How the Plan Works | Definitions | Restrictions

By participating in this program, you can direct money from your paycheck into an account to pay for certain health care and dependent care expenses. The money you place in this account is not taxed; it is subtracted from your pay before taxes are calculated. This means you pay less tax and you have pre-tax money to spend on health care and dependent care expenses.

The kinds of health care expenses you can pay for out of this account are those typically not covered under your health care plan, such as co-pays and deductibles. You can't use the money to reimburse yourself for your premium contributions because those are already paid on a pre-tax basis through payroll deduction.

If you currently pay for day care for your children or adult dependents, you can use the dependent care account to reimburse yourself for these expenses.

How the Plan Works:

Estimate your family's annual health and/or dependent care expenses, and enroll, electing the amount to be withheld for the plan year.

After incurring qualified medical or dependent care expenses, fill out a claim for reimbursement form, and mail that form and a copy of your receipt(s) to ASI, the administrator. You will receive a check for reimbursement by US mail. Direct deposit reimbursement is also available. See Participant Plan Information for an example of the potential savings.

Definitions:

The information you will read here and in other Flexible Spending Account 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 Flexible Spending Account Dependent Care program, a qualifying person must be:

• your dependent child who was under age 13 when the care was provided and 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 resides in your home) who was physically or mentally not able to care for himself or herself AND whom you can claim as an exemption (or could claim as an exemption except the person had $2,900 or more of gross income). See Internal Revenue Service Publication 503 or contact your tax advisor for additional information.

Restrictions:

• Health care expenses are limited to $5,000 per year.
• Dependent care expenses are limited to $5,000 per year per family. ($2,500 if married filing separate Federal Income Tax returns.)
• Additional dependent care restrictions:
  • your dependent care expenses must be for the care of one or more qualifying persons,
  • if you are married, your spouse must also work or be a full-time student,
  • you must provide ID numbers from your day care center or private provider for tax purposes,
  • your provider cannot be one of your own children under the age of 18.
• Changes to elections are not allowed during the calendar year. (Exception: Qualified Life Event changes, such as the birth of a child or employment status changes, etc. You must request FSA changes within 31 days of a Qualified Life Event change. Refer to the Summary Plan Description for additional information on Qualified Life Event changes.
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• All claims must qualify in order to be reimbursed.
• Plan carefully. Be conservative with your estimates, as any money you do not spend during the plan year will be forfeited.
• Orthodontic expenses may be assumed to be incurred at the time a monthly payment is due and paid. These monthly payments must be spread out evenly over the expected period of orthodontic treatment. Refer to the Summary Plan Description for additional information.