Page 11 - 2022-23 Drug Plastics Benefit Guide

Optum Flexible Spending Accounts

A Flexible Spending Account (FSA) helps you pay for health care or dependent care costs using
tax-free dollars. Your contribution is deducted from your paycheck on a pretax basis and is put
into the FSA. When you incur expenses, you can access the funds in your account to pay for
eligible expenses. This chart shows the eligible expenses for each FSA and how much you can
contribute each year. Each of these options reduces your taxable income.

Account type Eligible expenses Annual contribution limits

Most medical, dental and vision care expenses that Maximum contribution is $2,850 per year.
are not covered by your health plan (such as copays, You cannot enroll if you are enrolled in the
coinsurance, deductibles, eyeglasses and prescriptions) PPO (HSA) Green Plan.
Note: Participants will be issued a spending card to Funds are deducted throughout the year,
Health Care FSA pay for out-of-pocket expenses. Certain plan charges but all funds are available on August 1.
will not require additional paperwork to receive
reimbursement, such as plan copays or prescriptions.
Others could require validation with receipts although
payment was made using the card.

Dependent care expenses (such as day care, after Maximum contribution is $5,000 per year
school programs or elder care programs) for children ($2,500 if married and filing separate
Dependent Care FSA
under age 13 or elder care so you and your spouse tax returns).
can work or attend school full-time

Important information about FSAs

Your FSA elections are effective from August 1, 2022 through July 31, 2023. The Grace Period ends on
October 15, 2023 and claims for reimbursement must be submitted by January 15, 2024.

Please plan your contributions carefully. Any unused money remaining in your account(s) will be forfeited.
This is known as the “use it or lose it” rule and it is governed by Internal Revenue Service regulations. Note that
FSA elections do not automatically continue from year to year; you must actively enroll each year.

With Health Care FSA Without Health Care FSA
Annual Salary Before Taxes $30,000 $30,000
Less Health Care FSA Contribution -$2,000 $0
Taxable Income $28,000 $30,000

Less Income Taxes & Social Security (22%) -$6,160 -$6,600
Take-Home Pay $21,840 $23,400
Less Medical Care Expenses $0 -$2,000
Net Pay You Can Spend $21,840 $21,400
Tax Savings $440 $0

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