A Flexible Spending Account (FSA) lets you pay for eligible expenses with tax-free money. You contribute to an FSA with pretax money from your paycheck. This, in turn, may help lower your taxable income. There are two types of FSAs – Healthcare FSA and Dependent Care FSA.
- Healthcare FSA – A Healthcare FSA is used to pay for eligible medical expenses which are not covered by your insurance or other plan. These expenses can be incurred by you, your spouse, a qualifying child or relative. Your full annual contribution amount is available at the beginning of the plan year, so you don’t have to wait for the money to accumulate.
- Dependent Care FSA – The Dependent Care FSA is a great way to pay for eligible dependent care expenses such as before and after school care, day time baby-sitting fees, elder care services, nursery and preschool costs. Eligible dependents include your qualifying child up to age 13, spouse and/or relative. You can request reimbursement from your Dependent Care FSA after your dependent receives day care services. Unlike the Healthcare FSA, your full annual contribution is not available at the beginning of the plan year. You can only get reimbursed up tothe amount that is available in your account at that time.
If you enroll in a Health Savings account, you cannot enroll in a Health Care Flexible Spending Account, but may enroll in a Limited Health Care Spending Account.
Annual Contributions
- Annual Contribution Limits For Healthcare FSA:
- Minimum Annual Contribution: $150
- Maximum Annual Contribution: $3,050
- For Dependent Care FSA:
- Minimum Annual Contribution: $150
- The maximum contribution depends on your tax filing status.
- If you are married and filing separately, your maximum annual contribution is $2,500*.
- If you are single and head of household, your maximum annual contribution is $2500*.
- If you are married and filing jointly, your maximum annual contribution is $5,000*.
- If either you or your spouse earn less than $5,000* a year, your maximum annual contribution is equal to the lower of the two incomes.
- If your spouse is a full-time student or incapable of self-care, your maximum annual contribution is $3,000* a year for one dependent and $5,000 a year for two or more dependents.
Use your PayFlex Card, your Account Debit Card
The PayFlex debit card is a convenient way to pay for eligible Healthcare expenses. The card knows when the expense is eligible and whether you have funds available. When you use the card, save your Explanation of Benefits, itemized statements and detailed receipts. There may be times when PayFlex asks you to provide documentation to verify you used your card for an eligible expense. If you’re a new Healthcare FSA member, you’ll automatically receive one card in the mail before the beginning of the plan year. The card is not available for the dependent care FSA. Additional cards may be requested by calling the PayFlex customer service at 1-844-PAYFLEX.
Claims with PayFlex
PayFlex Systems USA, Inc.
Flex Department
PO Box 981158
El Paso, TX 79998-1158
or Fax to: 1-855-703-5305
This form can be found in the Resource Center at payflex.com or you may call PayFlex at 844-PAYFLEX to request a form.
After you log in to payflex.com, click on the Financial Center tab and select your account from the drop down. Click on File a Spending Account Claim to get started. When you submit a claim or validate a card swipe, you need to include supporting documentation that shows the following:
- Merchant or service provider name
- Name of patient (if applicable)
- Date of service
- Amount you were required to pay
- Description of item or service
- Go to payflex.com.
- Click on Create Your Profile and follow the online instructions.
- After successfully registering your account, My Dashboard will be displayed and you will be able to access your account information.
- To receive electronic account notifications, select My Settings at the top of the page and Select the notifications link
- Enter your email address and then re-enter to confirm
- Then select the notifications you wish to receive and click Submit.
- Online System at MyFBMC – Please Login
- For changes during open enrollment
- Paper Form
- New participants (Active or Retirees) who want to enroll for the first time
- Employees who need to update dependent information
- By paper form. Return your completed enrollment form to your Benefit Coordinator by the end of open enrollment
- If you are not making any changes to your benefits, you do not need to complete an enrollment form.
Form Instructions
Remember to complete all requested information for your benefits.
- Sections 1, 2, and 3:
- Simply follow all the instructions and complete the information requested.
- For each benefit you are adding, changing or canceling, you must check the appropriate box next to the corresponding benefit.
- For the benefit selections you are not altering, check the “Keep Coverage” box. If you complete an enrollment form, but do not indicate your desire to cancel or change an existing benefit, that benefit will continue regardless of other benefits which may or may not be indicated on the enrollment form.
- Heath Care Flexible Spending Account:
- Complete Boxes 1, 2, and 3
- Select your coverage.
- Add the Cost per pay period.
- If you are selecting Dependent Care Flexible Spending Account
- Select your coverage.
- as well as Married, filing separately, Married, filing jointly, or Single, head of household
- Add the Cost per pay period.
- Complete the subtotal boxes.
Reminder – If you enroll in a Health Savings account, you cannot enroll in a Health Care Flexible Spending Account, but may enroll in a Limited Health Care Spending Account.
- Enrolling for the first time?
- Enroll online or complete an enrollment form and make your benefit selections by checking the “Add Coverage” box.
- Changing your benefits?
- Make changes online or complete an enrollment form and change your selections by checking the “Change Coverage” box. Complete the line with the new coverage information.
- Adding a new benefit?
- Enroll online or complete an enrollment form and make your selections by checking the “Add Coverage” box. Complete the line with the new coverage information.
- Keeping all of your current benefits?
- All benefits will continue as currently enrolled.
- Canceling current benefits?
- Make changes online or complete an enrollment form and check the “Cancel Coverage” box for the benefit you want to cancel; otherwise, it will automatically continue for the plan year.
- To receive your claim payments quickly, sign up for direct deposit through the PayFlex member website.
- Log in to payflex.com. Click on the Financial Center tab.
- Select your account from the drop down menu and click on Enroll in Direct Deposit to get started.