Medical Care Assistance Plan (MCAP)

Medical Care Assistance Plan (MCAP) - Companion to your HMO, OAP, QCHP, or CDHP (if not enrolled in an HSA)

The Medical Care Assistance Plan (MCAP) pays for eligible medically necessary expenses incurred by the employee, spouse, and eligible dependents. Dependents must qualify under the Internal Revenue Code in order to be eligible.

All active employees are eligible to enroll in MCAP during the Benefit Choice Period. MCAP is not available to retirees, annuitants, or anyone enrolled in an HSA. Participants will be provided a debit card at no cost. Documentation may be required to substantiate certain expenses paid with the debit card.

MCAP contributions are limited by the IRS to $3,200 for FY2025 or $266.66 per month. The monthly limit is modified for university employees paid over less than 12 months. The maximum amount is a per person limit. A husband and wife, who are both eligible under the State Employee Group Insurance Program (SEGIP), may each contribute up to the $3,200 limit. The minimum amount for which an employee may enroll is $240 per year or $20 per month. Per IRS regulations, MCAP contributions are funded on the employee’s effective date or the first date of each plan year. The MCAP benefit is not available if enrolling in an HSA.  

The MCAP maximum contribution limit is $3,200 for the FY2025 plan year with a $640 maximum rollover. Participants who do not re­enroll for the new plan year will forfeit any amount eligible for rollover.

There are hundreds of eligible expenses for MCAP funds, including prescriptions, some over-the-counter items, doctor visit copays, health insurance deductibles and coinsurance.  MCAP funds may not be used for expenses that are covered under insurance. The employee will be responsible for reimbursing the FSA plan any amount claimed that was covered by insurance. Please refer to the Optum Financial Flexible Spending Account Reference Guide for a listing of eligible expenses or contact Optum Financial Customer Service at 888-469-3363.

MCAP Rollover

• Fiscal year 2025 MCAP funds – up to $640 –can roll over to the next plan year after the September 30th run-out period. Any amount remaining above the IRS allowed rollover amount will be forfeited. The rollover amount will be added to the new MCAP account in October. Employees may still contribute up to $3,200 a year regardless of carry-over amounts from the previous plan year. 
• Employees must re-enroll in MCAP for the new plan year in order to qualify for the rollover benefit. Participants who do not re-enroll for the new plan year will forfeit any monies remaining after the September 30^th run-out period. The MCAP benefit is not available if enrolling in an HSA.

Expense Reimbursement

• There are two ways to pay for health care expenses:
  • FSA Payment Card: This is a pre-loaded debit card that participants may use to swipe for eligible expenses. Eligible expenses are only those not covered by insurance. Ineligible expenses must be repaid. When using the FSA Payment Card, prescriptions, over-the-counter items, and standard copayments are paid directly out of the employee’s account often without the need to provide documentation to the plan administrator. However other expenses including vision and dental expenses still require an Explanation of Benefits (EOB). Please refer to the Optum Financial Flexible Spending Account Reference Guide for a listing of eligible expenses or contact Optum Financial Customer Service at 888-469-3363. Waiting for an Explanation of Benefits (EOB) to file for MCAP reimbursement? Find out what you should do by going to the Explanation of Benefits page.
    NOTE: The card has been programmed to work only at merchant locations that are designated as healthcare merchants based on their Merchant Category Code (MCC). Your FSA payment card can be used at health care-related merchants, such as hospitals and vision, dental and doctor’s offices. It can also be used at drugstores, pharmacies and grocery stores that have implemented the Inventory Information Approval System (IIAS) or certified 90% of their gross sales are FSA eligible. The payment card will not be able to be used at locations that are not approved health care merchants.
  • Pay with Personal Funds and Request Reimbursement: Pay using a personal credit card, cash, or check. Then, log on to the online account or Optum Financial Mobile app to file for reimbursement and upload the documentation. Use the Optum Financial Mobile app to snap a picture of the documentation and use the website to upload the picture of the documentation. A participant can also create a claim, print the MCAP Claim Form and submit the documentation via fax or mail.

MCAP Continuation

• MCAP participants who will be leaving payroll and wish to continue their MCAP account need to complete the MCAP Continuation Election form and submit the form to their agency group insurance representative (GIR) for processing prior to or at the time of termination, retirement or leave of absence. If the form is not submitted prior to leaving payroll, mail the completed form to CMS - Optional Tax Programs Unit, PO Box 19208, Springfield, Illinois 62794-9208. Those interested in continuing participation in MCAP through direct payments should contact their GIR as soon as possible or they may call the Optional Tax Programs Unit at 217-558-4509 or 800-442-1300. Please note: If the MCAP account has been terminated due to missed payroll deductions, it will not be activated until payment is received. 

Termination/Retirement

• A lump sum for the remainder of the plan year is required. Participants must have all remaining plan year MCAP deductions either:
  • Taken on a pre-tax basis: Payment would be deducted from the final paycheck or final lump sum payment check (sick time/vacation). This must be setup with an agency GIR prior to leaving employment.
  • Taken on a post-tax basis: Participants may write a check for the full amount due. Payment must be received to reinstate a participant’s MCAP account.

Unpaid Leave of Absence

• Payment for the period of time the employee is off payroll may be made:
  • On a post-tax basis through personal payments mailed directly to the Optional Tax Program Unit; please note no monthly bill will be mailed.

Employees who return to work from a leave of absence in which their enrollment in MCAP was terminated, may re-enroll for MCAP within 60 days of their return to payroll. Re-enrollment in MCAP is not a requirement. The effective date is the return to work date with payroll deductions beginning on the first day of the first full pay period following the member’s return to work date.

You cannot be enrolled in both an HSA and the MCAP Flexible Spending account.

Flexible Spending Account (FSA-MCAP) Forms and Publications

• MCAP Claim Form
• MCAP Continuation Election Form
• Optum Financial FSA Reference Guide