1 UNF DrBuilding 1 - J.J. Daniel Hall, Room 1101Jacksonville, FL 32224
Phone: (904) 620-2903
Fax: (904) 620-2742E-mail:firstname.lastname@example.org
A Flexible Spending Account (FSA) allows an employee to pay for eligible out-of-pocket medical and/or dependent care expenses with tax-free dollars. At the time of hire or during each open enrollment period, the employee must elect an annual amount to contribute to the FSA account. The amount selected will be deducted from the employee's paychecks on a pre-tax basis throughout the year. When an eligible expense is incurred, a claim form and receipt documentation is submitted to the People First Service Center for reimbursement from the FSA account.
FSAs have a "use it or lose it" policy, which means the employee will forfeit any amounts unused and not reimbursed for services received during the Plan year.
Standard PPO or HMO*
No medical coverage
*Not available with HIHP HMO or HIHP PPO
Any HIHP HMO or HIHP PPO*
*Not available with Standard HMO or PPO
$60 to $2,500 in pre tax dollars
$60 to $5,000 in pre tax dollars ($2,500 if you're married filing separate tax returns)
$60 to $5,000 in pre tax dollars
Out-of-pocket medical, prescription, dental , vision and over-the-counter medication expenses not paid by insurance or reimbursed from any other source.
Care for a child, disabled spouse or qualifying relative who is dependent on you and needs care so that you (and your spouse if you're married) can work.
Out-of-pocket dental, vision and over-the-counter medication expenses not paid by insurance or reimbursed from any other source. Not available for medical expenses.
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DCRA cost calculator
FSA claim form
FSA direct deposit
MRA cost calculator
LPMRA cost calculator
Qualifying status change
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