Flexible Spending Account (FSA)
ASI Flex FSA General Claim Form Claims incurred July 1, 2016 through September 15, 2017
HealthEquity Claims Claims incurred July 1, 2017 through September 15, 2018
The University of Utah offers a Flexible Spending Account (FSA) program (also known as a Section 125 Plan) for eligible medical expenses and/or dependent care expenses.
Additional Information
- Choosing Between Health Savings Account (HSA) and a Flexible Spending Account
- FSA Information Sheet
- Debit Card Overview
- PIN Number Option
HIGHLIGHTS OF FLEXIBLE SPENDING ACCOUNTS (FSAs):
- The University has two types of Flexible Spending Accounts:
- Health FSA - For reimbursement of eligible medical expenses incurred by you and your eligible dependents; and
- Dependent Care FSA - For reimbursement of eligible dependent day care expenses for your eligible dependents (see below for a definition of eligible dependents.)
- The University's Plan Year runs from July 1 through June 30.
- During Open Enrollment each year (held in April), you select the annual amount to be withheld from your pay. The annual amount will be divided by the number of pay periods in the Plan Year and an equal portion will be taken out each paycheck through pre-tax payroll deductions. You must make a new election each Plan Year-elections do not roll over from one year to the next.
- If you have been newly hired into a benefit-eligible position with the University, you may make an annual election during your Initial Enrollment Period (first 90 days following your date of hire). The annual amount will be divided by the number of pay periods remaining in the Plan Year and an equal portion will be taken out each paycheck through pre-tax payroll deductions.
- The minimum amount an employee can contribute is $5.00 per pay period per account. The maximum amount an employee can contribute is $2,500 per Plan Year to a Health FSA and $5,000 per Plan Year to a Dependent Care FSA (the IRS limits the amount individuals can contribute for dependent care expenses to $5,000 per calendar year per family).
- If you enroll in a Health FSA, you will receive two debit Visa® cards for use at eligible pharmacies and health care facilities.
- The University has a two and one-half month grace period following the end of the Plan Year in which employees may use any funds remaining at the end of the Plan Year. The grace period runs from July 1 through September 15 each year.
- You have until December 31 to request reimbursement for any medical or dependent care costs for the previous Plan Year.
- Funds may only be used for eligible expenses you incur after the date you begin participating and before the end of the grace period (September 15 following the end of the Plan Year) or the date you are no longer participating whichever occurs first, regardless of when you are billed or pay for the expenses.
- Requests for reimbursement of eligible expenses incurred through September 15 must be submitted on or before December 31 following the end of the Plan Year/grace period. Any funds remaining in your account after December 31 following the end of the Plan Year/grace period will be forfeited.
- Annual elections do not roll over from year to year. If you wish to continue participation, you must enroll and make new elections during Open Enrollment each year.
ELIGIBLE EXPENSES:
To be eligible, expenses must not be paid, reimbursed, or reimbursable from any other source. Expenses must be incurred during the Plan Year while you are participating in the Plan (expenses are treated as incurred when you are provided with the services and not when you are billed or pay for the services).
| Eligible Medical Expenses | |
| Eligible medical expenses are those incurred for the diagnosis, cure, mitigation, treatment, or prevention of disease or to affect any structure or function of the body. | |
Some examples of eligible medical expenses include:
|
Eligible medical expenses do not include:
|
| Eligible Dependent Care Expenses | |
Expenses incurred for the care of a Qualifying Dependent (defined below) necessary to allow you and your spouse, if any, to work or attend school. The care must be provided by someone other than your spouse or one of your dependents.
A Qualified Dependent is:
|
|
CHANGES TO ELECTIONS
FSA elections you make are irrevocable; however, IRS regulations will allow you to change your election amount if you experience a status change event such as death, divorce, or birth or adoption of a child. The election change must be consistent with the event. If you experience a status change event and wish to change your FSA election, you must request the change within 90 days of the date of the event or before June 30 (the end of the Plan Year), whichever is earlier. Contact the Benefits Department for more information or to obtain a form to make a change.
HOW TO ENROLL
If you are an employee in a benefit-eligible position, you may enroll in Flexible Spending by completing an enrollment form and submitting it to the Benefits Department during your Initial Enrollment Period (first 90 days after you are hired into a benefit-eligible position) or during Open Enrollment each April. Elections made during Open Enrollment are effective for the following Plan Year beginning July 1. You may also enroll in an FSA if you experience a status change event. Contact the Benefits Department for additional information.