Page 25 - Franklin Madison 2022 Benefits Guide
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Paying Eligible Expenses Ineligible Expenses


You may pay for your healthcare-related expenses You may not use your Dependent Care FSA to pay
with your WageWorks debit card—or you may for daycare-related expenses such as:
pay the healthcare provider directly and then ile y Care provided for non-work related reasons
a claim for reimbursement. If you ile a claim for
reimbursement, you will need to complete an FSA y Private school (kindergarten and higher)
claim form and submit it by mail or fax, along with y Overnight camp
your receipts. If you are iling a claim for an over- y Transportation or clothing costs
the-counter expense, you must include a copy of
the prescription. y Healthcare costs for dependents

You will receive your personalized WageWorks Paying Eligible Expenses
Debit Card by mail, along with instructions for iling You should pay your dependent care provider
claims and requests for reimbursements once your directly and then ile a claim for reimbursement.
enrollment is efective. Complete an FSA claim form and submit it by
e-mail, regular mail or fax along with your receipts.
Dependent Care FSA

The Dependent Care FSA lets you pay for eligible Tracking Your Account Balance and
dependent care expenses such as day care, nursery the Status of Your FSA Claims
school or summer day camp. The care must enable Online
you and your spouse to work, look for work or
attend school full-time. You can contribute from Log on to www.wageworks.com. You can review
$100 to $5,000 each year to this account.* secure, personal account information and claim
status, download claim forms, and more.
* If you are married and your spouse has a separate dependent
care FSA through his or her employer, the combined total of your
deposits cannot exceed 5,000. (If you ile separate tax returns, As a irst-time user you will be prompted to:
you and your spouse can each contribute up to $2,500.) And, you
cannot deposit more than your income or your spouse’s, whichever y Enter your personal information
is lower.
y Create a User Name and Password
Eligible Expenses
You can use your Dependent Care FSA to pay for By Phone
daycare-related expenses such as: Call 877.WageWorks (877.924.3967), Monday
through Friday from 8 a.m. to 8 p.m. ET. You can
y Babysitting and Au Pair services speak to a representative.
y Before- and after-school programs

y Day care centers or individuals who provide care
in or out of your home
y Elder care services

y Nursery pre-school programs

y Summer day camp



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