Page 23 - Guide
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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. Important
This includes out-of-pocket expenses for dental and vision care as well. Enrollment Note
You must actively elect any
Dependent Care lexible spending account (FSA)
funds every year. If you had an
You may use your dependent care spending account to pay for daycare FSA last year you must re-elect
expenses for a dependent under the age 13. Reimbursement through the the beneit this year. We cannot
dependent care account will be allowed only up to the current account automatically re-enroll you with
balance. Eligible expenses include: last year’s election. Employees
are not allowed to change the
Payments to a licensed daycare or nursery school amounts of deductions during the
Before and after school care or summer day care year unless they have a change in
family status.
2017 Maximum Contributions
Healthcare $2,600
Dependent care $5,000
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.
23
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. Important
This includes out-of-pocket expenses for dental and vision care as well. Enrollment Note
You must actively elect any
Dependent Care lexible spending account (FSA)
funds every year. If you had an
You may use your dependent care spending account to pay for daycare FSA last year you must re-elect
expenses for a dependent under the age 13. Reimbursement through the the beneit this year. We cannot
dependent care account will be allowed only up to the current account automatically re-enroll you with
balance. Eligible expenses include: last year’s election. Employees
are not allowed to change the
Payments to a licensed daycare or nursery school amounts of deductions during the
Before and after school care or summer day care year unless they have a change in
family status.
2017 Maximum Contributions
Healthcare $2,600
Dependent care $5,000
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.
23
