Page 39 - 2021 Mid Year Open Enrollment Guide
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Health FSA & LPFSA  Dependent Care FSA

 What are they, and should I consider enrolling?  The Dependent Daycare FSA offers a convenient   are unable to claim reimbursable expenses.
 The Company offers two types of accounts that may reimburse you for your eligible out-of-pocket   way to use pre-tax dollars to pay for eligible   Funds DO NOT roll over from year-to-year. Unlike
 expenses; a Health Care Flexible Spending Account (FSA) and a Limited Purpose Flexible Spending   child and elder care expenses (generally   an HSA, you must use the funds in your FSA
 Account (LPFSA).  expenses you incur so that you can work).   by December 31, 2021, or you lose them.
      Enrollment is not automatic. You must actively   Deadline for claims submission: All claims for
 Enrollment in these accounts is never automatic. It is mandatory that you actively enroll in your FSA   enroll in the Dependent Care FSA each year.  reimbursement for the 2021 plan year must be
 each year during Open Enrollment or your new hire enrollment.  filed prior to March 31, 2022.
      Contributions are deducted from each paycheck
      and deposited into an account that may be   Expenses You Can Pay with a
 HEALTH FSA  LPFSA (LIMITED PURPOSE FSA)  accessed with a claim form.  Dependent Daycare FSA:
                                               Child Care (while you work) for child(ren) under
      The Dependent Daycare FSA has IRS limitations
 Standard PPO, Core or Buy-Up HDHP   of $5,000 per year and further limitations for   age 13, provided by
 Which medical plan is this    (No HSA). You don’t need to be    Core or Buy-Up HDHP with HSA  certain married participants. Your taxable     • After school program
 account available for?  enrolled in a medical plan to    income will be reduced by the amount you     • Daycare center
 contribute to a Health FSA.  set aside for your FSA every pay period. It is
      important to estimate the amount of your out-of-    • An individual who is NOT also your tax
                                                  dependent
 This health care account is only  pocket expenses carefully and plan your payroll
 Eligible healthcare expenses,  contributions accordingly.    • Summer day camp
 available if you are contributing to
 What would I use this account for?  including dental, vision and  an HSA and you can only use it for
 prescription medication expenses.             Elder Care (of your tax dependent)
 eligible vision and dental expenses.  Unlike Health FSA, the Dependent Care FSA
      can only reimburse you for amounts you have      • In your home
      on deposit as you incur claims. You must incur     • Adult daycare
 What is the maximum amount I  $2,750 - the IRS pre-tax  reimbursable Dependent Care expenses during
 can contribute to this account?  contribution limit as of this writing  the 2021 plan year or during your benefit period   Not Reimbursable:
      if enrolling as a newly eligible employee.    • Health care expenses of your child or other
 Your entire goal amount is                       dependent
 When are the funds available?  available at the beginning of the  Before you enroll in Dependent
 benefit period.                                    • Babysitting for non-work related activities
      Day- care FSA, note this account
 You will forfeit amounts not  is NOT for reimbursement of     • Dance lessons
 What happens if I don’t use the                    • Tutoring services
 money during the year?  claimed for expenses incurred  dependent health care expenses!
 during the benefit period.                         • Field trips
      Do not enroll in this plan unless you expect
      to incur eligible expenses, such as daycare     • Dog walking
 Contribution allowed for Medicare   Yes  Yes, to end of year in which  services that can be substantiated with a
 enrolled?  Medicare enrollment first occurs
      receipt.                                 Note: For purposes of the 2021 Mid-Year Open Enrollment,
                                               your current Flexible Spending Account elections (if any)
                                               will continue through 12/31/2021 unless you modify the
 BFS HealthEquity 1-877-924-3967  Also consider: Compare the Dependent   election during the mid-year enrollment period. Modifications
 Provider Contact                              during the 2021 Mid-Year Open Enrollment will be audited
 BMC HealthEquity 1-866-346-5800  Daycare FSA to the Federal dependent care   to ensure you have not adjusted your annual election for an
      tax credit to see which approach provides you   amount lesser than what you have already received in year-
      with the better tax advantage. In some cases,   to-date reimbursements.
 How to File FSA Claims  you may be able to split your eligible expenses
 File claims with HealthEquity. File claims with HealthEquity through March 31,   between a Dependent Care FSA and the tax
      credit. You may wish to consult your tax advisor.
 2022 for 2021 FSA expenses incurred through December 31, 2021. Log on to
 https://www.wageworks.com/paymentoptions/ or use the WageWorks EZ
 Receipts mobile app, available in the App Store and Google Play.  Forfeiture of Benefits
      Be conservative in estimating health and
 To learn more visit www.wageworks.com/myfsa. There is also an online chat   dependent care expenses. You will forfeit
 option on the website and the app.  amounts remaining in your Health Care and/or
      Dependent Care FSA account(s) for which you




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