health FSA

The Chevron Health Care Flexible Spending Account (Health FSA) is a flexible spending account plan. A flexible spending account plan is a voluntary option that allows you to pay for certain eligible out-of-pocket health care 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. You must re-enroll in this plan every year during open enrollment to continue your participation, even if you're already currently participating.

Important restrictions to know about

If you enroll in the Chevron High Deductible Health Plan (HDHP) or the Chevron High Deductible Health Plan Basic (HDHP Basic), you cannot enroll in the Health FSA. And if you are enrolled in the Health FSA, you cannot open or contribute to a 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 HSA if you had previously elected to enroll in the Health FSA 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 HSA if you had previously elected to enroll in the Health FSA for the calendar year. You'll need to wait until the next year to open and contribute to an HSA. 

Did you know? The Health FSA is different from a health savings account (HSA). While they are similar in some ways, the differences are important to understand. Learn more about the difference

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:

• Use it or lose it. Meet the plan deadlines. This plan does not typically have a carryover 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.

• Your Health FSA contribution is deducted from your pay in equal amounts during the year. However, you can spend the total amount you elected to contribute for the year on day one of the effective date of your plan.  

• If you are enrolled in a high deductible health plan (HDHP or HDHP Basic), you are not eligible to enroll in a health FSA. 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 events, for example, you have or adopt a child. 

• 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. 

employees

• You can enroll in the Health FSA if you're a U.S.-payroll employee and you're eligible for Chevron's health benefits.

• You cannot participate in the Health FSA 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 Health FSA, 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 Health FSA 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 Health FSA during the current calendar year.

dependents

Under the Health FSA, 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. 

• 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. 

• 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.

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

The Health FSA 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 medical, prescription drug, dental, vision or other health care plan; double dipping is not permitted. In addition, expenses reimbursed under the Health FSA 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, unless that transportation has already been reimbursed under a travel reimbursement benefit under your health plan. 

• Are incurred during the calendar year while you're a participant in the Health FSA. 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 Health FSA summary plan description (see plan documents section on this page). For a complete list of items that may be considered qualified expenses or exclusions under the plan, access your Health FSA 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.

ineligible expenses

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

Some examples of ineligible Health FSA 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.

A Health FSA debit card will be issued to you for use on qualified health care expenses only under the Chevron Health Care Flexible Spending Account (Health FSA). 

• If this is your first time to participate in the Health FSA, 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 Health FSA.

• 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. 

• 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. 

• 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. 

ordering an extra card

Need to order a debit card for your dependent?

• Login to your Health FSA 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.

The IRS limits your annual contributions to a flexible spending account (FSA), and the limit may change from year-to-year.

• You cannot contribute more than the IRS annual limit each year.

• Important note: Employers, like Chevron, are permitted to set an annual limit for their plans that may be less than the IRS annual limit. The IRS typically announces increases to FSA contributions limits (if any) for the new year after Chevron has completed open enrollment-related activities. For this reason, Chevron is unable to increase our plan's contribution limit to align with any new IRS increase until the following year.

• The contribution limit applies to all of the contributions you have made to a health FSA during the current calendar year – including a similar plan through another employer. If your spouse is eligible to make contributions to a health FSA, under IRS rules, each of you may contribute up to the maximum IRS annual limit to your own health FSA. This applies even if both spouses participate in the same health FSA sponsored by the same employer.

2025 contribution limits

Employee contribution limits for the Chevron Health FSA:

• $120 is the minimum contribution.

• $3,200 in 2025 per individual.*

• Company contribution in 2025, Chevron will contribute a flat amount of $500.00 per enrolled employee to the Health FSA. This special, one-time company contribution is in addition to the maximum amount you’re allowed to contribute to the Chevron Health FSA. This one-time contribution is not subject to the 2025 IRS maximum for health care flexible spending account employee contributions. Learn more.

The contribution limit applies to all of the contributions you have made to a health FSA during the current calendar year – including a similar plan through another employer. If your spouse is eligible to make contributions to a health FSA, under IRS rules, each of you may contribute up to the maximum IRS annual limit to your own health FSA. This applies even if both spouses participate in the same health FSA sponsored by the same employer.

