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BENEFITS

Flexible Spending Accounts

FSA Plan Year: January 1 - December 31

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
funded with tax-free dollars using convenient payroll Important FSA Rules
deductions. Only expenses for services incurred during the plan
year are eligible for reimbursement from your accounts. If you
are using your debit card, you must save your receipts, just in Because FSAs can give you a significant tax
case ADP needs a copy for verification. Also, all receipts advantage, they must be administered
should be itemized to reflect what product or service was according to specific IRS rules:
purchased. Credit card receipts are not sufficient per IRS
guidelines. Your FSA elections will expire each year on
December 31st. If you plan to participate in the
ADP | Health Care FSA FSA for the upcoming plan year, you are
This plan is used to pay for expenses not covered under your required to re-enroll.
health plans, such as deductibles, coinsurance, copays and
expenses that exceed plan limits. You may defer up to $2,750 Health Care FSA
pre-tax per year. Up to $500 of any unspent funds remaining in
your account at the end of the plan year will
Eligible health care expenses include: carryover to the next plan year, and unspent
funds above $500 will be forfeited.

Important Note for HSA Medical
Participants:
Coinsurance, Medical and Dental Eye Exams, If you enroll in the HSA Medical Plan and
Copays and Prescriptions and Eyeglasses contribute to your HSA account, you may only
Deductibles Orthodontia and Lasik Eye participate in the Health Care FSA to cover out-
Surgery
of-pocket Dental and Vision expenses through
the Limited Purpose Plan.
ADP | Dependent Care FSA
This plan is used to pay for eligible expenses you incur for child Dependent Care FSA
care, or for the care of a disabled dependent, while you work. Unused funds will NOT be returned to you or
Employees may defer up to $5,000 pre-tax per year. carried over to the following year. You must file
claims by December 31st of the plan year.
Eligible dependent care expenses include:

Licensed nursery schools, Adult daycare facilities
qualified childcare centers,
after school programs,
summer camps (under age
13), preschool

Educational Video
Click here to learn more about how our Health Care and Dependent Care FSAs work.

Flexible Spending Accounts
http://video.burnhambenefits.com/fsa/

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