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Flexible Spending Accounts General Information

How the Plan Works

This plan works on the calendar year: January 1 (or new hire effective date) through December 31.

Estimate your family's annual health and/or dependent-care expenses, and enroll, electing the amount to be withheld for the plan year. You can roll over up to $500 of unused health-care FSA funds for use in the following plan year.  Dependent-care FSA elections cannot roll over from one plan year to the next.  It is important to make conservative estimates, because you will forfeit any unused dependent-care FSA funds and any health-care FSA funds over $500. In addition, you must re-enroll each year in order to continue participation for the next calendar year.

When you incur a qualified expense, you submit a claim form and proof of payment to the plan administrator, ASIFlex, who will then issue you a reimbursement check or deposit the reimbursement directly into your bank account. You may also choose to use a no-fee debit card to pay for qualified health-care expenses at the time of purchase. Please note that you may need to submit follow-up documentation to ASI for your debit card purchases.

You will have until April 30 of the following year to submit claims to ASI for eligible expenses incurred during the calendar year. Any expenses that you do not claim by this time will not be reimbursed.

Health-Care FSA

Co-pays; deductibles; eligible medical, dental and vision expenses not covered by health plans; over-the-counter drugs (with a prescription); and illness-related transportation expenses for you and your eligible dependents can be paid for through a Health-Care FSA.

Employees who are enrolled in the Health Savings Account Option (HSAO) medical plan may not enroll in the full Health-Care FSA, but may enroll instead in the Limited Health Care FSA. You can use the Limited Health Care FSA only to pay for expenses related to dental, vision, or out-of-network preventive care services for you and your eligible dependents.

You may contribute up $2,550 to a Health-Care or Limited Health-Care FSA.

Optional Debit Card for Health-Care FSA

If you enroll in the Health-Care FSA, you have the option of signing up for an FSA debit card. The debit card can be used to pay for eligible expenses incurred at doctors’ offices and at certain grocery stores and pharmacies. For a complete listing of locations that accept the debit card, please visit ASIFlex’s website. The debit card is not available with the Limited Health Care FSA or the Dependent Care FSA.

The debit card can reduce paperwork for most co-pays and over-the-counter purchases. However, depending on the expense, ASI could request follow-up documentation after the purchase has been made. It is important always to keep follow-up documentation even if ASI does not request it.

ASI will mail a debit card application along with your FSA enrollment confirmation to your home address in late December/early January. If you wish to sign up for the debit card, you will need to complete the application and return it to ASI. It will take approximately two weeks to receive your debit card once ASI has received your application. 

Dependent-Care FSA

The Dependent Care FSA plan can be used for daycare expenses incurred while you and your spouse work or attend school full time. A dependent's medical expenses cannot be claimed through the Dependent Care FSA. You must have a Health Care FSA to claim these expenses.

The IRS limit for annual dependent care expenses is $5,000 per family ($2,500 if married filing separate federal income tax returns). You must provide a tax ID number or Social Security Number for your daycare center or private provider for tax purposes. Your provider cannot be one of your own children under the age of 19.

The FSA plan documentation refers to "dependent" and "qualifying person"; these terms are interchangeable and may differ from the definition of dependent for other health-care programs.

For purposes of claiming expenses under the FSA Dependent Care plan, a qualifying person must be

  • Your dependent child who was (a) under age 13 when the care was provided, (b) for whom you have custody more than 50% of the year, and (c) whom you can claim as an exemption on your federal income tax return; or
  • Your dependent (child older than age 13, spouse, parent, or other family member for whom you have custodial responsibility) who (a) is physically or mentally unable to care for himself or herself, (b) shares the same residence with you, and (c) has an income less than the federal exemption amount.

Enrollment and Changes to Elections

Newly hired/newly eligible employees must enroll in this plan within 30 days of hire date (or benefit-eligibility date).

All benefits-eligible employees who wish to participate in an FSA for the upcoming calendar year must enroll during the annual open enrollment period (usually October–November). FSA elections do not carry over from year to year.

You cannot make changes to your elections during the calendar year, unless a qualifying life event occurs (e.g., birth of a child or change in employment status). You must request FSA changes within 31 days of a qualified life event change.

Additional Information 

Contact ASIFlex

ASIFlex Tax Savings Calculator

Participant Plan Information (describes plan provisions as well as qualifying and non-qualifying expenses)

Qualifying/Non-qualifying Expenses (for both dependent-care and health-care FSAs)

IRS Publication 502 (filing for medical and dental expenses)

IRS Publication 503 (filing for childcare and dependent-care expenses)

Forms

FSA HIPAA Notice

​Claim Form (Flexible Spending Account claims should be submitted using your EmplID. To learn your Health Insurance ID, visit UAccess Employee and select Employee/Manager Self Service > Self Service > Benefits > Benefits Summary.)

Direct Deposit Enrollment Form