Page 19 - Guide
P. 19
Flexible Spending Accounts (FSA)
Flexible Spending Account (FSA) What Documentation Is
Needed?
Use lexible beneits to bring home more of your paycheck. Documentation for medical
An FSA allows you to set aside a portion of your salary, before taxes, expenses, required by the IRS,
to pay for qualiied medical or dependent care expenses. Because that includes a third-party receipt
portion of your income is not taxed, you end up with more money in containing the following
your pocket. Any unused funds at the end of the year will be forfeited. information:
If you terminate employment, only expenses incurred before your
termination date are eligible expenses under the FSA. Date service was received or
purchase made
Changes to your FSA Description of service or item
If you choose to elect the CDHP medical plan with HSA, you will no purchased
longer be able to elect the healthcare FSA. FSA contributions are not Dollar amount (after
allowed along side HSA contributions. You may however, still elect to insurance, if applicable)
contribute to the dependent care FSA. Prescription drug number or
Healthcare name
You can use your FSA to pay for copays, healthcare deductibles, and other
out-of-pocket expenses which are not covered under your beneit plans.
This includes out-of-pocket expenses for dental and vision care as well.
Dependent Care
You may use your dependent care spending account to pay for daycare
expenses for a dependent under the age 13. Reimbursement through the Important
dependent care account will be allowed only up to the current account Enrollment Note
balance. Eligible expenses include: You must actively elect any
lexible spending account (FSA)
Payments to a licensed daycare or nursery school funds every year. If you had an
Before and after school care or summer day care FSA last year you must re-elect
the beneit this year. We cannot
2017 Maximum Contributions automatically re-enroll you with
Healthcare $2,600 last year’s election. Employees
Dependent care $5,000 are not allowed to change the
amounts of deductions during the
year unless they have a change in
family status.
Remember, you cannot have a Healthcare FSA if you or a spouse is contributing
to an HSA. Refer back to page 6 for more details.
19
Flexible Spending Account (FSA) What Documentation Is
Needed?
Use lexible beneits to bring home more of your paycheck. Documentation for medical
An FSA allows you to set aside a portion of your salary, before taxes, expenses, required by the IRS,
to pay for qualiied medical or dependent care expenses. Because that includes a third-party receipt
portion of your income is not taxed, you end up with more money in containing the following
your pocket. Any unused funds at the end of the year will be forfeited. information:
If you terminate employment, only expenses incurred before your
termination date are eligible expenses under the FSA. Date service was received or
purchase made
Changes to your FSA Description of service or item
If you choose to elect the CDHP medical plan with HSA, you will no purchased
longer be able to elect the healthcare FSA. FSA contributions are not Dollar amount (after
allowed along side HSA contributions. You may however, still elect to insurance, if applicable)
contribute to the dependent care FSA. Prescription drug number or
Healthcare name
You can use your FSA to pay for copays, healthcare deductibles, and other
out-of-pocket expenses which are not covered under your beneit plans.
This includes out-of-pocket expenses for dental and vision care as well.
Dependent Care
You may use your dependent care spending account to pay for daycare
expenses for a dependent under the age 13. Reimbursement through the Important
dependent care account will be allowed only up to the current account Enrollment Note
balance. Eligible expenses include: You must actively elect any
lexible spending account (FSA)
Payments to a licensed daycare or nursery school funds every year. If you had an
Before and after school care or summer day care FSA last year you must re-elect
the beneit this year. We cannot
2017 Maximum Contributions automatically re-enroll you with
Healthcare $2,600 last year’s election. Employees
Dependent care $5,000 are not allowed to change the
amounts of deductions during the
year unless they have a change in
family status.
Remember, you cannot have a Healthcare FSA if you or a spouse is contributing
to an HSA. Refer back to page 6 for more details.
19
