Page 23 - 2016 Enrollment
P. 23
American Food & Vending
Flexible Spending Accounts (FSA)
Flexible Spending Account (FSA) What Documentation Is
Use lexible beneits to bring home more of your paycheck. Needed?
An FSA allows you to set aside a portion of your salary, before taxes, Documentation for medical expenses,
required by the IRS, includes a third-
to pay for qualiied medical or dependent care expenses. Because party receipt containing the following
that portion of your income is not taxed, you end up with more information:
money in your pocket. Any unused funds at the end of the year will
be forfeited. If you terminate employment, only expenses incurred Date service was received or
before your termination date are eligible expenses under the FSA. purchase made
Description of service or item
Changes to your FSA purchased
If you choose to elect the CDHP medical plan with HSA, you will no Dollar amount (after insurance, if
longer be able to elect the Healthcare FSA. FSA contributions are not applicable)
allowed along side HSA contributions. You may however, still elect to
contribute to the Dependent Care FSA. Prescription drug number or name
Healthcare
You can use your FSA to pay for copays, healthcare deductibles,
and other out-of-pocket expenses which are not covered under your
beneit plans. This includes out-of-pocket expenses for dental and Important Enrollment
vision care as well. Note
You must actively elect any lexible
Dependent Care spending account (FSA) funds every year.
You may use your dependent care spending account to pay for If you had an FSA last year you must
daycare expenses for a dependent under the age 13. Reimbursement re-elect the beneit this year. We cannot
through the dependent care account will be allowed only up to the automatically re-enroll you with last year’s
election. Employees are not allowed to
current account balance. Eligible expenses include: change the amounts of deductions during
the year unless they have a change in
Payments to a licensed daycare or nursery school family status.
Before and after school care or summer day care
2016 Maximum Contributions
Healthcare $2,550
Dependent care $5,000
Remember, you cannot have a Healthcare FSA if you or a spouse is
contributing to an HSA. Refer back to page 7 for more details.
23
Flexible Spending Accounts (FSA)
Flexible Spending Account (FSA) What Documentation Is
Use lexible beneits to bring home more of your paycheck. Needed?
An FSA allows you to set aside a portion of your salary, before taxes, Documentation for medical expenses,
required by the IRS, includes a third-
to pay for qualiied medical or dependent care expenses. Because party receipt containing the following
that portion of your income is not taxed, you end up with more information:
money in your pocket. Any unused funds at the end of the year will
be forfeited. If you terminate employment, only expenses incurred Date service was received or
before your termination date are eligible expenses under the FSA. purchase made
Description of service or item
Changes to your FSA purchased
If you choose to elect the CDHP medical plan with HSA, you will no Dollar amount (after insurance, if
longer be able to elect the Healthcare FSA. FSA contributions are not applicable)
allowed along side HSA contributions. You may however, still elect to
contribute to the Dependent Care FSA. Prescription drug number or name
Healthcare
You can use your FSA to pay for copays, healthcare deductibles,
and other out-of-pocket expenses which are not covered under your
beneit plans. This includes out-of-pocket expenses for dental and Important Enrollment
vision care as well. Note
You must actively elect any lexible
Dependent Care spending account (FSA) funds every year.
You may use your dependent care spending account to pay for If you had an FSA last year you must
daycare expenses for a dependent under the age 13. Reimbursement re-elect the beneit this year. We cannot
through the dependent care account will be allowed only up to the automatically re-enroll you with last year’s
election. Employees are not allowed to
current account balance. Eligible expenses include: change the amounts of deductions during
the year unless they have a change in
Payments to a licensed daycare or nursery school family status.
Before and after school care or summer day care
2016 Maximum Contributions
Healthcare $2,550
Dependent care $5,000
Remember, you cannot have a Healthcare FSA if you or a spouse is
contributing to an HSA. Refer back to page 7 for more details.
23
