Flexible Spending Accounts

Provided by: Clarity

Healthcare FSA

The Healthcare FSA is used to reimburse out-of-pocket healthcare expenses incurred by you and your dependents. The maximum you can contribute to the Healthcare FSA is $3,300. You may carry over $660 of unused funds to the next plan year.

Eligible Expenses Include:

• Doctor office copays
• Non-cosmetic dental procedures (crowns, dentures, orthodontics)
• Prescription contact lenses, glasses, and sunglasses
• LASIK eye surgery

Limited Purpose FSA

For those enrolled in Med 1 EPO HSA Plan, you may participate in a Limited Purpose FSA. The maximum you can contribute to the Limited Purpose FSA is $3,300. Eligible expenses under the Limited Purpose FSA include dental and vision expenses only. You may carry over $660 of unused funds to the next plan year.

How Much Should I Contribute?

You should contribute the amount of money you expect to pay out-of-pocket for eligible expenses for the plan period. If you do not use the money you contributed, it will not be refunded to you or carried forward to a future plan year. This is the use-it-or-lose-it rule.

Dependent Care FSA

The Dependent Care FSA is used to reimburse expenses related to the care of eligible dependents. The maximum that you can contribute to the Dependent Care FSA is $5,000 if you are a single employee or married filing jointly. If you are a married employee filing separately, the maximum you can contribute is $2,500.

Eligible Expenses Include:

• Au Pair
• After-school programs
• Baby-sitting/dependent care to allow you to work or actively seek employment
• Day camps and preschool
• Adult/eldercare for adult dependents

REMINDER: You cannot participate in both the Health Savings Account (HSA) and Healthcare Flexible Spending Account (FSA).