*Employers, like Chevron, are permitted to set an annual limit for their plans that may be less than the IRS annual limit. The IRS typically announces increases to health flexible spending account limit (if any) for the new year after Chevron has completed open enrollment-related activities. For this reason, should the IRS choose to increase the limit in 2025, Chevron is unable to change the HCSA maximum contribution limit for the 2025 plan year to align with any potential new IRS limit increase.

2024 contribution limits

Employee contribution limits for the Chevron Health FSA:

• $120 is the minimum contribution.

• $3,050 in 2024 per individual.*

• Chevron does not contribute to the Health FSA in 2024.

The contribution limit applies to all of the contributions you have made to a health FSA during the current calendar year – including a similar plan through another employer. If your spouse is eligible to make contributions to a health FSA, under IRS rules, each of you may contribute up to the maximum IRS annual limit to your own health FSA. This applies even if both spouses participate in the same health FSA sponsored by the same employer.

*Employers, like Chevron, are permitted to set an annual limit for their plans that may be less than the IRS annual limit. The IRS typically announces increases to health flexible spending account limit (if any) for the new year after Chevron has completed open enrollment-related activities. For this reason, should the IRS choose to increase the limit in 2024, Chevron is unable to change the HCSA maximum contribution limit for the 2024 plan year to align with any potential new IRS limit increase.

If you're eligible to participate, enroll:

• On the BenefitConnect website.
• By calling the HR Service Center. Choose the option for Benefits, then Health coverage.
• You must re-enroll in this plan every year during open enrollment to continue your participation, even if you're already currently participating.

Tip: When you enroll in health benefits on the BenefitConnect website or through the HR Service Center, know that your election is not immediate with each of the claims administrators. You must wait until your coverage is activated with the claims administrators before your Health FSA debit card can be generated and for your coverage to display in the plan administrator's system.

• If you enroll during open enrollment, your debit card will be generated in December, and your coverage fully activated on January 1 of the new year.

• If you enroll mid-year as a new hire or due to a qualifying life event, please allow at least 7 business days for BenefitConnect/HR Service Center to process your enrollment election with the claims administrators. Know that this could take slightly less or slightly more days, depending on when you enrolled.

• If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)

If you’re eligible, you can enroll in the Health FSA at any of the following times: 

• During open enrollment.
• During the first 31 days after you become an eligible employee.
• During the first 31 days after a qualifying life event. 

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 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.  

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:

Open enrollment

During open enrollment you can re-enroll and elect the amount of your annual contribution election during open enrollment. Changes you elect during open enrollment take effect January 1 of the following year.

Life event

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. To report a life event and understand what changes you may be eligible to make:

• Go to the BenefitConnect website and click the Report a Life Event link just under the main banner on the home page.

• Call the HR Service Center. Choose the option for Benefits, then Health coverage.

• Your Health FSA contribution is deducted from your pay in equal amounts during the year. However, you can spend the total amount you elected to contribute for the year on day one of the effective date 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. There is no rollover allowed, and this money is not available for future expenses or a refund.  

How to get reimbursed

After you receive eligible health care services, you can request 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 Health FSA. 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, so you should always save your receipts. You will be notified if this applies to you. 

• Online Website Account*. Access your Health FSA 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 Health FSA 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 Health FSA 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. (See the contact information at the bottom of this page.)

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 the Chevron Health FSA, you have two approaches to reimbursement: the entire cost of the treatment or monthly.

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 Health FSA 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 the first round - banding fees - submit:

• Completed Health FSA 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 Health FSA claim form.
• An itemized statement or monthly coupons from the orthodontist.
• Proof of the monthly payment.

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 Health FSA.

If you do not elect COBRA

If you do not elect COBRA coverage for your Health FSA (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 Health FSA special purpose debit card after termination from Chevron. 

• Submit a claim for reimbursement of eligible expenses by using the form, the online tool, or the mobile app. 

COBRA and the Health FSA

Generally, you can elect COBRA coverage for your Health FSA 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 Health FSA, 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. 

• Your cost will be your monthly election amount plus the 2% administrative fee. 

• If you elect the Health FSA 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 Health FSA special purpose debit card after termination from Chevron, even if you choose to elect COBRA coverage for the Health FSA.

• Submit a claim for reimbursement of eligible expenses by using the form, the online tool, or the mobile app.

Go to the Leaving Chevron resource on this website for more information about other things you need to do and the choices you need to make regarding your benefits when you leave.