Page 22 - Tender Greens EE Guide 01-20

Igoe | Flexible Spending Accounts
Flexible Spending Accounts (FSAs) are special tax-advantaged
accounts used to pay for eligible out-of-pocket health care and
dependent care expenses. If elected, your account(s) will be Important FSA Rules
funded with tax-free dollars using convenient payroll deductions. Because FSAs can give you a significant tax
Only expenses for services incurred during the plan year are eligible advantage, they must be administered according
for reimbursement from your accounts. If you are using your debit to specific IRS rules:
card, you must save your receipts, just in case Igoe needs a copy for
verification. Also, all receipts should be itemized to reflect what Healthcare FSA
product or service was purchased. Credit card receipts are not Up to $500 of any unspent funds remaining in your
sufficient per IRS guidelines. account at the end of the plan year will carry-
over to the next plan year, and unspent funds
Healthcare FSA above $500 will be forfeited.

This plan is used to pay for expenses not covered under your health Important Note for HDHP Medical Participants:
plans, such as deductibles, coinsurance, copays and expenses that If you enroll in the HDHP Medical Plan and
exceed plan limits. Team Members may defer up to $2,750 pre-tax contribute to your HSA account, you may only
per year (subject to IRS changes). Eligible expenses include: participate in the Healthcare FSA to cover out-of-
pocket Dental and Vision expenses through the
Limited Purpose Plan.

Dependent Care FSA
Coinsurance, Medical and Dental Eye Exams, Unused funds will NOT be returned to you or
Copays and Prescriptions and Eyeglasses and carried over to the following year. You must incur
Deductibles Orthodontia Lasik Eye claims by December 31.
Surgery
Tip!

Go to www.fsastore.com to shop for FSA-eligible products, and for If you are unable to estimate your health care
a list of eligible expenses. and dependent care expenses accurately, it is
better to be conservative and underestimate
Dependent Care FSA rather than overestimate your expenses.

This plan is used to pay for eligible expenses you incur for child care,
or for the care of a disabled dependent, while you work. Team
Members may defer up to $5,000 pre-tax per year. Eligible
expenses include:

Educational Video

Flexible Spending Accounts
Licensed nursery schools, Adult daycare facilities http://video.burnhambenefits.com/fsa/
qualified childcare centers, after
school programs, summer camps
(under age 13), preschool

22 Team Member Benefits