Page 16 - PriMed 2022 Benefits Guide

Flexible Spending Accounts (FSAs)

Flexible Spending Accounts (FSAs), administered by Navia, allow you to set aside pre-tax dollars to pay for
eligible health and dependent care expenses. As an eligible employee, you may choose to enroll in one or both
Flexible Spending Accounts. Each year, you must elect the annual amount you want to contribute to each
account ($60 minimum). Your contributions will be deducted pre-tax from your paycheck which can help
reduce your taxable income.

Register online at: http://www.naviabenefits.com to set up an account - Employer Code “PRM”.

Health Care FSA Dependent Care FSA

IRS Maximum 2022 IRS Maximum $2,850 2022 IRS Maximum $5,000

Eligibility For those enrolled in an HMO or PPO plan You and your spouse (if applicable) work
full-time

Eligible Expenses*  Health care expenses, such as  Dependent care expenses for a child
deductible, copays and prescription under 13
 Eyeglasses or contact lenses  Private day care providers and nannies
 Laski surgery  Licensed care for disabled dependents
 Orthodontia  Care for an elderly parent who is
dependent on you

Availability of Funds Full election available upon the benefits You can be reimbursed up to the amount
effective date available in your account

Payment or  Use FSA debit card  Use FSA debit card
Reimbursement  Submit a claim form for out-of-  Submit a claim form for out-of-pocket
pocket expenses expenses

For a complete list of eligible expenses, refer to IRS Publication 502: Medical and Dental Expenses, available at
www.irs.gov/publications.

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