Page 9 - 2022 Drive Open Enrollment Guide - Non Union

Flexible Spending Accounts

A Flexible Spending Account (FSA) helps you pay for health care or dependent care using tax-free dollars. Your
contribution is deducted from your paycheck on a pretax basis and is put into the FSA. When you incur expenses, you
can access the funds in your account to pay for eligible expenses.

This chart shows the eligible expenses for each FSA and how much you can contribute each year. Each of these options
reduces your taxable income.

Account type Eligible expenses Annual contribution limits

Most medical, dental and vision care Maximum contribution is $2,850 per
expenses that are not covered by your health year.
Health Care FSA
plan (such as copayments, coinsurance,
deductibles, eyeglasses and prescriptions) Funds are deducted throughout the
year, but all funds are available on
January 1.

Dependent care expenses (such as day care, Maximum contribution is $5,000 per
after school programs or elder care programs) year ($2,500 if married and filing
Dependent Care FSA
for children under age 13 or elder care so you separate tax returns).
and your spouse can work or attend school full-
Funds must be available in your account
time
before a claim can be filed.
Most dental and vision care expenses that are
not covered by your dental and vision plans
Limited Purpose (such as copayments, coinsurance, deductibles, Maximum Contribution is $2,850 per year
FSA
glasses, contacts, etc.) – Only available if you
enroll in a Empire Blue Cross Blue Shield HDHP.
Transit expenses (such as public transportation
Maximum Contribution per month is $280
for buses, subway, train, trolley, ferry, water
for transit expenses and $280 for
Commuter Benefits taxi, light rail and ridesharing such as UberPool
commuter related parking expenses
and Lyft Shared)
(deducted once per month)
Parking expenses (such as garages and lots)
Please Note: The IRS Annual Contribution Limits are subject to change.

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. Our Health Care FSA allows you to carry over $570 in unused
funds to the following plan year. If you are enrolled in an FSA in 2021 and do not elect an FSA for 2022, up
to $570 will be automatically carried over into a Limited Purpose FSA for 2022. You will only be able to use
these funds for qualified dental and vision expenses.

Please plan your contributions carefully. Any unused money remaining in your Health Care Flexible Spending
account(s) greater than $570 will be forfeited. Any monies in Dependent Care Flexible Spending accounts will
also be forfeited. 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.
The minimum election to enroll in the Health Care FSA and Dependent Care FSA is $500.

Dependent Care FSA elections may be capped to adhere to non-discrimination testing. The company typically
notifies participants of these results each November.

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