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FINANCE DIVISION Employee Benefits Department 619.725.8130 F 619.725.81322019 FLEXIBLE SPENDING ACCOUNT ELECTION FORM Last Name:First Name:Employee ID#:Address:Phone: (City:State:)Zip:HEALTH CARE
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How to fill out 2019 flexible spending account

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How to fill out 2019 flexible spending account

01
To fill out your 2019 flexible spending account, follow these steps:
02
Determine your anticipated expenses: Start by calculating and estimating your eligible medical, dental, and vision expenses for the upcoming year. These can include doctor visits, hospital stays, prescription medications, and certain medical equipment.
03
Set a contribution amount: Decide how much you want to contribute to your flexible spending account for 2019. Make sure to take into account your expected expenses and any contribution limits set by your employer.
04
Enroll in your employer's program: Contact your employer's human resources department or benefits administrator to enroll in your company's flexible spending account program for 2019. They will provide you with the necessary enrollment forms and information.
05
Fill out the enrollment form: Carefully complete the enrollment form, providing all required information such as your name, address, social security number, and desired contribution amount. Pay attention to any deadlines for submitting the form.
06
Choose your funding method: Decide whether you want to fund your flexible spending account through payroll deductions or through a lump sum payment. Make sure to understand the advantages and limitations of each method before making a decision.
07
Submit the form: Once you have completed the enrollment form, submit it to your employer's human resources department or benefits administrator according to their instructions. Keep a copy of the form for your records.
08
Keep track of expenses: Throughout the year, keep track of all eligible expenses that you incur. Save receipts, invoices, and other documentation to support these expenses during the reimbursement process.
09
Submit reimbursement claims: Whenever you have eligible expenses, submit reimbursement claims to your employer's flexible spending account provider. Follow their guidelines for submitting claims and provide all necessary documentation.
10
Follow up on claims: Stay informed about the status of your reimbursement claims and follow up with the provider if needed. Make sure to comply with any deadlines for submitting claims.
11
Use your funds wisely: Use your flexible spending account funds prudently to cover eligible expenses. Be mindful of any set expiration dates for using the funds, as unspent balances may be forfeited at the end of the plan year.

Who needs 2019 flexible spending account?

01
Not everyone needs a flexible spending account for 2019, but it can be beneficial for individuals who:
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- Anticipate regular medical, dental, or vision expenses throughout the year.
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- Want to save money on taxes by contributing pre-tax dollars towards eligible healthcare expenses.
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- Have a high deductible health plan or limited insurance coverage.
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- Have predictable healthcare expenses, such as recurring prescriptions or ongoing treatments.
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- Have dependents who require medical, dental, or vision care.
07
- Are planning to undergo elective medical procedures or surgeries.
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- Are expecting significant healthcare expenses for themselves or their dependents.
09
It is important to consider your personal financial situation and healthcare needs when deciding if a flexible spending account is right for you.
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Flexible spending account election allows employees to set aside a portion of their pre-tax earnings to pay for eligible expenses such as medical or childcare costs. This reduces their taxable income and may result in tax savings.
Employees who wish to participate in a flexible spending account program typically have to file an election during the initial enrollment period or open enrollment period provided by their employer.
Employees can fill out the flexible spending account election form provided by their employer, indicating the amount of money they want to contribute to the account and the eligible expenses they plan to use it for.
The purpose of flexible spending account election is to help employees save money on eligible expenses by allowing them to use pre-tax dollars, thus reducing their taxable income.
Employees typically need to report their desired contribution amount, the type of expenses they plan to use the funds for, and any other required information specified by their employer.
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