Page 31 - 2022 SoFi - August Open Enrollment

What happens to my FSA upon termination from SoFi?
ƒ Your Flexible Spending Accounts will terminate upon your termination of employment from SoFi.
ƒ For your Health Care (including Limited) FSA, eligible health expenses provided prior to your date of termination
will be eligible for reimbursement. However, services provided after your termination date are NOT eligible
unless you are eligible for and elect to continue coverage under COBRA. If you had a Health Care FSA with
a positive balance at the time of your separation from SoFi, you will receive notice from P&A Group with
information on continuing your FSA through COBRA. If you are not sure if your FSA is COBRA eligible you may
call 800-688-2611.
ƒ Your Dependent Care FSA balance will be available for reimbursement for eligible services provided at
any time within the Plan Year. To obtain a claim form, please visit www.padmin.com or contact P&A Group
at 800-688-2611.

OCTOBER 1, 2022 – DECEMBER 31, 2022

Health Care FSA Dependent Care FSA Limited Health Care FSA
(Cigna HDHP Enrollees only)
Provider Information P&A Group: www.padmin.com

Employees who are not Employees with children Employees who are
enrolled in the Cigna Choice under the age of 13, enrolled in the Cigna
Who is eligible for this plan?
Fund HSA. where both parents work Choice Fund HSA.
or go to school full-time.
Up to $712.50 per employee Up to $1,250. IRS restricts a Up to $712.50 per employee
Maximum contribution amount calendar year per household
limit of $1,250.*
Eligible Expenses Eligible Expenses Eligible Expenses
• Health related costs • Child Care • Dental and vision
(medical, dental, • Preschool expenses
and vision copays)
• Before or after-school care • Orthodontia expenses
• Prescription medication Ineligible Expenses Ineligible Expenses
What expenses are allowed?
Ineligible Expenses • Education expenses • Medical expenses
• Cosmetic surgery (copays, medication,
• Transportation expenses
• Non-prescription for childcare and other health
medication related costs)
• Insurance premiums • Dependent care expenses
The IRS will allow up to Use it or lose it. The IRS will The IRS will allow up to
$570 of unused health care not allow unused Dependent $570 of unused health care
funds to carryover to the Care funds to be rolled funds to carryover to the
next plan year. You must over. Consult your full plan next plan year. You must
What happens to the account elect a minimum of $150 summary for more details. elect a minimum of $150
funds at the end of the year? for the next plan year in for the next plan year in
order to be eligible for any order to be eligible for any
rollover funds. rollover funds.
Consult your full plan Consult your full plan
summary for more details. summary for more details.
*Highly compensated employees may have a lower DCFSA limit, subject to IRS testing.
This is a partial summary of benefits only. The Summary Plan Description (SPD) contains a complete detail of benefits, limitations and exclusion.
The SPD also describes grievance procedures for disputes. We strongly encourage you to review the SPD before applying for coverage. You may
obtain a copy from the People Team.

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