Page 18 - Community Health Systems Guide 2020 v2 (CHSI Review)

Flexible Spending Accounts (FSA)

Anthem Blue Cross | Flexible Spending
Accounts
You can set aside money in Flexible Spending Accounts (FSA) Important FSA Rules
before taxes are deducted to pay for certain health and Because FSAs can give you a significant tax
dependent care expenses, lowering your taxable income and advantage, they must be administered
increasing your take home pay. Only expenses for services according to specific IRS rules:
incurred during the plan year are eligible for reimbursement from
your accounts. Please remember that if you are using your debit Health Care FSA
card, you must save your receipts, just in case Anthem Blue Cross You must forfeit any money left in your
needs a copy for verification. Also, all receipts should be itemized account(s) after your expenses for the year
to reflect what product or service was purchased. Credit card have been reimbursed. The IRS does not allow
receipts are not sufficient per IRS guidelines. the return of unused account balances at the
end of the plan year, and remaining balances
Health Care FSA cannot be carried forward to a future plan
year.
This plan is used to pay for expenses not covered under your
health plans, such as deductibles, coinsurance, copays and Important Note for HSA Medical
expenses that exceed plan limits. Employees may defer up to Participants:
$1,500 pre-tax per year. Eligible expenses include: If you enroll in the HSA Medical Plan and
contribute to your HSA account, you may only
participate in the Health Care FSA to cover
out-of-pocket Dental and Vision expenses
through the Limited Purpose Plan.

Coinsurance, Medical and Dental Eye Exams, Dependent Care FSA
Copays and Prescriptions and Eyeglasses and Unused funds will NOT be returned to you or
Deductibles Orthodontia Lasik Eye carried over to the following year.

Go to www.fsastore.com to shop for FSA-eligible products, Tip!
and for a list of eligible expenses. If you are unable to estimate your health care
and dependent care expenses accurately, it is
Dependent Care FSA better to be conservative and underestimate
rather than overestimate your expenses.
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. Employees may defer up to $5,000 pre-tax per year.

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

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