Health Care FSA

The Health Care flexible spending account (Health Care FSA) allows you to set aside before-tax dollars to help pay for eligible expenses in a given year

HEALTH CARE FSA

A Health Care FSA—serviced by Fidelity Investments®—allows you to reimburse yourself for eligible out-of-pocket health care expenses using before-tax dollars. For additional details about eligible expenses, see IRS Publication 502.

You can contribute up to $3,300 before-tax for 2026 (this is the contribution limit, even though the IRS’s annual contribution limit for 2026 is $3,400).

USING YOUR FSA

Once you enroll and make your FSA contribution election on MyBenefits Online, Fidelity sends you additional information (including a debit card called the NetBenefits® Access Card). You can then use your card to pay for eligible expenses, or you can submit claims for eligible expenses via the NetBenefits website.

The NetBenefits website is also where you go for account information throughout the year, including the status of any submitted claims.

CONTACT INFO & APPS

You forfeit unused amounts

You forfeit any amount remaining in your Health Care FSA at the end of the coverage period. If you participate in a Health Care FSA, you have until March 31, 2027, to submit claims for 2026 eligible expenses.

Important

If—as a MDLZ employee residing in the U.S.—you were enrolled in one of the two medical coverage options that’s paired with a Health Savings Account (HSA) under the Mondelēz Global Medical Plan and you contributed to your HSA, you can’t enroll in the Health Care FSA until the next plan year. Due to current law, you can’t contribute to an HSA and a Health Care FSA in the same plan year.

Looking for more details?

You can access more detailed information about the Health Care FSA, including an overview of eligible health care expenses, in the Summary Plan Description (SPD) posted under the Reference Center on MyBenefits Online. Or visit the NetBenefits website.

