Page 19 - QSC EE Guide 07-19 Remote

Short Plan Year: July 1 - December 31, 2019 | Ongoing Plan Year: January 1 - December 31, 2020
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 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 case
Discovery needs a copy for verification. Also, all receipts should be itemized to reflect what product or service was
purchased. Credit card receipts are not sufficient per IRS guidelines.

Health Care FSA
Important FSA Rules

This plan is used to pay for expenses not covered under Health Care FSA
your health plans, such as deductibles, coinsurance, copays
and expenses that exceed plan limits. Employees may defer Up to $500 of any unspent funds
up to $1,350 pre-tax in the short plan year, and $2,700 in the remaining in your account at the end of
ongoing plan year. Eligible expenses include: the plan year will carry-over to the next
plan year, and unspent funds above
$500 will be forfeited.

Important Note for HSA Medical

Participants:
If you enroll in the HSA Medical Plan
Coinsurance, Medical and Dental Eye Exams, and contribute to your HSA account,
Copays and Prescriptions and Eyeglasses you may only participate in the Health
Deductibles Orthodontia and Lasik Eye Care FSA to cover out-of-pocket Dental
Surgery and Vision expenses through the
Limited Health Care Reimbursement
Go to www.fsastore.com to shop for FSA-eligible products, Plan. QSC will allow you to use your FSA
and for a list of eligible expenses. funds for qualified medical expenses
incurred after the statutory annual
deductible set by the IRS has been
Dependent Care FSA satisfied.

Dependent Care FSA
This plan is used to pay for eligible expenses you incur for Unused funds will NOT be returned to
child care, or for the care of a disabled dependent, while you you or carried over to the following
work. Employees may defer up to $2,500 pre-tax in the year. You must file claims by the end of
short plan year, and $5,000 in the ongoing plan year. Eligible the plan year.
expenses include:

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