Page 12 - Ampact 2022 Benefit Guide

Flexible Spending Account (FSA)

A Flexible Spending Account (FSA) helps you pay for health care (including several over-the-counter items),
dependent care, or transit costs using tax-free dollars. Health Care and Limited Purpose Flexible Spending

Accounts–total contributions are preloaded and immediately available for use at the beginning of the plan
year and deducted in equal amounts per paycheck.

Health Care FSA

This allows you to pay with pre-tax dollars for certain IRS- Important information about FSAs

approved health care expenses not covered by your
insurance. The current annual maximum amount you Your Flexible Spending Account (FSA) elections are

can elect to contribute to the plan is $2,850 (2022) effective from August 1, 2022, through July 31, 2023.
Expenses can be incurred by you, your Claims for reimbursement must be submitted by

spouse/domestic partner or eligible dependents. You October 29, 2023. Please plan your contributions
may roll over up to $570 to the next plan year. carefully. Any money remaining in your Health Care FSA
Examples include:
• Your medical plan’s co-pays, deductible and or Limited Purpose FSA over $570 and any amount in
coinsurance your Dependent Care FSA as of July 31, 2023, will be
• Medical supplies such as hearing aids, crutches, forfeited. This is known as the “use it or lose it” rule and it
and orthopedic shoes is governed by IRS regulations. Note that FSA elections
• Vision services, including contact lenses, do not automatically continue from year to year; you
contact lens solution, eye examinations,
must actively enroll each year. Please visit IRS.gov for a
eyeglasses and laser eye surgery list of eligible medical expenses.
• Dental services and orthodontia
• Chiropractic services and Acupuncture

Dependent Care FSA
The Dependent Care FSA allows you to use pre-tax dollars to pay for qualified dependent care expenses such as
caring for children under age 13 or caring for elders. The annual maximum amount you may contribute to the

Dependent Care FSA is $5,000 (or $2,500 if married and filing separately) per plan year. Dependent care dollars do
not roll over to the next plan year. Examples include:
• The cost of child or adult dependent care
• The cost for an individual to provide care either in or out of your house

• Nursery schools and preschools

Limited Purpose FSA Transit /Parking FSA
The limited purpose FSA is only available if you have Transit/Parking FSA allow you to set aside pre-tax dollars for

elected a high deductible health plan. This plan is IRS-approved parking or mass-transit commuting expenses.
paired with an HSA and allows you to use pre-tax Unlike traditional FSAs, the IRS does not have a "use it or lose

dollars for eligible dental and vision expenses only. it" rule for the parking or transit FSAs. Any funds unused at
You may roll over up to $570 to the next plan year. the end of the plan year are rolled over to the next year.

Current Annual Maximum Contributions

Medical FSA Dependent Care Limited Purpose Transit/Parking
FSA FSA FSA
$2,850 $5,000 $2,850 $280 per month

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Effective August 1, 2022-July 31, 2023