Page 13 - 2022 Infoblox Benefits Guide

Spending Income Optional
Spending
Accounts
Contents Eligibility Medical Contributions Dental Vision A c c oun ts Protection Benefits Contacts

Flexible Spending

Accounts (FSA)

Flexible Spending Accounts allow you to pay for eligible health care and dependent care expenses using
tax-free dollars. There are two types of FSAs — the Health Care FSA and the Dependent Care FSA:

Health Care FSA Dependent Care FSA

Contribute up to $2,850 per year, pretax to pay Contribute up to $5,000 per year, pretax
for services not covered by your medical, dental or (or $2,500 if married and filing separate
vision plan such as copays, coinsurance, deductibles, tax returns) to pay for day care expenses.
prescription expenses, lab exams Note: You can’t use a Health Care FSA or
and tests, contact lenses and eyeglasses. HSA to cover dependent care expenses.

Receive a debit card to pay for eligible You must submit claims and be reimbursed;
medical expenses. no debit cards are provided.

Eligible expenses include medical
copays, coinsurance, deductibles, Can only be used to pay for eligible dependent
eyeglasses, and over-the-counter medications care expenses including day care, after-school
prescribed by your doctor. programs and elder care programs.

Submit claims up to March 31 of the following year Submit claims up to March 31 of the following
for expenses from January 1 to December 31. year for expenses from January 1 to December 31.
If you do not spend all the money in this If you do not spend all the money in this
FSA by March 31, per IRS regulations, FSA by March 31, per IRS regulations,
you will forfeit the unused amount. you will forfeit the unused amount.

If you are a participant in an HSA, you are not eligible for the Health Care FSA reimbursement account.

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