Page 20 - Veritone EE OOS Benefit Guide_2020

FLEXIBLE SPENDING ACCOUNTS

The FSA plan year is July 1, 2020 - June 30, 2021
Flexible Spending Accounts (FSAs) are special tax-advantaged accounts used to pay for eligible out-of- Important FSA Rules
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 Health Care FSA
eligible for reimbursement from your accounts. If you are using your debit card, you must save your receipts, Because FSAs can give you a significant tax
just in case Igoe needs a copy for verification. Also, all receipts should be itemized to reflect what product or advantage, they must be administered according to
service was purchased. Credit card receipts are not sufficient per IRS guidelines. specific IRS rules:

You must forfeit any money left in your account(s)
HEALTH CARE FSA
after your expenses for the year have been
This plan is used to pay for expenses not covered under your health plans, such as deductibles, reimbursed. The IRS does not allow the return of
coinsurance, copays and expenses that exceed plan limits. Employees may defer up to $2,750 pre-tax per unused account balances at the end of the plan year,
year. Eligible expenses include: and remaining balances cannot be carried forward to
a future plan year.

Important Note for HSA Medical Enrollees:
If you enroll in the HSA Medical Plan and contribute
to your HSA account, you may only participate in the
Coinsurance, Copays and Medical and Dental Eye Exams, Eyeglasses Health Care FSA to cover out-of-pocket Dental and
Deductibles Prescriptions and Orthodontia and Lasik Eye Surgery Vision expenses through the Limited Purpose Plan.

Go to www.fsastore.com to shop for FSA-eligible products, and for a list of eligible expenses. Dependent Care FSA
Unused funds will NOT be returned to you or
DEPENDENT CARE FSA carried over to the following year. You must file

This plan is used to pay for eligible expenses you incur for child care, or for the care of a disabled claims by June 30, 2021.
dependent, while you work. Employees may defer up to $5,000 pre-tax per year. Eligible expenses
include:

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

20 EMPLOYEE BENEFITS