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Debit Card Account Use For Contribution
The WageWorks FSA debit card Healthcare Most medical, dental, and vision $2,700 annual
is an easy way to keep cash in FSA care expenses not covered maximum
under the plan (e .g ., copays,
your pocket while using your FSA . deductibles, orthodontia expenses,
Many payments made with the lasik surgery, and prescription
card are approved automatically, eyewear) . May be used for eligible
dependents regardless of whether
so no further paperwork is they are covered under a DAWSON
required . Both healthcare and benefit plan .
dependent care expenses may be Dependent Dependent day care expenses $5,000 annual
paid with the debit card . Care FSA (e .g ., daycare, after school maximum; $2,500
programs for children under age if married and filing
If WageWorks cannot determine 13, or elder care programs for your separate tax returns
the use of your debit card is for legal tax dependents) so you and
an eligible expense, a request your spouse can work or attend
school full-time .
for substantiation will be sent
which will require you to submit
a copy of the receipt which
clearly indicates the nature of An Example of How the FSA Plans Work
the expense . The reason for
this request is to prove funds Semi-Monthly Deductions Without FSA With FSA
were used to pay eligible Gross Monthly Pay $1,000 $1,000
medical, dental, and vision care Dependent Day Care Spending ($104 .00)
expenses . Failure to respond to Account Contribution
substantiation requests will result Medical Spending Account ($25 .00)
Contribution
in the suspension of your debit
card . Taxable Pay $1,000 $871
Less FICA Taxes* ($77) ($66)
Less Federal Income Tax* ($200) ($174)
Take Home Pay $724 $631
Cost of Daycare ($104)
Cost of Un-Reimbursed Medical ($25)
Expenses
Discretionary Income $595 $631
* Please note the tax rate used in this example is an estimate . Actual tax rate will vary
based on local and state taxes in your area .
16 2019 Benefits Guide
The WageWorks FSA debit card Healthcare Most medical, dental, and vision $2,700 annual
is an easy way to keep cash in FSA care expenses not covered maximum
under the plan (e .g ., copays,
your pocket while using your FSA . deductibles, orthodontia expenses,
Many payments made with the lasik surgery, and prescription
card are approved automatically, eyewear) . May be used for eligible
dependents regardless of whether
so no further paperwork is they are covered under a DAWSON
required . Both healthcare and benefit plan .
dependent care expenses may be Dependent Dependent day care expenses $5,000 annual
paid with the debit card . Care FSA (e .g ., daycare, after school maximum; $2,500
programs for children under age if married and filing
If WageWorks cannot determine 13, or elder care programs for your separate tax returns
the use of your debit card is for legal tax dependents) so you and
an eligible expense, a request your spouse can work or attend
school full-time .
for substantiation will be sent
which will require you to submit
a copy of the receipt which
clearly indicates the nature of An Example of How the FSA Plans Work
the expense . The reason for
this request is to prove funds Semi-Monthly Deductions Without FSA With FSA
were used to pay eligible Gross Monthly Pay $1,000 $1,000
medical, dental, and vision care Dependent Day Care Spending ($104 .00)
expenses . Failure to respond to Account Contribution
substantiation requests will result Medical Spending Account ($25 .00)
Contribution
in the suspension of your debit
card . Taxable Pay $1,000 $871
Less FICA Taxes* ($77) ($66)
Less Federal Income Tax* ($200) ($174)
Take Home Pay $724 $631
Cost of Daycare ($104)
Cost of Un-Reimbursed Medical ($25)
Expenses
Discretionary Income $595 $631
* Please note the tax rate used in this example is an estimate . Actual tax rate will vary
based on local and state taxes in your area .
16 2019 Benefits Guide
