Coverage

Employees may set aside money from their paychecks pre-tax for reimbursement for qualified medical expenses.   The medical Flexible Spending Account (FSA) reimburses eligible expenses incurred by the employee or dependents which are not paid by an existing health care plan such as Over-the-counter medication and co-pays.  Please remember that if you do not use the full amount in your account, you lose the unused balance in accordance with Federal law.

The medical FSA may reimburse eligible expenses for a spouse and dependents as long as they are claimed on the federal tax return, regardless of who is covered on the employee's medical insurance. 

Contribution Amount

• Minimum Annual Contribution: $0.00 (but if opting in, the minimum per pay period is $5.00 for bi-weekly and $10.00 for employees paid monthly). 
• Maximum Annual Contribution:  $5000

Eligible Expenses

• Medical co-payments and deductibles
• Permissible over the counter drugs and prescriptions
• Vision expenses such as exams, eyeglasses, contacts and LASIK surgery.
• Mileage for eligible medical expenses.
• Other IRS approved expense that are not reimbursed by any other benefit.

    Full List of Eligible Expenses

Important Information

• Use it or Lose it:   Claim Deadlines Apply.  If funds remain in the account at the end of the claim deadline, they will be forfeited. 
• Uniform Reimbursement:  After your first medical FSA contribution on your plan, you will have access to the total amount you have elected for the year regardless of the balance in your spending account. 
• Contribution Changes:  Contribution amounts may only be changed if you experience a qualified family status change event (i.e. marriage, birth of child, divorce etc.)
• Retirement/Employment Termination:  Per IRS regulations, claims may only be submitted for services prior to the retirement or termination date unless you elect to continue your account by making contributions under COBRA. 
• Separate Accounts:  The medical and dependent care spending accounts may not be co-mingled.

Eligibility

• All regular full-time employees, effective the first of the month after 30 days of continuous service
• All regular part-time employees (budgeted for at least 1,000 hours/year), effective the first of the month after 60 days of continuous service

Forms, Links and Vendor Information

FSA Enrollment Form (pdf)

FSA Direct Deposit Form (pdf)

FSA Medical Reimbursement Form (pdf) 

FSA Plan Brochure

Medical Expense Calculator  (How much money should you allocate to your FSA?)

Flores and Associates Website  (Claims may now be submitted online.  Log in on the website to access the correct forms).

Plan Administrator

Davidson College

Member Services

Flores and Associates
200 South Tryon Street, Suite 1100
Charlotte, NC  28202

704-335-8211 / 704-335-0818
www.flores247.com

Last Update 10/22/08