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2015 Flexible Spending Account Office Use Only Approved by Date Effective Date See the Summary Plan Description for more information at www.oregon.gov/DAS/PEBB 1. I am enrolling Newly Eligible Employee.

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What is flexible spending account?

A flexible spending account (FSA) is an employer-sponsored benefit that allows employees to set aside a portion of their earnings to pay for qualified expenses, such as medical or dependent care, on a pre-tax basis.

Who is required to file flexible spending account?

Employees who have enrolled in a flexible spending account offered by their employer are required to file for reimbursement of qualified expenses.

How to fill out flexible spending account?

Employees can fill out flexible spending account forms provided by their employer, submitting necessary documentation and receipts for qualified expenses.

What is the purpose of flexible spending account?

The purpose of a flexible spending account is to help employees save money on out-of-pocket expenses related to healthcare or dependent care by using pre-tax dollars.

What information must be reported on flexible spending account?

Employees must report details of qualified expenses, such as the date of service, provider, and amount paid, when submitting for reimbursement from a flexible spending account.

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