Flexible Spending Account Plan - Anderson University



Flexible Spending AccountA FLEXIBLE SPENDING ACCOUNT (FSA) PLAN is available to Anderson University faculty and staff to provide an opportunity to use salary dollars to purchase benefits on a pre-tax basis. Benefits purchased through FSA are not subject to State, Local, Federal and FICA withholdings. Following is a brief summary of the FSA Plan options and how to file claims. The University Flexible Spending Account Plan is intended to qualify as a "cafeteria plan" under Section 125 of the Internal Revenue Code. How the Plan WorksThe following example shows how participation in the FSA Plan affects your take home pay. This example is based on a $2,400 per month ($28,800 per year) salary, a flexible spending election of $200 and an estimated withholding of 26.65% (7.65% FICA + 15% Federal + 4.0% State & County).Without FSAWith FSA$ 2,400Less6401,760Less200$ 1,560Income/month Est. withholdingsFlexible spendingTake home pay$ 2,400Less200$ 2,200Less586$ 1,614Income/monthFlexible spendingEst. withholdingTake home paySavings=$54 per monthUnreimbursed Medical ExpenseYou may include medical expenses for yourself, your spouse and/or your dependents. You may elect to participate in the Unreimbursed Medical Expense plan even if you are not participating in an Anderson University health plan. Limited Unreimbursed Medical Expense Accounts are for those enrolled in a high deductible (CDHP) health plan and Health Savings Account for 2013. This account may be used only for dental and vision expenses. If you prefer, you may use your HSA account for dental and vision expenses. Please complete the “Limited Unreimbursed Medical” section on the Election Form.The maximum unreimbursed medical reduction amount for 2014 is $2,500 annual, or $208.33 per month. This election cannot be changed during the calendar year unless there is a “qualifying event” as defined by the IRS (see additional information below).Dependent Care ExpensesYou may include work-related dependent care expenses incurred for children under the age of 13; private school tuition for Kindergarten and above may not be included. IRS regulations require that persons for whom you are claiming dependent care expenses be claimed as dependents on your Federal Income Tax return. The IRS has established calendar year limits for Dependent Care Expenses under a cafeteria plan as follows: the lesser of your income, your spouse's income, or $5,000. (In the case of married individuals filing separate returns, the maximum amount is $2,500.) The IRS also requires that the name, address and tax identification number of the person(s) performing child or dependent care services be included on the Federal Income Tax return of the employee benefiting from the dependent care exclusion. Please contact Human Resources if you would like more information.Filing ClaimsClaim forms are available in the Office of Human Resources located in Decker Hall, Room 10 or at and should be submitted as follows:Unreimbursed Medical Claims for expenses covered by insurance must include an explanation of benefits (EOB) from your health insurance carrier. IRS rules permit only the reimbursement of expenses not paid by insurance. Non-covered items may be submitted with a dated, itemized receipt and the name of family member incurring the expense. Dependent Care Expense Claims may be submitted by attaching a proper receipt. The receipt must include: the provider name; payment amount; dates of service; and provider tax ID# (this number must be reported on your Federal Income Tax Return). Claims may be submitted to Human Resources at anytime during the month. Eligible claim reimbursements will be added to net pay and deposited with your next regularly scheduled paycheck. Generally, monthly payroll claims must be received by the 10th of the month and bi-weekly payroll claims received 10 days prior to pay day.Contact Human Resources at extension 4130 for additional information about FSA Claim filing procedures.Change of Status RulesThe IRS has published a list of circumstances under which midyear changes in health, group term life, unreimbursed medical and dependent care plans may be made. Under these rules, a Flexible Spending Plan change may only be made if 1) it is a qualified change in status as listed in the IRS regulations and 2) the resulting benefit change is consistent with your change in status. This means if there is a qualified change in status, only benefit changes that are directly impacted by the change in status are permitted. For health, life and unreimbursed medical and dependent care expense plans, the following qualify as a change in status: a change in legal marital status; a change in number of dependents; a change in employment status by the employee, spouse, or dependent that leads to a loss or gain of eligibility under a plan; a change in the dependent’s ability to satisfy the requirements of coverage due to age, student status, etc.; a change in dependent care costs imposed by the dependent care provider; or a change in residence of the employee, spouse or dependent. Please contact Human Resources if you have questions or wish more information about the change of status provisions. ................
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