Sample Benefit Enrollment Guide

2019 Benefit Guide

Remember: Use It or Lose It Healthcare and dependent care funds do not rollover to the next plan year.

services must be necessary to allow you to work or attend school

Healthcare FSA HSAPPO members are not eligible.

full-time. Dependent care expenses are reimbursable as long as

the provider is not your dependent for income tax purposes. To

You may participate in this FSA if you are not contributing to a

be reimbursed, you will be asked to provide the Tax ID of the

Health Savings Account (HSA).

provider when submitting receipts.

You may contribute up to $2,700 per year to your Healthcare

Commuter FSA Everyone is eligible regardless of medical plan.

FSA. These dollars can only be used on eligible healthcare

expenses. A complete list of eligible expenses can be found on

irs.gov under the IRS Publication 502.

You can contribute a portion of your salary on a pre-tax basis to

pay for eligible expenses such as transit passes, vanpooling and

Dependent Care FSA Everyone is eligible regardless of medical plan.

parking.

„ „ Public Transit: $265/month „ „ Parking: $265/month

You may contribute up to $5,000 per year or $2,500 per year if

you are married and file separate tax returns. Eligible dependents

include children younger than 13 and dependents of any age

who are unable to care for themselves due to a disability. The

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