Medical Expense Reimbursement Plan (FSA)

The County offers you a great way to save money by paying for certain medical care expenses with pre-tax dollars. The FSA plan is convenient and easy to use.

FSA Resources

FSA DCAP Participant Portal EBSD Phone: 909.387.5787 EBSD Email: hrfsadcap@hr.sbcounty.gov

How the Plan Works

With an FSA, employees elect to set aside a portion of their biweekly salary before taxes are calculated and taken out. The money that is set aside is placed into the employee’s account, from which reimbursement for qualifying medical care expenses that the participant, their spouse or eligible dependent(s) incur.


Eligibility

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.


Enrollment

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)
    • Marriage
    • 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.


Contribution Limits

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.


Eligible Expenses

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.


Run-out Period

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.


Additional Information

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.

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