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mummi City of Cocoa I Employee Benefit Highlights 12020-2021 FF"A A. Flexible Spending Accounts (Continued) FSA Guidelines • Employee may carry over up to $550 of unused Health Care FSA HERE'S HOW IT WORKS!, funds into the next plan year after a plan year ends and all claims have been filed (only if the employee re-enrolls the next year). Employee earning $30,000 elects to place $1,000 into a Health Dependent Care funds cannot be carried over. Care FSA.The payroll deduction is$41.66 based on a 24 pay period • The Health Care FSA has a run out period at the end of the plan year schedule.As a result,health care expenses are paid with tax-free (90 days)to submit reimbursement on eligible expenses incurred dollars,giving the employee a tax savings of$227. during the period of coverage within the plan year(October 1 to September 30). • Dependent Care FSA allows a grace period at the end of the plan witna Withouta year (75 days).The grace period allows additional time to incur 1 Health Care FSA Health Care FSA claims and use any unused funds on eligible expenses after the Salary $30,000 $30,000 plan year ends.Once the grace period ends,any unused funds still FSA Contribution -$1,000 -$0 remaining in the account will be forfeited. , j Taxable Pay $29,000 $30,000 • When a plan year ends and all claims have been filed with the Estimated Tax $6,568 $6,795 exception of the$550 rollover for the Health Care FSA,all unused 22.65%=15%+7.65%FICA funds will be forfeited and not returned. Atter Tax Expenses -$0 -$1,000 • Employee can enroll in either or both of the FSAs only during the Spendable Income $22,432 $22,205 Open Enrollment period,a Qualifying Event,or New Hire Eligibility Tax Savings period. -- • Money cannot be transferred between FSAs. • Reimbursed expenses cannot be deducted for income tax purposes. • Employee and dependent(s)cannot be reimbursed for services not Please Note:Be conservative when estimating health care and/or dependent care received. expenses. IRS regulations state that any unused funds remaining in an ESA,after a plan year ends and after all claims have been filed cannot be returned or carried • Employee and dependent(s)cannot receive insurance benefits or forward to the next plan year with the exception of the$550 carry over that may be any other compensation for expenses reimbursed through an FSA. allowed for the Health Care FSA.This rule is known as"use-it or lose-it." • Domestic Partners are not eligible as federal law does not recognize them as a qualified dependent. Filing a Claim TASC I Phone:(800)422-4661 I Claims Fax:(608)663-2754 www.tasconline.com Claim Form:A completed claim form along with a copy of the receipt as proof of the expense can be submitted by mail or fax.The IRS requires FSA participants to maintain complete documentation,including copies of receipts for reimbursed expenses,for a minimum of one(1)year. Debit Card: FSA participants will automatically receive a debit card for payment of eligible expenses. With the card, most qualified services and products can be paid at the point of sale versus paying out-of-pocket and requesting reimbursement.The debit card is accepted at a number of medical providers and facilities,and most pharmacy retail outlets.TASC may request supporting documentation for expenses paid with a debit card. Failure to provide supporting documentation when requested,may result in suspension of the card and account until funds are substantiated or refunded back to the City.Please keep the issued card for use next year.Additional or replacement cards may be requested,however,a small fee may apply. 1 22 14 ©2016,Gehring Group,Inc.,All Rights Reserved