- Current Employees
- Change Forms
- Compensation Forms
- Employee Assistance Program
- Employee State Discounts
- Flex Spending Accounts
- Insurance Info & Forms
- Leave Forms
- Leave Information and FAQ's
- Other Resources
- Self-Service FAQ
- Staff Holidays
- Tax Forms
Flex Spending Account
Plan Documents and Forms
- FlexComp Plan Document
- FlexComp Summary Document
- FlexComp Guidelines for OTC
- FlexComp Plan Enrollment Agreement
- FlexComp Reimbursement Voucher
- FlexComp Day Care Cost Verification
- FlexComp Status Change Form
- FlexComp Medical Spending Account and Dependent Care Spending Account Worksheet
Please use this Publication with caution, because it is intended to assist taxpayers in determining their tax deductions, not to explain which expenses are reimbursable under a health care reimbursement account. For this reason, some of the statements in the Publication do not apply to health care reimbursement accounts. For example, the Publication states that a tax deduction is based on when you pay for an expense. In the case of a health care reimbursement account, an expense must be incurred during a Period of Coverage to be eligible for reimbursement from your account for that Period of Coverage, regardless of when you pay for it. Also, certain expenses listed in the Publication as deductible - such as insurance premiums and certain long-term care expenses - cannot be reimbursed from a health care reimbursement account.
This form is a guide only and is subject to change. Receipts must "clearly" state what over-the-counter medications were purchased to be reimbursed from FSA.
Frequently Asked Questions
What is the FlexComp Plan?
FlexComp is a Cafeteria Plan. It allows you to save taxes on the amount you pay for eligible insurance premiums, medical expenses, and dependent care expenses.
How can this be beneficial to me?
The biggest advantage is the tax savings. Since the dollars you contribute to the plan are deducted before income and social security tax are deducted, you will pay less taxes which means you have more money to spend or save. However, you should be aware you are reducing the social security taxes paid which could slightly reduce your social security benefits.
If I take pre-tax dollars out of my pay, won't I make less money?
Generally, your net take home pay will increase by the amount of tax savings, which will typically be 25-39% of your contribution. The amount of tax savings will depend on other deductions you may have and your income tax bracket.
Once I enroll can I change or terminate my elections during the Plan year?
You may change your election only if there is a change in your family status that causes your FlexComp plan expenses to change. This includes marriage, divorce, death of a spouse or child, birth/adoption of a child, termination or commencement of a spouses employment, and other events that the administrator determines, will permit an election change in accordance with IRC (Internal Revenue Code) Section 125 regulations.
What is the turn-around time for FlexComp reimbursement?
What form needs to be completed for medical/dependent care reimbursement?
The FlexComp Reimbursement Voucher
What documentation is needed to be reimbursed for expenses?
Complete a reimbursement voucher, attach the required itemized billings or receipts and send to the Payroll Office.
I do not feel comfortable with others seeing some of the information on an Explanation of Benefits statement from Blue Cross/Blue Shield. Is it acceptable to white or black out any of the information?
Yes, the only information that is needed for audit purposes is the name of the patient, date of service and charges. The name of the medical facility and doctor are not needed.
What do I need from my day care provider?
You need to have your day care provider complete the signature and tax ID/SS # portion of the reimbursement voucher.
May I submit photocopies of my receipts instead of the originals?
Where do I get the reimbursement forms needed?
The Payroll Office will have the necessary forms; or, you can print them from the Payroll Web Page
May I submit for more medical reimbursement than what has been deducted from my paychecks so far?
Yes. You may submit up to your annual limit at any time throughout the plan year.
How often can I submit claims for medical/dependent care expenses? Am I limited to submitting one claim a month?
You may submit claims as frequently or as infrequently as you wish, just as long as the dates-of-service have occurred. Whatever works best for you.
Why didn't I receive the full reimbursement check for the day-care expenses I submitted?
Your reimbursement from your dependent care account will not exceed the amount of your payroll deduction to date.
There is an error on my payroll deductions for FlexComp. Who do I contact to correct it?
FlexComp Specialist in the Payroll Office
Are contact lens solutions reimbursable through FlexComp?
Yes. Previously they were non-allowable expenses. However, the IRS has changed that.
Are prescription sun-glasses and reading glasses reimbursable?
Yes, sun-glasses are and if there is a prescription or if there is a note of recommendation for reading glasses from a doctor accompanying flex reimbursement voucher.
What if I don't use all my account balance?
The IRS requires that any unused funds at the end of the grace period be forfeited. We recommend that you be conservative in your elections.
What is the grace period?
It is the time period from January 1 through March 15 in which expenses can be incurred in order to use up any remaining balance from the prior Plan Year.
Who will benefit from the grace period?
Those participants who were unable to use their full election amount in the prior Plan Year.
Does the grace period apply to both flex plans?
Yes, it applies to both medical and dependent care expenses.
Can I pick what plan year I want to be reimbursed from?
No, claims will be paid in the order in which they are received. Eligible expenses incurred during the grace period and approved for reimbursement will be paid first from available amounts that are remaining in the previous Plan Year and then from amounts that are available for the current Plan Year.
What is the last day to submit vouchers for expenses that were incurred in the plan year or during the grace period?
The deadline is 90 days after the end of the plan year; in other words, 90 days after December 31 of any given year.