity | Attn: Reimbursement Accounts | 15 W Scenic Pointe Dr | Ste 100 | Draper, UT 84020 

This page applies to U.S.-payroll employees. This page provides only certain highlights of benefits or program provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and legal plan documents, the legal documents will prevail to the extent permitted by law. This is not a plan text or a summary plan description. There are no vested rights with respect to Chevron health care plans or any company contributions toward the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union represented employees.