Page 10 - 2022 DPR Construction Benefit Guide_Administrative Employees

Flexible Spending Accounts

Flexible Spending Accounts (FSAs) allow you to pay for eligible health care and day care expenses using
tax-free dollars. There are three types of FSAs – the Health Care FSA, the Limited Purpose FSA and
the Day Care FSA:

Used to pay for services not covered by your medical, dental or vision plan such as copays, coinsurance,
Health Care deductibles, prescription expenses, lab exams and tests, contact lenses and eyeglasses. If you enroll in the Health
FSA Care FSA and then decide to move to the Cigna HDHP/HSA, then your funds up to the carryover amount (listed
below) will carry over into a Limited Purpose FSA.

Limited Purpose Used if you are enrolled in the Cigna HDHP medical plan; it works the same way as the standard Health Care FSA;
FSA however, you may only use it to pay for eligible vision and dental expenses.

Used to pay for day care expenses associated with caring for elder or child dependents that
Day Care are necessary for you and your spouse/domestic partner to work or attend school full-time.
FSA
You cannot use your Health Care FSA to pay for Day Care expenses.

HEALTH CARE FSA* LIMITED PURPOSE FSA* DAY CARE FSA*

Contribute up to $5,000 per year,
Contribute up to $2,850 per year, pre-tax. Contribute up to $2,850 per year, pre-tax. pre-tax, or $2,500 if married and filing
separate tax returns.

Only for those enrolled in the High You must submit claims and be
Receive a debit card to pay for Deductible Health Plan (HDHP). Receive a
eligible medical expenses. reimbursed if you enroll in this
debit card to pay for eligible expenses. FSA; no debit cards are provided.

To pay for eligible medical, dental and Use a debit card to pay for eligible dental Can only be used to pay for eligible
vision copays, coinsurance, deductibles, and vision expenses only (eyeglasses or day care expenses including day care,
and prescription or over-the-counter contact lenses, dental or vision copays, after-school programs, summer camps
medication copayments, as well as orthodontia, etc.). and elder care programs.
eyeglasses or contact lenses, etc.

Submit claims up to 60 days after the
Carryover up to $570, which can be Carryover up to $570, which can be used
following year starts for expenses incurred
used during the following year. during the following year.
from January 1 to December 31.

* Any required legislated changes will be complied with. Please visit the Navia section in the HR Toolbox for more info.

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