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Welcome!We’re pleased to offer you the most advanced and user-friendly account solution.
– Accounts that help you SAVE• Health Savings Account (HSA)• Limited Purpose Flexible Spending
Account (LPFSA)• Dependent Day Care FSA (DCRA)
– Easy access to funds and information• Participant portal and mobile app • Payment card• Dedicated microsite - connectyourcare.com/qualcomm• Customer service available 24x7 at 1-855-687-2128• New! Exclusive Qualcomm service email address
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The HSA Advantage• Use for you, your spouse
and eligible tax dependents (even if not covered by your health plan).
• Distributions allowed at any time without restriction.
• Funds never expire.• Distribution is tax-free* for
qualified medical expenses.
• Your HSA is yours forever! *State taxes apply to contributions, investment and interest earnings in CA, NJ, & AL
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Examples of Qualified Medical Expenses• Acupuncture• Alcoholism treatment• Ambulance• Automobile modifications
for physically handicapped
• Birth control pills• Braille books &
magazines • Chiropractic care• Christian Science
practitioner• Contact lenses & related
materials• COBRA premiums• Crutches• Dental treatment• Dentures• Diagnostic services• Drug addiction treatment
• Eye examination • Eye glasses• Fertility treatment• Flu shot• Guide dog or other
animal aide• Hearing aids• Hospital services• Immunization• Insulin• Laboratory fees• Laser eye surgery• Long-term care
premiums or expenses
• Medical testing device• Nursing services• Organ transplant• Orthodontia• Physical exam
• Physical therapy• Prescription drugs• Psychiatric care• Retiree medical
insurance premiums• Smoking cessation
program• Sunscreen & sun block
(SPF15+, broad spectrum)
• Surgery• Transportation for
medical care• Weight loss program
necessary to treat obesity
• Wheelchair
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Examples of Qualified OTC ExpensesSome over-the-counter items are eligible for purchase with HSA funds.
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Eligible without a Prescription:• Bandages• Braces & supports• Catheters• Contact lens supplies &
solutions• Denture adhesives• Diagnostic tests & monitors• Family planning items• First aid supplies• Insulin & diabetic supplies• Ostomy products• Reading glasses• Wheelchairs, walkers, canes
Eligible with a Prescription*:• Allergy & sinus medicine• Antibiotics• Cold sore remedies• Cough, cold & flu• Feminine anti-fungal/anti-itch• Hemorrhoidal preps• Laxatives• Motion sickness• Pain relievers• Respiratory treatments• Sleep aids & sedatives• Stomach remedies
Dual Purpose Items:These items can be used for a medical purpose or for general health and well being and are eligible only with a prescription, doctor’s directive or letter of medical necessity:• Dietary and weight loss
supplements• Fiber supplements• Orthopedic shoes & inserts• Snoring cessation aids• Vitamins & herbal
supplements
* A “prescription” means a written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.
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Examples of Not Qualified Expenses• Cosmetic surgery • Concierge service fees
(billed for future services; no treatment actually provided)
• Exercise equipment • Fitness programs • Funeral expenses • Hair transplants • Household help
• Illegal operations and treatments
• Maternity clothes • Most insurance premiums
(COBRA, long term care and retiree medical premiums are allowed)
• Teeth whitening
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Account Access – Anywhere, Anytime
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“Great website and using the card could not be easier.
Overall I cannot find a single thing I would want to be changed about this HSA.”
‐ Citi HSA participant
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Three Ways to PayPayment Card • Easy way to pay, funds deducted directly from your account• Dental and vision expenses are pulled from your LPFSA first, until
depleted• Receipts may be requested for LPFSA expenses
• Press credit to use with no PIN, or debit to use PIN (preset as last 4 digits; reset your PIN by calling 1-888-999-0121)
Health Plan Claims – UHC and Kaiser• Claims sent from your health plan to CYC• Pay your portion your provider or reimburse yourself• “Claims from Insurance Plan” section portal
Pay With Personal Funds & Request Reimbursement • Eligible expenses paid using personal funds (all DCRA expenses)• Enter request online or on mobile application• Submit documentation for LPFSA and DCRA claims
– Snap picture with the mobile app
– Upload scanned images on portal
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Roll Over Your Previous HSA • All HSA funds in
one account, one payment card
• Eliminate any fees for previous HSA
• Easy to transfer process– Complete transfer
form and mail it to the address on the form.
– Transfers may take 4-6 weeks depending on your prior Trustee/Custodian’s processing time.
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Rollover Formconnectyourcare.com/
qualcomm
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Mobile Solutions• Mobile App
– Available for Android, iOS and Windows devices– View account balance, alerts and transaction history– Submit a new claim – Make payments to your providers– Tap to call Customer Service– Upload claim documentation with your device’s camera
• Mobile Browser– Streamlined version of online account
• Mobile Alerts - Two-Way Texting– Request and receive information via text message– Sign up for this feature through your online account
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