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Flexible Spending Accounts (FSAs)

Flexible Spending Accounts (FSAs) allow you to pay for eligible out-of-pocket health
and/or dependent care expenses through pretax payroll deductions. You determine

how much you want to contribute each year to one or both accounts. Each pay
period, funds are deducted from your pay on a pretax basis and are deposited to your

FSA, which decreases your taxable income.

Health Care FSA

Eligible Expenses: Most medical, dental and vision care
expenses that are not covered by your health plan (such
as copayments, coinsurance, deductibles, eyeglasses and
doctor-prescribed over the counter medications)
Maximum Contribution Limit: $2,750 per year

Dependent Care FSA

Eligible Expenses: Payments to licensed day care facilities,
before- or after-school programs, in-home child care, and
elder care
Maximum Contribution Limit: $5,000 per year ($2,500 if
married and filing separate tax returns)

Important Information About FSAs

• Your elections are in effect from January 1 through
December 31.
• Unused funds are forfeited if not used by December
31 (claims must be submitted no later than March
31 of the following year).

• Save your receipts! Health Equity and/or the IRS may
require you to submit a receipt to prove eligibility of a
reimbursed expense.

• The Health Care FSA is not available to those
enrolled in a Health Savings Account (HSA).

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