Page 15 - Sample Calendar Layout EE Guide

ABC Company provides you with an opportunity to participate in two different Flexible Spending Accounts (FSA) administered through Igoe.

FSAs allow you to set aside a portion of your income, before taxes, to pay for qualified health care, dependent care and/or commuter expenses. Because
that portion of your income is not taxed, you pay less in Federal income tax, Social Security tax, and Medicare tax. The end result is that you decrease your
taxable income and increase your take-home pay.

The FSA plan year is January 1, 2019 - December 31, 2019.

HEALTH CARE FSA
IMPORTANT FSA RULES
For 2019, you may contribute up to $2,650 to cover eligible health care expenses incurred by you,
your spouse, and your children to age 26. Eligible expenses include: Health Care FSA
Because FSAs can give you a significant
tax advantage, they must be
administered according to specific IRS
rules:

2.5 MONTH GRACE PERIOD
For your HCFSA you can incur claims
Coinsurance, Copays Prescriptions Dental Treatment Eye Exams, Eyeglasses through March 15, 2020 and must file
and Deductibles and Orthodontia and Lasik Eye Surgery claims by March 31, 2020.

Go to www.fsastore.com for a list of eligible expenses and more. After the grace period, unused funds
will be forfeited. Use it or lose it.

DEPENDENT CARE FSA

For 2019, you may contribute up to $5,000 (per family) to cover eligible dependent care expenses
($2,500 if you and your spouse file separate tax returns). Eligible expenses include: Dependent Care FSA
Unused funds will NOT be returned to
you or carried over to the following
year. You must file claims by March 31,
2020.

Educational Video

Babysitters, nursery schools, preschool or Care of a household member who is physically or Flexible Spending Accounts
daycare centers for children under age 13 mentally incapable of caring for him/herself and http://video.burnhambenefits.com/fsa/
qualifies as your federal tax dependent