Flexible Spending Account (FSA) Fact Sheet
Flexible Spending Account Introduction Letter and
Instructions for Direct Deposit Setup
Employees appointed to work more than 50% FTE on an annual basis are eligible to enroll for either or both of a Health Care Flexible Spending Account and a Dependent Care Flexible Spending Account. These Flexible Spending Accounts provide pre-tax reimbursement of expenses which would normally be paid with after-tax dollars.
Health Care Flexible Spending Account
This account provides pre-tax reimbursement of medical, dental, and vision care costs that are not reimbursed by a health insurance plan for you, your spouse, and your children who are your federal income tax dependents. These costs include expenses applied to meet a health plan deductible, copayments (e.g. a $20 office visit copayment or a 20% copayment for a dental x-ray), as well as certain items not covered by a health insurance plan. You may not be reimbursed for services before they are performed.
Eligible expenses must be incurred in the period for which you elected a Flexible Spending Account. They do not include expenses incurred before you made the FSA election, expenses incurred after your employment is terminated (unless you are eligible for and elect COBRA continuation for your FSA) or expenses incurred in the next year after the period for which you made your FSA election.
Dependent Care Flexible Spending Account
This account provides pre-tax reimbursement for childcare and other dependent care expenses that you incur so that you, and your spouse (if you are married), can work or attend school full time. The expenses must be incurred for a child who is under age 13 or for a physically or mentally disabled dependent who lives with you at least eight hours per day. The individual for whom care is provided must be your dependent for federal income tax purposes.
Enrollment for a Flexible Spending Account
The minimum contribution you can make to either a Health Care FSA or a Dependent Care FSA is $10 per month. The maximum contribution you can make to a Health Care FSA is $500 per month. The maximum contribution you can make to a Dependent Care FSA is $5,000 per year.
You may enroll for a Health Care FSA or Dependent Care FSA during the first 31 days of your eligible employment, annually during the Open Enrollment period for the following calendar year, and when you experience a qualifying change in family status such as your marriage, divorce, or the birth or death of a dependent during the year. You cannot change the amount of your FSA election or cease contributions to your FSA in mid-year unless you experience a qualifying change in family status and this change is consistent with the FSA change.
You must claim reimbursement for your qualifying expenses by the deadline for your election period (March 31 of the year following the calendar year of your election period). If you do not claim FSA reimbursement by the deadline for filing for reimbursement, you are ineligible for reimbursement of these expenses. FSA contributions are made on a “use it or lose it” basis.
Further questions about Flexible Spending Accounts can be directed to My Cafeteria Plan.com, at 1-800-865-6543 or at www.businessplansinc.com