Page 25 - OpenX 2022 Book of Benefits

ACCOUNT TYPE ELIGIBLE EXPENSES ANNUAL CONTRIBUTION LIMITS

Maximum contribution is $2,750 per year.
Most medical, dental and vision care
expenses that are not covered by You cannot enroll if you are enrolled in the
Health Care FSA your health plan (e.g., copayments, CDHP+HSA Plan.
coinsurance, deductibles,
Funds are deducted throughout the year,
eyeglasses and prescriptions).
but all funds are available on January 1.

Dental and vision expenses that are Maximum contribution is $2,750 per year.
not covered by your health plan
This is available to those enrolled in the
(e.g., copayments, coinsurance,
Limited Purpose FSA CDHP plan with an HSA.
deductibles, eyeglasses, contact
lenses and lens solution, dental Funds are deducted throughout the year,
cleanings and fillings). but all funds are available on January 1.

Maximum contribution is $5,000 per year
Dependent care expenses (e.g., day ($2,500 if married and filing separate tax
care, after-school programs and returns). This is available to all employees
elder care programs) for children with qualifying dependents, regardless of
Dependent Care FSA medical plan enrollment.
under age 13 or elder care so you
and your spouse can work or attend Funds are deducted throughout the year
school full time. and must be in the account for you to
reimburse yourself.

Important information about FSAs
Your FSA elections are effective from January 1 through December 31. Claims for reimbursement must
be submitted by March 31 of the following year. This is known as the grace period. Our Healthcare and
Limited-Purpose FSAs allow you to carry over to the following year up to $550 in unused funds.

Please plan your contributions carefully. Any unused money over $550 that remains in your HCFSA or LPFSA
and any amount in your DCFSA account(s) will be forfeited after the grace period. 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.

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