Flexible Spending Accounts

FSA 2011-2012

FSA 2012-2013

Flexible Spending Accounts 2011-2012

Pima County’s Flexible Spending Account is administered by Application Software Inc. (ASI).

ASI web page www.asiflex.com

Administrative fees:
Plan Year 2011-2012
Section 125 and/or 132 - $1.40 per pay period (paid by the County for all active employees)

Flexible Spending Accounts allow the employee to deposit money in an account(s) on a pre-tax basis. The funds which are set aside are used by the employee for reimbursement of eligible out-of-pocket costs incurred in the areas of health (medical, dental and/or vision), dependent care, parking and/or transit.

Section 125, Health and Dependent Care:

Summary & Plan Description:
125 Reference Guide	125 Claim Form
125 Change in Status	Direct Deposit Form

Section 125 Health Care (Maximum $5,000 per year)

Effective January 1, 2011, Over-The-Counter (OTC) medication without a doctor's prescription are not considered qualified medical expenses and therefore not reimbursable under federal guidelines.

• Eligible expenses include your out-of-pocket costs for medical, dental and vision care. Such costs are prescriptions, office visit co-pays, dental work, orthodontics, prescription eyeglasses, etc. Use the Health Care Worksheet below to estimate your annual expenses.
• You may include expenses for yourself, your legal spouse, or anyone who is a qualified tax dependent.  Expenses for domestic partners qualify only if they are a qualified tax dependent. More information on qualified tax dependents is available at www.asiflex.com.
• You may set aside up to $5,000 for the year in this account.
• You will lose any money left in the account after the end of the plan year (June 30th).

Limited Purpose FSA

If you enroll in the HDHP w/HSA, you will only be eligible for a Limited Purpose Flexible Savings Account. Only dental or vision expenses that are not covered by the health plan are reimbursable under a Limited Purpose FSA.

Section 125 Dependent Care (Maximum $5,000 per year)

• Eligible expenses include paying someone to take care of a dependent in order for you to work. The dependent care services must be necessary in order for you or, if you are married, for you and your spouse to work or attend school full time (unless your spouse is disabled).
• Use the Dependent Care Worksheet available from your departmental benefits representative, Human Resources or at an Open Enrollment Meeting to estimate your annual expenses.
• You may set aside up to $5,000 for the year in this account.
• You will lose any money left in the account after the end of the plan year (June 30th).

 

Section 132, Pre-tax Parking and Transit:

Transportation Reimbursement Arrangement (TRA)
132 Enrollment Form	132 Claim Form
Direct Deposit Form

Section 132 Parking (Maximum $230 per month)

• Reimbursement includes qualified parking near your workplace. If your parking expenses are established as a payroll deduction, you will not need to submit claim forms for reimbursement nor will you need to pay the administrative fee. Pre-tax parking forms are available through the Payroll Department.
• If you park in a lot not paid through payroll deduction, you may set aside and be reimbursed for up to $230 per month in this account. Claim forms and administrative fees are required.
• Any money leftover at the end of the plan year will rollover to the next year.

Section 132 Transit (Maximum $230 per month)

• Transit passes between your residence and workplace are eligible costs to include in this account.
• You may set aside up to $230 per month in this account.
• Any money leftover at the end of the plan year will rollover to the next year.

Flexible Spending Accounts 2012-2013

Section 125, Flexible Spending Accounts (FSA)

If you want to participate in the Health Care or Dependent Care FSA, you must re-enroll each year. 

Pima County’s Flexible Spending Account is administered by Application Software Inc. (ASI). Current plan year claims must be incurred by June 30, 2012 and submitted no later than September 30, 2012.

If you enroll in the HDHP with HSA, you will be eligible for a Limited Purpose Flexible Savings Account only. Only dental or vision expenses that are not covered by the health plan are reimbursable under a Limited Purpose FSA.

Over-The-Counter (OTC) items without a doctor’s prescription may not be considered qualified medical expenses and therefore not reimbursable under federal guidelines.  Please consider this information when determining election amounts.

 

Health Care FSA limit is $2,500

 

Summary & Plan Description

 

125 Reference Guide

 

Section 132, Pre-tax Parking and Transit

 

Current Flex Parking and Transit payroll deductions will continue in the new plan year.  You may change or cancel these deductions at any time. Please contact your Departmental Benefits Representative for instructions.

 

132 Enrollment Form

 

Transportation Reimbursement Arrangement (TRA)