Page 12 - 2016 New Hire Guide (Non-PA)

New Hire Guide

Dependent Care FSA

The dependent care FSA lets you use pre-tax dollars towards
qualiied dependent care. The maximum amount you may contribute
to the dependent care FSA is $5,000 (or $2,500 if married and iling

separately) per plan year.

Examples of FSA Eligible Expenses

„ Healthcare spending account

ˆ Doctor’s visit copays
ˆ Prescription drug copays

ˆ Medical and dental deductibles

ˆ Over-the-counter medications (with a written prescription)
ˆ Hearing aids

ˆ Eye glasses

ˆ Contacts
ˆ Contact lens solution

ˆ Dental services

ˆ Orthodontia
ˆ Acupuncture

ˆ Laser vision correction surgery

„ Dependent care spending account

ˆ Cost of child or adult day care*
ˆ Nursery school

ˆ Preschool (excluding kindergarten)
* An eligible dependent is a tax dependent child under age 13 or tax dependent spouse,
parent, or child unable to care for themselves

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