You can use your PCA for medical expenses like doctor's office visits, as well as other eligible healthcare costs. Check with your employer for a complete list. In addition to services your health plan covers, like doctor's office visits, categories of eligible expenses can include:
- Dental services
- Eye exams, eyeglasses, contact lenses and solution, and laser surgery
- Orthodontia, dental cleanings, and fillings
- Prescription drugs
- Physical therapy, speech therapy, and chiropractic expenses
However, your company may not include all of the categories above. You can't use the money for experimental treatments, cosmetic procedures, or insurance premiums.
The PCA is usually combined with a Preferred Provider Organization (PPO) plan. With this plan, you may have a higher deductible - but PCA funds can be used to "pay down" your deductible.
You can also use PCA funds for pharmacy expenses. If you use all of your PCA funds, you pay additional medical expenses until you meet your deductible for the year. Once you've met the deductible, you pay only the coinsurance percentage for covered services specified in your plan.
If you don't use all of your PCA funds during the plan year, you may be able to carry over some or all of your money to the next year, as long as you enroll in the same type of Humana plan with the same employer. Your employer determines whether you have this option, how much can be carried over, and when funds are available. See your Summary Plan Document for details.
Beginning Jan. 1, 2011, over-the-counter medications such as pain relievers, cough syrup, and allergy medicines will require a prescription to be eligible for reimbursement from an FSA or PCA. The HumanaAccess Card will not be able to be used to purchase OTC medications.
How it works example - single coverage
Troy chooses a PCA PPO plan that includes:
- $500 PCA
- $2,000 deductible
His healthcare costs for the year involve a sore throat that just won't go away. Troy's healthcare costs for the year total $300:
| Doctor's office visit |
$150 |
| Lab tests |
$100 |
| Two prescription copayments |
$50 |
How Troy uses his PCA for healthcare costs
| PCA funds at the start of the year |
$500 |
| Cost of medical services (counts toward deductible) |
$250 |
| Cost of prescriptions (doesn't apply to deductible) |
$50 |
| Troy uses PCA to pay |
$300 |
| PCA funds remaining |
$200 |
| Deductible remaining |
$1,750 |
Summary
Troy used his PCA to pay all of his healthcare costs for the year. The amounts associated with his health plan - the doctor's visit and lab tests - apply to his deductible.
How it works example - employee and child
Mia chooses a PCA PPO plan that includes:
- $2,000 PCA
- $3,000 deductible
Mia has one doctor's appointment during the year and has outpatient surgery on her foot. Her daughter, Melissa, gets an ear infection. She goes to the doctor and fills one prescription. Their healthcare costs for the year total $2,150.
| Two doctor's office visits |
$300 |
| Outpatient surgery |
$1,800 |
| One prescription |
$50 |
How Mia uses her PCA for healthcare costs
| PCA funds at the start of the year |
$2,000 |
| Cost of medical services (counts toward deductible) |
$2,100 |
| Cost of prescriptions (doesn't apply to deductible) |
$50 |
| Mia uses PCA to pay |
$2,000 |
| PCA funds remaining |
$0 |
| Mia pays remaining deductible out of pocket |
$150 |
Summary
Mia used her PCA to cover all but $150 of her medical and prescription drug costs for the year. The amounts associated with her health plan - the doctor's visits and outpatient surgery - apply to her deductible.
