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0 3       F S A Basics




          The two most common FSAs are a Medical FSA and Dependent Care FSA. You can have both accounts
          at the same time, but you must enroll in and fund separate elections for each. For individuals contributing
          to a Health Savings Account, you may have the option to select a Limited Purpose FSA instead
          of the Medical FSA.



            M E D I C A L F S A                             D E P E N D E N T  C A R E F S A
            ( M E D I C A L E X P E N S E S  F O R Y O U R F A M I L Y )    ( D A Y C A R E  E X P E N S E S )

            What are these funds used for? Funds can be     What are these funds used for? Funds can be
            used to pay for eligible medical expenses provided   used for a qualified person, who is often one of
            to you, your spouse, or eligible dependents.    the following:
                                                            • A dependent child under the age of 13 for whom
            When can I start using the funds in my account?
                                                             you can claim a tax exemption.
            Your full plan year election is available to use on
                                                            • A spouse or dependent who is physically or
            the first day of the plan year.
                                                             mentally incapable of self-care and for whom
            What is an eligible expense? You can use these   you can claim a tax exemption.
            funds to pay for expenses that primarily prevent,
                                                            When can I start using the funds in my account?
            treat, diagnose or alleviate a physical or mental
                                                            Unlike a Medical FSA, your entire Dependent Care
            defect or illness. Common eligible expenses include:
                                                            FSA balance is not available at once. Dependent
                Copayments, coinsurance,                    Care funds become available as they are
                and deductible expenses                     deposited from payroll.
                Dental care (e.g. exams, fillings, crowns)   What is an eligible expense? You can pay for
                Vision care, eyeglasses, contact lenses     expenses that enable you or your spouse to be
                                                            gainfully employed, look for work, or attend school
                Chiropractic care
                                                            full-time. Common eligible expenses include:
                Prescription drugs and over-the-counter
                drugs and medicines                            Before and after school care, child care,
                                                               in-home dependent care, day care in a facility,
            What isn’t allowed?                                nursery school, and adult care
            • You cannot use these funds to pay for expenses   What isn’t allowed? You cannot use these funds
              that are for personal care, cosmetic, or general   to pay for services provided for education,
              health purposes.                              overnight camps, or services provided by the
                                                            child’s parent or other dependent for income
            • You cannot reimburse expenses from any other
                                                            tax purposes You also cannot claim a federal tax
              source (e.g. insurance).
                                                            credit for any expenses reimbursed through your
            • You cannot have a Medical FSA if you are enrolled  Dependent Care FSA. Consult a tax professional
              in a Health Savings Account (HSA). However,   to determine if a Dependent Care FSA or the
              a Limited Purpose FSA may be available.       federal tax credit would be more advantageous.

            What happens to funds I don’t use? Check your   What happens to funds I don’t use? Expenses
            plan highlights for information about how unused  must be incurred within the plan year. Refer to
            funds are treated.                              your plan highlights for deadlines to submit claims.
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