Page 15 - Hitachi Benefits Booklet Final

Flexible Spending Accounts (FSAs) are special tax-advantaged
accounts used to pay for eligible out-of-pocket health care and Important FSA Rules
dependent care expenses. If elected, your account(s) will be
funded with tax-free dollars using convenient payroll Because FSAs can give you a significant tax
deductions. Only expenses for services incurred during the plan advantage, they must be administered
year are eligible for reimbursement from your accounts. If you according to specific IRS rules:
are using your debit card, you must save your receipts, just in
case Igoe needs a copy for verification. Also, all receipts should Health Care FSA
be itemized to reflect what product or service was purchased.
Credit card receipts are not sufficient per IRS guidelines. You must forfeit any money left in your account
after your expenses for the year have been
reimbursed.

Igoe | Health Care FSA Healthcare FSA $500 Carry-Over

This plan is used to pay for expenses not covered under your
health plans, such as deductibles, coinsurance, copays and A minimum of $50 and up to $500 of unspent
expenses that exceed plan limits. Employees may defer up to funds remaining in your account at the end of
$2,750 pre-tax per year. Eligible expenses include: the plan year will carry-over to the next plan
year, and unspent funds less than $50 or more

than $500 will be forfeited.

Important Note for HSA Medical
Participants:
Coinsurance, Medical and Dental Eye Exams,
Copays and Prescriptions and Eyeglasses If you enroll in the HSA Medical Plan and
Deductibles Orthodontia and Lasik Eye contribute to your HSA account, you are not
Surgery eligible to participate in the Health Care FSA.

Go to www.fsastore.com to shop for FSA-eligible products, and Dependent Care FSA
for a list of eligible expenses.
Unused funds will NOT be returned to you or
carried over to the following year. You must
Igoe | Dependent Care FSA incur claims by December 31, 2020.

This plan is used to pay for eligible expenses you incur for child
care (under age 13), or for the care of a disabled dependent, Register Online: www.goigoe.com
while you work. Employees may defer up to $5,000 pre-tax per Company ID: IgoHitach
year. Eligible expenses include:

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