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FLEXIBLE SPENDING ACCOUNT (FSA) DIRECT PLAN DESIGN GUIDE Please complete this form and return to Further 45 days before your effective date, so we can properly administer your plan. If you have any
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How to fill out using your flexible spending

01
Start by checking with your employer if you have a flexible spending account (FSA) available.
02
If you have an FSA, determine how much money you want to contribute to it for the year.
03
Understand which expenses are eligible for reimbursement with your FSA. Common eligible expenses include medical and dental expenses, prescription medications, and certain over-the-counter items.
04
Keep track of your eligible expenses throughout the year by saving receipts and documentation.
05
Submit reimbursement claims to your FSA provider according to their specific instructions. This may involve completing a claim form and providing the necessary documentation.
06
Wait for your FSA provider to review and process your claim. Once approved, you will typically receive reimbursement either through direct deposit or a check.
07
Monitor your FSA balance throughout the year to ensure you do not exceed the allowed amount and to maximize the benefits of using your flexible spending.

Who needs using your flexible spending?

01
Anyone who anticipates having eligible medical or dental expenses can benefit from using a flexible spending account (FSA). This includes individuals or families who regularly incur medical costs such as prescription medications, doctor visits, or necessary procedures.
02
Employees who have access to an FSA through their employer can take advantage of the pre-tax savings and potentially reduce their overall healthcare expenses.
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Flexible spending accounts (FSAs) are accounts that let you set aside money, before taxes, for certain eligible expenses.
Employees who participate in a flexible spending account (FSA) are required to file using their flexible spending.
To use your flexible spending, you typically need to submit a claim form along with documentation of the expense.
The purpose of using flexible spending is to save money on eligible expenses by using pre-tax dollars.
You must report information such as the date of the expense, the amount spent, and the type of expense when using your flexible spending.
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