Employees are eligible to participate in an FSA if they are covered under a Memorandum of Understanding, Compensation Plan, Employment Contract, or Contract with an entity that expressly provides eligibility for an FSA.
Per IRS regulations, an employee’s election is irrevocable. Employees may not revoke or change their election for the remainder of the Plan Year unless a Section 125 qualifying
Mid-Year Change-in-Status Event is experienced.
Employees may enroll in an FSA:
- During the annual Open Enrollment period each year
- Within sixty (60) days of a Section 125 Qualifying Change-in-Status Event. The requested FSA election change must be consistent with the event. This may include but is not limited to the following midyear Change-in-Status Events:
- Commencement of County employment (New Hire)
- Hired into a position that makes you newly eligible to participate in the plan or changes your benefits (e.g. employer match)
- Divorce or legal separation
- Death of spouse or dependent
- Birth or adoption of a child or placement for adoption/guardianship
- Termination of spouse's employment
- Commencement of spouse's employment
The requested FSA election change must be consistent with the event. For more information regarding midyear Change-in-Status Events, refer to the
Cafeteria Plan/Section 125 webpage.
FSA plan elections are only valid for the current plan year. Plan participants must elect to enroll each year in order to continue participation.
There is an annual maximum contribution of $2,550 pursuant to IRS regulations. The minimum and maximum contribution amounts correspond with the employees bargaining unit allowable contributions, which may not coincide with the IRS maximum. Please refer to the appropriate Memorandum of Understanding, Exempt Compensation Plan, Salary Ordinance, or Contract for specific minimum and maximum contribution limits.
Use It or Lose It and Roll Over Provisions
Be as accurate as possible when estimating the total annual FSA contribution amount. If you are in an eligible group/unit, you will be allowed to roll over up to $500 of unused funds at the end of the plan year. Do not contribute more money into the FSA than will be used or rolled-over, as it is subject to forfeit. Forfeited funds will be applied toward the cost of administering the plan.
When requesting reimbursement for over-the-counter medicines (OTC) or a general health expense, the claim must include the following documentation:
OTC Medicines: A legal prescription for the OTC medicines. Prescription must include date issued, patient name, provider’s address and license number, medication name, duration of prescription including recommended dosage or number of refills
General Health: An FSA Verification of Medical Necessity Form, also referred to as a Letter of Medical Necessity (LMN) completed by a provider establishing that a specific product and/or service is medically necessary to cure, mitigate, treat, or prevent a disease and will be primarily used to alleviate or prevent a physical or mental defect or illness.
To view a list of eligible expenses, refer to the
FSA Eligible Medical Expense List.
Claims for eligible expenses incurred within the plan year must be submitted for reimbursement no later than ninety (90) days after the end of the plan year.
All claims for reimbursement are subject to review and require both a claim reimbursement form and copies of supporting documentation. Employees have the option to file claims either electronically or manually.
- Electronic: Submit claim and upload supporting documentation (e.g. receipts) online via the FSA/DCAP Participant Portal. If claiming mileage online, participant must upload a print out of an online map source (e.g. mapquest) that includes the starting and ending destination points and total miles traveled.
- Manual: Submit paper reimbursement claim form and copies of supporting documentation. If claiming mileage, the mileage expense worksheet section of the Medical Expense Reimbursement (FSA) Plan Claim form must be completed.
Claimed expenses must clearly indicate for whom the expense(s) is incurred, be itemized per individual and should not be listed as a combined expense. Supporting documentation from the provider, vendor, or merchant (independent third parties*) should clearly demonstrate the information listed on the claim form in order for EBSD to substantiate claimed expenses. For additional information on submitting claims, please refer to the FSA Summary Plan Description.
Claims for reimbursement shall contain the following:
- Date of service(s) or sale(s)
- For services/treatment (e.g. office visit), list the date employee or eligible dependent incurred service/treatment from a provider. Do not list the date paid for the service
- For sales, list the date product was purchased from a merchant or vendor
- Amount claimed for reimbursement of service/treatment or sale incurred
- Indicate the amount paid or billed for the services received or product purchased
- Provider or merchant name
- Expense Category (e.g. medical expense, dental, vision, etc.)
- Type of Expense (e.g. office visit, orthodontic, prescription eyeglasses, over-the-counter medicines etc.)
- Name of person who the expense (e.g. treatment/service/sale) was incurred
In addition to the above, supporting documentation from the provider, vendor, or merchant (e.g. receipt, statement, or bill) must include the following:
- Description of service or product rendered
- Payment received for expense
- Amount paid to other party (e.g. insurance) for expense
- For manual claims in which mileage has been claimed, a print out of an online map source (e.g. mapquest) that includes the starting and ending destination points and total miles traveled
*Note: Canceled checks to providers, vendors, or merchants are not sufficient as stand-alone documentation, as they do not satisfy the independent third party documentation requirements.
The methods to obtain reimbursement for eligible medical care expenses from an FSA account are as follows:
- Benefit Card: Employees have the ability to access FSA account funds directly at the point of service using the Benefit Card. This will commonly be referred to as a "Benny" card. The card allows employees to obtain real time reimbursement for expenses that are able be auto substantiated without having to file a claim form or supporting documentation. Select expenses are able to be reimbursed at point of sale or service, but may require additional documentation in order to be approved.
Note: If you participate in both the County's Medical Expense Reimbursement (FSA) Plan and the Dependent Care Assistance Plan (DCAP), account funds will be accessible on the same Benefit Card. For more information, see Frequently Asked Questions.
- Mileage claims for eligible medical expenses that were reimbursed via the Benefit Card must be submitted using the Medical Expense Reimbursement (FSA) Plan claim form to obtain reimbursement.
- Direct Deposit and Checks: In accordance with the County’s Direct Deposit Policies, FSA reimbursements will be issued via Direct Deposit. FSA claim reimbursement will be deposited in the employee’s balance account on file with EMACS. Employees can view their designated balance account via EMACS – Self Service or the FSA/DCAP Participant Portal. In the case of unforeseen circumstances that impact the account (e.g. identity theft), employees will be able to request that funds be issued via check for the duration of one pay period.
Note: This webpage contains only a summary and partial listing of FSA Plan benefits, terms, conditions, exclusions and limitations. For a full and complete listing, please refer to the appropriate plan document. If any differences appear between this summary and the plan document, the information in the plan document shall govern.