Page 16 - 2022 Penn Engineering Guide

Flexible Spending Accounts

Use the following worksheet to estimate the amount of your health care expenses that will not Making Changes – FSA’s
be covered under the Medical Plan. This will help you decide how much of your annual base
earnings to contribute to the Health Care FSA. You can change the amount of
your contribution during the
Your expected share of medical coverage (deductibles $ Plan Year only if you have a
and co- payments) + change in family status as

Medical, dental and vision expenses exceeding plan defined by the IRS. A change in
$ family status is marriage or
maximums +
divorce, the birth, adoption or
Health care expenses not covered by the Medical or Dental $ placement for adoption of a
Plan + child, the death of a
dependent or your spouse’s
Total: Consider contributing this annual amount to your $
account (up to $2,850 per year) = loss of employment. Your
change must be consistent
Your Dependent Care FSA with your family status
You may use your Dependent Care FSA for child or dependent care expenses that are necessary change.
for you or your spouse to work outside the home. If your spouse is a full-time student, child and
If you have outstanding claims
dependent care expenses are also reimbursed within certain limits.
at the end of the Plan Year
that were incurred during the
You may contribute up to $5,000 a year to your Dependent Care FSA ($2,500 if you are married
Plan Year, you may file a claim
but file separate federal tax returns). The IRS places this total limit on the amount of dependent
up to March 31st of the
care expenses that can be reimbursed. If you or your spouse’s income for the year is less than following year. Any money left
$5,000, your Dependent Care FSA contributions will be limited to this amount. You may be in either of your FSA accounts
asked to provide proof of your spouse’s income. is automatically forfeited.

Eligible dependent care expenses include: For more details on eligible
• the cost of a day care center (but not school), health care expenses and
• a summer day camp, excluding boarding or overnight camps, or dependent care expenses,
refer to IRS Publication 502
• a sitter in your home to care for an eligible dependent while you work.
and 503.

When you incur an eligible expense, you pay the expense first; then file for reimbursement
Use It or Lose It. Plan
from your Dependent Care Flexible Spending Account. For your claim to be processed, you carefully!
will need to include the Social Security number (SSN) or the Tax Identification number (TIN) of The IRS requires that you
your dependent care provider on your claim form. After your claim is processed, you will be forfeit any unused amounts
reimbursed for the expense, up to your current account balance. If your claim exceeds your left in your FSA at the end of
current account balance, you will receive the remainder of the reimbursement, up to the the Plan Year.

amount of your annual election, as the money is deducted from your pay and deposited into

your account.

If you use the Dependent Care FSA, you can’t use the dependent care federal tax credit
for the same expenses when you file your income tax returns.

Filing Claims
Using your debit card, there is no need to file a paper claim. It is important to save your paid

receipt; you may be asked to provide proof of your expense. Claims may be submitted through

a Provider, On-line submission, EZ Receipts, Pay my Provider, or Pay me Back features through

WageWorks®. Claims are processed daily and you can elect Direct deposit or check
reimbursement. 15