Features	Outside the U.S.	In the U.S.
Features	Outside the U.S.	Preferred Benefits (In-Network)	Non-Preferred Benefits (Out-of-Network)
Individual Deductible	$0 per calendar year	$700 per calendar year	$1,350 per calendar year
Family Deductible	$0 per calendar year	$1,400 per calendar year	$2,700 per calendar year
Prior Plan Credit	Does not apply
Individual Coinsurance Limit	$0 per calendar year	$3,000 per calendar year	$6,000 per calendar year
Does not include deductibles, copays, benefit penalties, 50% items, and Outpatient Prescription Drugs; includes Outpatient Prescription Drugs when outside the U.S.
Family Coinsurance Limit	$0 per calendar year	$6,000 per calendar year	$12,000 per calendar year
Does not include deductibles, copays, benefit penalties, 50% items, and Outpatient Prescription Drugs; includes Outpatient Prescription Drugs when outside the U.S.
Lifetime Maximum	Unlimited
Member Payment Percentages
Hospital Services
Inpatient	No charge	20% after deductible	40% after deductible
Outpatient	No charge	20% after deductible	40% after deductible
Private Room Limit	The institution’s semiprivate rate
Pre-certification Penalty	No penalty	No penalty	$400
To avoid penalties and/or benefit reductions for non-preferred benefits received in the U.S., contact the service center to determine if precertification is needed for a procedure.
Non-Emergency Use of the Emergency Room	No penalty	50% after deductible	50% after deductible
Emergency Room	No charge	20% after deductible	20% after deductible
Non-Urgent Use of Urgent Care Provider	No charge	20% after deductible	40% after deductible
Urgent Care	No charge	20% after deductible	40% after deductible
Ambulance	No charge	20% after deductible	40% after deductible
Physician Services
Physician Office Visit	No charge	20% after deductible	40% after deductible
Specialist Office Visit	No charge	20% after deductible	40% after deductible
Virtual Care and Virtual Primary Care	Not covered	No charge	Not covered
Walk-in Clinics	No charge	20% after deductible	40% after deductible
Designated Walk-in Clinics, no charge when outside the U.S. Walk-in Clinics are free-standing health care facilities that (a) may be located in or with a pharmacy, drug store, supermarket, or other retail store, and (b) provide limited medical care and services on a scheduled or unscheduled basis. Urgent care centers, emergency rooms, the outpatient department of a hospital, ambulatory surgical centers, and physician offices are not considered to be a Walk-in Clinic.
Mental Health Services*
Mental Health Inpatient Coverage (Unlimited days per calendar year)	No charge	20% after deductible	40% after deductible
Mental Health Outpatient Coverage (Unlimited visits per calendar year)	No charge	20% after deductible	40% after deductible
Alcohol/Drug Abuse Services*
Substance Abuse Inpatient Coverage (Unlimited days per calendar year)	No charge	20% after deductible	40% after deductible
Substance Abuse Outpatient Coverage (Unlimited visits per calendar year)	No charge	20% after deductible	40% after deductible
Other Services
Skilled Nursing Facility (120 days per calendar year)	No charge	20% after deductible	40% after deductible
Hospice Care Facility Inpatient (60 days lifetime maximum)	No charge	20% after deductible	40% after deductible
Hospice Care Facility Outpatient (Unlimited lifetime maximum)	No charge	20% after deductible	40% after deductible
Home Health Care (120 visits per calendar year)	No charge	20% after deductible	40% after deductible
Private Duty Nursing (70 shifts per calendar year)	No charge	20% after deductible	40% after deductible
Spinal Disorder Treatment (Unlimited visits per calendar year)	No charge	20% after deductible	25% after deductible
Short-Term Rehabilitation	No charge	20% after deductible	25% after deductible
Includes coverage for Occupational and Physical Therapies; unlimited visits per calendar year.
Speech Therapy	No charge	20% after deductible	40% after deductible
Includes coverage for Speech Therapies; 60 visits per calendar year.
Diagnostic Outpatient X-ray	No charge	20% after deductible	40% after deductible
Diagnostic Outpatient Lab	No charge	20% after deductible	40% after deductible
Bariatric Surgery (Unlimited per lifetime)	No charge	20% after deductible	40% after deductible
Base Infertility Services	No charge	20% after deductible	40% after deductible
Base plan coverage is limited to the testing and treatment of an underlying condition.
Other Services
Comprehensive Infertility Services	No charge	20% after deductible	40% after deductible
Six cycles of Comprehensive plan coverage include coverage of Artificial Insemination and Ovulation Induction.
ART Infertility Services	No charge	20% after deductible	40% after deductible
Six cycles per lifetime for Advanced Reproductive Technology (ART) coverage with cryopreservation, storage, and unlimited embryo transfers.
Autism	Autism covered same as any other expense Member cost sharing is based on the type of service performed and the place of service where it is rendered.
Payment for Non-Preferred Providers**	Not applicable	Not applicable	Professional: 105% of Medicare Facility: 140% of Medicare
Routine Hearing Exam (Includes one routine exam every 12 months.)	No charge	No charge	40% after deductible
Hearing Aids	No charge	20% after deductible	40% after deductible
One hearing aid per ear, up to $1,000 maximum per ear every three years, for child to age 24.
Aetna Assistance Program (Unlimited calendar year maximum)	No charge	No charge	No charge
Employee Assistance Program (EAP)	Included	Included	Included
Includes up to five counseling sessions per issue, per year, per enrolled member. Access benefits by calling the member service number on ID card: 1-800-231-7729 or collect 1-813-775-0190. Services include: cultural adjustment assistance, marital/family stress, child care and behavioral concerns, social adaptation needs, alcohol/substance abuse, work/life balance, and depression.
Wellness Benefits
Routine Children Physical Exams	No charge	No charge	No charge
Seven exams in the first 12 months of life, three exams in the second 12 months of life, three exams in the third 12 months of life, one exam per 12 months thereafter to age 22 (includes immunizations).
Routine Adult Physical Exams	No charge	No charge	No charge up to a $1,000 calendar-year maximum (includes immunizations, X-rays, and labs)
Adults age 22+ & -65: one exam/12 months; Adults age 65+: one exam/12 months (includes immunizations).
Routine Gynecological Exams	No charge	No charge	No charge
Includes one exam and pap smear per calendar year.
Mammograms (Unlimited visits per calendar year)	No charge	No charge	No charge
Prostate Specific Antigen (PSA) (Unlimited visits per calendar year)	No charge	No charge	No charge
Digital Rectal Exam (DRE) (Unlimited visits per calendar year)	No charge	No charge	No charge
Cancer Screening	No charge	No charge	No charge
Recommended: Members age 45 and older.
Prescription Drug Coverage
Generic Drugs (365-day maximum supply)	No charge	$10 copay per month supply (includes Mail Order Drugs)	40% no deductible
Brand Name Drugs (365-day maximum supply)	No charge	$20 copay per month supply (includes Mail Order Drugs)	40% no deductible
Vision Expenses
Routine Eye Exam	No charge	No charge	No charge up to a maximum of $35 after $10 per-visit deductible
Covered under medical. Includes one routine exam per calendar year.
Single, Bifocal, Trifocal & Lenticular Vision Lenses (Two lenses, once every calendar year)	No charge	No charge	No charge
Frames-Retail (Once every other calendar year)	No charge up to $100	No charge up to $100	No charge up to $100
Contact Lenses (In place of lens and frame allowances, once every calendar year)	No charge up to $110	No charge up to $110	No charge up to $110
Comprehensive Dental
Calendar Year Deductible	$50 per calendar year
Family Deductible	$150 per calendar year
Type A Expense (Diagnostic & Preventative)	No charge
Type B Expense (Basic Restorative)	20% after deductible
Type C Expense (Major Restorative)	50% after deductible
Type D Expense (Major Restorative)	50% after deductible
Orthodontic Treatment (Dependent children only)	50% after deductible
Calendar Year Maximum	$2,000
Orthodontic Lifetime Maximum	$2,000
TMJ Lifetime Maximum	$1,200
Implants Calendar Year Maximum	$2,000
Services and Programs Included in Quote
Informed Health Line (24-hour nurse line)		International Maternity Management Program
International Case Management		Well-Being Assessment
This Plan includes coverage under the extent required in accordance with the Federal Mental Health Parity and Addiction Equity Act (MHPAEA), beginning with plan years starting on or after January 1, 2018. * Payment for Non-Preferred Providers: We cover the cost of care differently based on whether health care providers, such as doctors and hospitals, are “in-network” or “out-of-network.”

Health Care FSA

The Health Care flexible spending account (Health Care FSA) allows you to set aside before-tax dollars to help pay for eligible expenses in a given year

You forfeit unused amounts

Important

Looking for more details?

What's Covered - ppo

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