Page 19 - Ria Benefits Guide 2020 FINAL CA

FLEXIBLE SPENDING ACCOUNTS

Health Care FSA & Dependent Care FSA

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 Infinisource 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.

NOTE: If you wish to continue your FSA in 2021, you must re-enroll in the FSA, per IRS guidelines. This plan runs on a calendar
year January 1st. - December 31st.
Health Care FSA
This plan is used to pay for expenses not covered under your health plans, such as deductibles, coinsurance, copays and expenses that
exceed plan limits. Employees may defer up to $2,750 pre-tax per year. Eligible expenses include:

Coinsurance, Copays and Medical and Dental Eye Exams, Eyeglasses and Lasik
Deductibles Prescriptions and Orthodontia Eye Surgery

Dependent Care FSA
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. This is a
“use it or lose it” benefit. Any unused balance at the end of the plan year will be forfeited to the employer. Employees may defer up to

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

Limited Scope Flexible Spending Account
A limited scope FSA is a healthcare flexible spending account that only reimburses you for eligible dental and vision expenses and is
only available to those who elect the Aetna Qualified High Deductible Health Plan (HDHP $1,400 OAMC) and open a Health Savings
Account. By establishing a limited scope FSA, you can save money on taxes by using your limited scope FSA for your dental and vision
expenses while preserving your HSA funds for other purposes, including saving them for the future. Employees may set aside up to
$2,750 per year. The limited scope FSA is administered by Infinisource at www.infinisource.com.

Infinisource Commuter Express
The Transit/Parking program allows employees to pay for eligible transportation and parking expenses with pre-tax dollars. You can set
aside up to $265 per month for transit expenses and $265 per month for parking expenses. The Commuter Express website is
www.infinisource.com.
• Eligible mass transit expenses include train, light rail, public or subscription bus and eligible van pool (7 or more adults).
• The eligible parking expenses include parking at or near your primary long-term business location or at or near a park and ride if
you use mass transit.
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