FLEXIBLE SPENDING ACCOUNT PROGRAM

Sign up for a Pay Raise!!!!

Flexible Spending Accounts Allow You to Set Aside Pre-Tax Dollars to Pay for Out-of-Pocket Healthcare

AND Dependent Care.

o For Youo For Your Spouse (as Federally Defined)o For Your Eligible Dependentso Participation in your Employer’s Health

Plan is Not Required

Your Plan Details

Plan Year January 1 to December 31

Healthcare Maximum

$2,600

Dependent Care Maximum

$5,000.00 *

Run Out Period 60 Days*$2,500- Dependent Care Maximum if spouse also participates in a Dependent Care Account

Examples of Qualified Healthcare Expenses

o Birth Controlo Hearing Careo Prescription Drugso Medical Supplieso Smoking Cessation

Programso Mileage to and from

doctor appointments

o Deductibleso Co-paymentso Vision Careo Acupunctureo Orthodontiao Counselingo Dental careo Chiropractic

Examples of Qualified Dependent Care Expenses

Care for children up to age 13 Care of a disabled dependent Payment to an eligible daycare facility In-home care by a non-relative

provider Day camp, pre-school, after care Registration fees

Flexible Spending Accounts-Tax Savings

Without FSA With FSA Benefit BankSalary $1,000 $1,000To FSA Plan ($100) $100Taxable Salary $1,000 $900Income Tax (20%) ($200) ($180)Social Security Tax (7.65%)

($76) ($69)

Salary After Taxes $724 $651Healthcare Expenses ($100) ($100)Take-Home Pay $624 $551 ($100)From FSA Plan $100Net Take-Home Pay $624 $651Net Savings with FSA $27

FSA Plan Reminders

Estimate your elections carefully Unused funds will be forfeited if not claimed

by the end of the run-out period Expenses must be incurred during the plan

year Funds cannot crossover between accounts

(i.e. Healthcare funds cannot be used for Dependent Care expenses)

How FSA Debit Card Works

Debit card with a MasterCard Logo Is pre-loaded with the amount of your annual

contribution for the Healthcare FSA Will also work for Dependent Care, Parking, and

Transit FSA, but only as payroll contributions are posted

Accepted for eligible expenses at approved providers

Card Features

Direct payment to the provider or merchant from your FSA

No request for Reimbursement forms to complete

No waiting for a reimbursement check You may request additional card for a

spouse/dependent at no cost 24/7 access to debit card website for balance

and transaction information

Manual Claims

Manual claims are available when:A provider does not accept the debit cardExpenses incurred when your card is

damaged, lost or stolenExpenses required additional documentation

before approval