Medical Spending FSA
(Not compatible with HSA Plan) | Limited-Purpose FSA
(Compatible with HSA Plan) | Dependent Care FSA
(Compatible with all plan options) |
| ELECT UP TO $2,750 TAX-FREE | ELECT UP TO $2,750 TAX-FREE | ELECT UP TO $5,000 TAX-FREE |
- Your Medical Spending FSA may be used to reimburse out-of-pocket medical expenses for you, your spouse, and your dependents.
- Eligible expenses include deductibles, coinsurance and prescriptions.
Dental, vision and hearing expenses may also be reimbursed. - The maximum annual Medical Spending FSA election is $2,750. The entire annual amount you elect may be used at any time during the plan year and is available January 1.
| - If you have elected to contribute to an HSA in 2022, you may also enroll in a Limited-Purpose FSA, even though both accounts may reimburse dental and vision expenses.
- To comply with HSA rules, your Limited- Purpose FSA may only be used to reimburse out-of-pocket dental and vision expenses for you, your spouse, and your dependents.
- The maximum annual Limited-Purpose FSA election is $2,750. The entire annual amount you elect may be used at any time during the plan year and is available January 1.
| - The annual maximum contribution to a Dependent Care FSA is $5,000 (or
$2,500 if you are married and filing taxes separately.) - The Dependent Care FSA is used to reimburse you for certain expenses for children under age 13, or individuals unable to care for themselves. Unlike Medical Spending FSAs and Limited- Purpose FSAs, Dependent Care FSAs may only reimburse expenses up to the amount you have contributed to date.
- Funds are available three business days after payroll deduction. Dependent Care FSA is for dependent daycare only.
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How to Use Your Funds
» When you enroll in the Medical Spending or Limited Purpose FSA, you will receive a debit card from
HSA Bank in the mail. The card will hold Medical Spending and/or Limited-Purpose funds. It will NOT hold Dependent Care funds.
» If you use the card at an Inventory Information Approval System (IIAS) merchant, the transaction will be approved at the point of sale. Generally, large pharmacies, grocery stores, and box stores (i.e.:
Walgreens, Albertsons, Walmart) have IIAS capability.
» If the expense will be considered for insurance reimbursement, try to wait until you receive the Explanation of Benefits (EOB) from the insurance company to be sure that the debit card transaction is for the correct out-of-pocket amount.
» If the merchant does not accept the card, submit the expense through the HSA Bank website (www.hsabank.com) or by mail.
» Medical Spending/Limited Purpose reimbursement requests, as well as debit card transaction documentation, can be sent electronically, by fax, or by mail to HSA Bank. Claims are normally reimbursed within a week of HSA Bank receiving the claim.
» For dependent care, you must submit the expense through www.hsabank.com or by mail. After submission, you will be asked which method of reimbursement you prefer (electronic transfer, check, etc.).
» Visit www.hsabank.com for a list of eligible expenses and to set up direct deposit for expense reimbursement.
» The Medical Spending FSA, Limited Purpose FSA, and Dependent Care FSA are separate. You cannot transfer funds between accounts or charge multiple accounts for the same expenditure.
» Keep your receipts and invoices. You may be required to submit documentation of your expenditures.
» By law, any money left in your FSA(s) at the end of the year must be forfeited. This is called the "use it or lose it" rule. However, there is a grace period ending March 15, 2023 to use your 2022 Medical Spending FSA or Limited Purpose FSA dollars on eligible expenses. All claims must be submitted by March 31, 2023. Note: If you currently participate in the Medical Spending FSA and elect the HSA medical plan for 2022, your FSA funds will expire on December 31, 2021. The grace period does not apply, and you may not roll these funds into a Limited Purpose FSA for 2022. This is an IRS rule.
» Dependent Care FSA funds must be used by December 31, 2022, and all claims must be filed by March 31, 2023.
» If you retire or otherwise leave City employment, your FSA funds will terminate on the date of your departure. You will have 90 days following your departure date to submit claims for expenses incurred before you left. You cannot submit claims for services received after your departure date.