Page 14 - Allegacy 2019 Benefit Guide Part Time

Flexible Spending Accounts

Allegacy offers employee two flexible spending accounts – a Healthcare FSA and a dependent care FSA. You may set
aside monies in these accounts on a pre-tax basis up to the plan maximum and, as long as you use the monies for IRS
eligible expenses, you do not have to pay state, federal and FICA taxes!

 For those participating in the Healthcare FSA, employees may contribute monies on a pre-tax basis each pay
period up to a maximum of $2,700. These monies are to be used for qualified health, dental, vision and
prescription drug expenses.
 For those participating in the Dependent Care FSA, employees may contribute monies on a pre-tax basis each
pay period up to the IRS maximum of $5,000. These monies are to be used for dependent care expenses.
Please see https://www.irs.gov/pub/irs-pdf/p503.pdf for covered expenses.

Helpful Information:

 www.FSAstore.com is a consumer site where you may purchase Healthcare FSA qualified over-
the- counter eligible items. This site clearly indicates which items are considered FSA (or HSA) eligible.
 Please note that employees enrolled in a Health Savings Account (HSA) compatible plan (both Allegacy health
plans are considered HSA compatible) will be enrolled in a Limited Scope Healthcare FSA if elected. This
means that the funds set aside in the FSA may only be used to reimburse eligible dental and vision expenses
only. However, an employee with HSA funds may use those funds for all eligible expenses including medical,
dental, vision and prescription drugs.
 You may access FSA monies through use of a debit card provided by our administrator, Stanley Benefits.
Your initial debit cards are provided at no cost to you and will be reloaded with your new annual election if
you participate each year until the card expiration date at which time you will be mailed a new card. If you
have lost your debit card or need additional cards, there is a small cost at time of request.
 Full-time employees that are not covered under one of the Allegacy’s medical plans are eligible to receive a
contribution to their FSA from Allegacy totaling up to $500 annually, if the employee participates in the
Allhealth Wellness program and meets the quarterly engagement criteria. You will be able to earn $125 FSA
credit per quarter if you satisfy your quarterly criteria/goals; incentive payout will occur in January 2020.

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