How It Works
- You may choose to contribute up to $5,000 per calendar year, unless you are married and filing a separate return - then you can contribute a maximum of $2,500. The amount you elect is payroll deducted.
- Unlike the Healthcare Flexible Spending Account, you must have enough money available in your account to cover the expense.
- A debit card will be provided to you. The debit card provides a convenient way to pay for eligible expenses, thus eliminating the need to pay out of pocket, file claims, and be reimbursed. EPSI could request receipt documentation for your debit card transactions. Remember to retain all receipts, per IRS guidelines. Not all providers accept the FSA debit card. For those providers who do not accept the debit card, you will pay at the time of transaction and complete a claim form to request reimbursement.
- The IRS requires that any unused money in your account at the end of the plan year must be retained by your employer. Be sure to use the entire amount of your FSA balance in order to avoid forfeitures. Claims must be incurred within 2 ½ months following the last day of the plan year (by March 15, 2014) in order to be eligible for reimbursement. All 2013 FSA claims must be submitted to the FSA administrator by April 30th, 2014 in order to be considered for reimbursement.
Eligible Dependent Care FSA Expenses
Eligible Expenses Must be for the Care of:
• A dependent child, elderly parent or relative who is physically or mentally incapable of caring for himself or herself
• You can elect a Dependent Care FSA even if you have declined health care coverage.
FSA Claims - How it Works
Debit Card Purchases
You will receive a debit card for your FSA plan. This debit card may be used to pay for eligible dependent care expenses. Using a debit card is a convenient way to pay for your FSA expenses. Many dependent care providers accept the debit card. When you use your debit card, the funds are pulled from your account and paid to the day care provider directly. This eliminates the need for you to pay out-of-pocket and file a claim to be reimbursed.
Please remember to keep all FSA claim receipts, even if you use your debit card. Some debit card claims will require you to provide a receipt to the plan administrator. In the event the FSA administrator needs additional information from you, you will receive a letter requesting receipt(s).
Not all vendors accept the debit card. Should you need to pay for an eligible expense and be reimbursed from your FSA, you will need to submit a claim to the address indicated on the claim form with appropriate documentation. Click here for a claim form.
Documents & Additional Information
FSA Open Enrollment letter - An informative letter about the FSA plan with important open enrollment information.
Dependent Care FSA Voucher Reimbursement Form - This is the claim form.
Dependent Care Fixed Payment Reimbursement Form - This form allows for one single submission of recurring dependent care FSA claims. (Example: Day care cost of $600 per month. Submit the form one time to set-up automatic reimbursements with EPSI without having to provide a claim form each month.)
Direct Deposit form - Submit this form to receive your reimbursements directly into the account of your choice.
Contact Employer Plan Services, Inc. (EPSI)
For questions about the Dependent Care Flexible Spending Account, contact the Benefits Service Center at1-855-481-1489 or EPSI at 1-800-447-6588 | www.mybenny.com |