Page 17 - Benefits Enrollments Guide - Hospice of WS

Hospice and Palliative CareCenter provides you the opportunity to pay for out-of-
pocket medical, dental, vision and dependent care expenses with pre-tax dollars
through Flexible Spending Accounts. These accounts can save you money if used wisely! A
health care FSA is used to reimburse out-of-pocket medical expenses incurred by you and
your dependents, while a dependent care FSA is used to reimburse expenses related to care
of eligible dependents while you and your spouse work.

Health Care FSA

 Employees can contribute a maximum of $2,600 to the health care FSA to be used for
qualified health expenses such as medical copays, deductibles, dental and vision
expenses.
 Debit cards will be provided to all enrolled participants.
 If you enroll in the health care FSA you will have 24/7 online access to your account
information at Flores247.com.
 There is a $500 carryover benefit per year for your health care FSA. Any remaining
funds, over $500, will be forfeited after the last day of the plan year.
 The carryover amount will not count against your health care FSA annual allowable
election.

Limited Scope FSA: If you elect the HDHP medical plan and contribute to an HSA, you may
only use FSA monies for eligible dental and vision out-of-pocket expenses.

Dependent Care FSA

 Dependent care maximum amount is $5,000 per benefit year.
 Work related child care services must be provided by an eligible provider.
 Applies to dependent children 12 years or younger or a person of any age who you claim
as a dependent on your taxes and who is mentally or physically incapable of caring for
himself/herself.
 Applies to time that employee (and spouse if applicable) work, seek work, or attend
school full-time.
 Dependent care FSA is not annualized (“Pay as you go”).
 Annual Election and “Use it or Lose it” rules apply.

Voluntary Long Term Care

Group# 401045
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