Page 7 - 2020-21 Sample Benefits Guide
P. 7
[Company Name] Benefits Enrollment Guide
Flexible Spending Account (FSA)
A lexible spending account (FSA) allows you to set aside pre-tax dollars from your paycheck to cover qualiied
expenses you would normally pay out of your pocket. We offer [one/two/three] types of FSA programs.
Healthcare FSA Use It or Lose It
The healthcare FSA helps you pay for certain IRS- Carefully consider your FSA contribution amounts for
approved medical expenses not covered by your the plan year. At the end of the year or grace period,
insurance plan with pre-tax dollars. The maximum you lose any money left over in your FSA.
contribution to the healthcare FSA is $2,700 per plan
year.
Eligible Expenses
Funds you elect to contribute to the healthcare FSA Healthcare FSA
are available in full on the irst day of the plan year. Doctor’s visit copays
For example, if you elect to contribute $1,000, the full
election is available to you on day one. You’ll continue Prescription drug copays
to pay for the election pre-tax from your paycheck Medical and dental deductibles
throughout the plan year. Over-the-counter medications (with a written
prescription)
Limited Health FSA Hearing aids
The limited health FSA is similar to the healthcare FSA Eyeglasses
except you are limited to spending your pre-tax dollars
on eligible dental and vision care services only. Limited Health FSA
Hearing aids
Dependent Care FSA Eyeglasses
The dependent care FSA lets you set aside pre-tax Dental cleanings
dollars to use toward qualiied dependent care. The Eye exams
maximum amount you may contribute to the dependent Dependent Care FSA
care FSA is $5,000 (or $2,500 if married and iling Cost of child or adult daycare*
separately) per plan year. Funds you contribute to the
dependent care FSA function like a debit card; you need Nursery school
to accumulate the funds before you can use them. Preschool (excluding kindergarten)
* An eligible dependent is a tax dependent child under age
13 or a tax dependent spouse, parent, or child unable to care for
themselves.
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Flexible Spending Account (FSA)
A lexible spending account (FSA) allows you to set aside pre-tax dollars from your paycheck to cover qualiied
expenses you would normally pay out of your pocket. We offer [one/two/three] types of FSA programs.
Healthcare FSA Use It or Lose It
The healthcare FSA helps you pay for certain IRS- Carefully consider your FSA contribution amounts for
approved medical expenses not covered by your the plan year. At the end of the year or grace period,
insurance plan with pre-tax dollars. The maximum you lose any money left over in your FSA.
contribution to the healthcare FSA is $2,700 per plan
year.
Eligible Expenses
Funds you elect to contribute to the healthcare FSA Healthcare FSA
are available in full on the irst day of the plan year. Doctor’s visit copays
For example, if you elect to contribute $1,000, the full
election is available to you on day one. You’ll continue Prescription drug copays
to pay for the election pre-tax from your paycheck Medical and dental deductibles
throughout the plan year. Over-the-counter medications (with a written
prescription)
Limited Health FSA Hearing aids
The limited health FSA is similar to the healthcare FSA Eyeglasses
except you are limited to spending your pre-tax dollars
on eligible dental and vision care services only. Limited Health FSA
Hearing aids
Dependent Care FSA Eyeglasses
The dependent care FSA lets you set aside pre-tax Dental cleanings
dollars to use toward qualiied dependent care. The Eye exams
maximum amount you may contribute to the dependent Dependent Care FSA
care FSA is $5,000 (or $2,500 if married and iling Cost of child or adult daycare*
separately) per plan year. Funds you contribute to the
dependent care FSA function like a debit card; you need Nursery school
to accumulate the funds before you can use them. Preschool (excluding kindergarten)
* An eligible dependent is a tax dependent child under age
13 or a tax dependent spouse, parent, or child unable to care for
themselves.
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