Page 14 - 2016 Open Enrollment

Open Enrollment

Flexible Spending Account

(FSA)

Flexible spending accounts are tax favored accounts that allow you
to pay for eligible medical and dependent care expenses with pre-tax

dollars.

The Healthcare and Dependent Care FSA accounts are available to
you regardless of your participation in a medical plan.

If you are enrolled in the HSA plan you are eligible to
participate in the Limited FSA and Dependent Care FSA only.

You may contribute to a Healthcare FSA (HCFSA) if you do not
elect medical coverage through Pericient OR if you choose to
participate in Pericient’s PPO plan option. You may not contribute

to a Healthcare FSA if you are contributing to an HSA elsewhere.

Regardless of the medical plan you elect, you may contribute to the

Dependent Care Flexible Spending Account. You must make a new
election each year if you wish to participate in either or both lex
spending accounts.

For a complete listing of eligible healthcare
and dependent care expenses please
see IRS Publication 502 by logging onto
www.irs.gov/pub/irs-pdf/p502.pdf.

Important

It is important to know that both of these FSA accounts are a
“use it or lose it” beneit; unused funds are not rolled over and
are forfeited at the end of the plan year.

14