This voluntary benefit plan offers eligible employees the ability to pay for eligible out-of-pocket health care expenses with pre-tax dollars:
Enrollment Information:
- Eligible employees may enroll in the plan within 60 days of hire or during open enrollment.
- To enroll within 60 days of hire, employees must complete the Benefits Worksheet and DCRA/HCRA Form. The DCRA/HCRA Form must be completed (initialed, signed, dated) and uploaded to the Benefits Worksheet.
- To enroll during open enrollment, please complete the 2023 DCRA/HCRA Form.
To access the Benefits Worksheet, please follow the steps below:
- Log in to MyCoyote (for optimal viewing, please use Chrome or Firefox)
- Go to My Employment
- Go to Benefits Worksheet
- Click the "Create New Requests" button
- For 2022, employees may contribute between $20 to $229.16 each month ($2,750 maximum per year) to their flexible spending account.
- For 2023, employees may contribute between $20 to $237.50 each month ($2,850 maximum per year) to their flexible spending account.
- Employees enrolled in this account will receive two (2) ASIFLex debit cards at no additional cost. This card eliminates most out-of-pocket expenses and claims paperwork (exceptions apply).
- Contributions are deducted from the employee's pay before federal, state and Social Security (FICA) taxes are calculated.
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Employees must re-enroll every year during open enrollment to continue participation for the following calendar year. To re-enroll, employees must complete a Benefits Worksheet and DCRA/HCRA Form.
Reimbursement Information:
- Employees can file a claim for reimbursement online at my.asiflex.com with the ASI- assigned user ID and password, or by completing a HCRA/DCRA Claim Form and attaching an itemized bill for health care expenses.
- Once you have filled out the form and attached all required documentation, you can fax it to (573) 874-0425 or mail it to:
ASI
P.O. Box 6044
Columbia, MO 65205-6044
- Once you have filled out the form and attached all required documentation, you can fax it to (573) 874-0425 or mail it to:
- In addition to the claims reimbursement processes outlined above, enrolled employees also have the option of requesting an FSA Debit Visa Card, also called the "ASIFlex Card." The Card eliminates most out-of-pocket expenses and claims paperwork (exceptions apply).
- Eligible expenses must be:
- medically necessary,
- incurred by an employee, employee's spouse, or eligible dependents (including domestic partner)
- not covered by the employee's own or another insurance plan
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Any money left in employee's account after expenses have been paid for the plan year may be forfeited.
If an employee re-enrolls for the next plan year, there will be an extended grace period through March 15 of the following year.
If an employee does not re-enroll for the next plan year, they must utilize all their funds by December 31st of their plan year.
- Please refer to the Health Care Reimbursement Account Brochure for more detailed information.