Page 7 - Benefits Guide
P. 7
FLEXIBLE SPENDING ACCOUNT Eligible Expenses
(FSA) Healthcare FSA
A lexible spending account (FSA) allows you to set aside pre-tax dollars z Doctor’s visit copays
from your paycheck to cover qualiied expenses you would normally pay z Prescription drug copays
out of your pocket. We offer [one/two/three] types of FSA programs. z Medical and dental
deductibles
Healthcare FSA z Over-the-counter medications
(with a written prescription)
The healthcare FSA helps you pay for certain IRS-approved medical care z Hearing aids
expenses not covered by your insurance plan with pre-tax dollars. The z Eyeglasses
maximum contribution to the healthcare FSA is $2,650 per plan year.
Limited Health FSA
Funds you elect to contribute to the healthcare FSA are available in full z Hearing aids
on the irst day of the plan year. For example, if you elect to contribute z Eyeglasses
$1,000, the full election is available to you on day one. You’ll continue to z Dental cleanings
pay for the election pre-tax from your paycheck throughout the plan year. z Eye exams
Dependent Care FSA
Limited Health FSA z Cost of child or adult
daycare*
The limited health FSA is similar to the healthcare FSA except you are z Nursery school
limited to spending your pre-tax dollars on eligible dental and vision care z Preschool (excluding
services only. kindergarten)
* An eligible dependent is a tax
Dependent Care FSA dependent child under age 13
or a tax dependent spouse,
The dependent care FSA lets you set aside pre-tax dollars to use toward parent, or child unable to care for
themselves.
qualiied dependent care. The maximum amount you may contribute
to the dependent care FSA is $5,000 (or $2,500 if married and iling
separately) per plan year. Funds you contribute to the dependent care FSA
function like a debit card; you need to accumulate the funds before you
can use them.
Use It or Lose It
Carefully consider your FSA contribution amounts for the plan year. At
the end of the year or grace period, you lose any money left over in your
FSA.
[Client Name] 7 7
(FSA) Healthcare FSA
A lexible spending account (FSA) allows you to set aside pre-tax dollars z Doctor’s visit copays
from your paycheck to cover qualiied expenses you would normally pay z Prescription drug copays
out of your pocket. We offer [one/two/three] types of FSA programs. z Medical and dental
deductibles
Healthcare FSA z Over-the-counter medications
(with a written prescription)
The healthcare FSA helps you pay for certain IRS-approved medical care z Hearing aids
expenses not covered by your insurance plan with pre-tax dollars. The z Eyeglasses
maximum contribution to the healthcare FSA is $2,650 per plan year.
Limited Health FSA
Funds you elect to contribute to the healthcare FSA are available in full z Hearing aids
on the irst day of the plan year. For example, if you elect to contribute z Eyeglasses
$1,000, the full election is available to you on day one. You’ll continue to z Dental cleanings
pay for the election pre-tax from your paycheck throughout the plan year. z Eye exams
Dependent Care FSA
Limited Health FSA z Cost of child or adult
daycare*
The limited health FSA is similar to the healthcare FSA except you are z Nursery school
limited to spending your pre-tax dollars on eligible dental and vision care z Preschool (excluding
services only. kindergarten)
* An eligible dependent is a tax
Dependent Care FSA dependent child under age 13
or a tax dependent spouse,
The dependent care FSA lets you set aside pre-tax dollars to use toward parent, or child unable to care for
themselves.
qualiied dependent care. The maximum amount you may contribute
to the dependent care FSA is $5,000 (or $2,500 if married and iling
separately) per plan year. Funds you contribute to the dependent care FSA
function like a debit card; you need to accumulate the funds before you
can use them.
Use It or Lose It
Carefully consider your FSA contribution amounts for the plan year. At
the end of the year or grace period, you lose any money left over in your
FSA.
[Client Name] 7 7
