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Flexible Spending Account (FSA) Enrollment Form 2015 Plan Year Employee Name: UNIT#: If you wish to enroll in a Flexible Spending Account (Health FSA and/or Dependent Day Care FSA) for the 2015 Plan
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How to fill out flexible spending account open:

01
Determine eligibility: Check if you meet the requirements for a flexible spending account (FSA). Typically, you need to be employed and your employer should offer an FSA program.
02
Review available options: Consult with your employer or benefits provider to understand the different FSA plans available to you. There may be variations in contribution limits, claim procedures, and eligible expenses.
03
Decide on contribution amount: Determine how much money you want to contribute to your FSA for the upcoming year. Consider your expected medical expenses and any specific healthcare needs.
04
Enroll during open enrollment: Typically, FSAs are offered as part of an employer's open enrollment period. Complete the necessary forms and submit them within the given timeframe.
05
Understand reimbursement procedures: Familiarize yourself with the procedures for reimbursement. This may involve submitting medical receipts, completing claim forms, or utilizing a debit card provided by your FSA provider.
06
Keep track of eligible expenses: Ensure you understand what expenses are considered eligible under your FSA. This usually includes medical, dental, and vision expenses, as well as some over-the-counter items. Retain receipts or documentation for these expenses.
07
Maximize your contributions: If possible, contribute the maximum allowed amount to your FSA. Unused funds may be forfeited at the end of the plan year, so it's important to take full advantage of the account.
08
Regularly review account balance: Monitor your FSA balance throughout the year. This will help you plan your spending and avoid losing unused funds.

Who needs flexible spending account open?

01
Individuals with anticipated medical expenses: FSAs are beneficial for those who expect to incur medical, dental, or vision expenses during the plan year. This can include prescription medications, doctor visits, and other healthcare-related costs.
02
Families with dependents: If you have dependents who require medical or dental care, having an FSA can help offset the costs associated with their healthcare needs.
03
Employees with high out-of-pocket costs: If you have substantial out-of-pocket expenses for medical treatments or procedures, an FSA can provide some relief by allowing you to pay for these expenses with pre-tax dollars.
04
Individuals who want to save on taxes: Contributions to an FSA are made on a pre-tax basis, reducing your taxable income. This can result in lower tax liability and increased savings.
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A flexible spending account (FSA) allows employees to set aside a portion of their pre-tax earnings to pay for eligible expenses such as medical or dependent care costs.
Employees who wish to participate in a flexible spending account program offered by their employer are required to file an open enrollment form.
Employees can typically fill out the necessary paperwork during their employer's open enrollment period, providing details on the amount they wish to contribute and the eligible expenses they plan to use the funds for.
The purpose of a flexible spending account is to help individuals save money on eligible expenses by allowing them to use pre-tax dollars.
Employees must report the amount they wish to contribute, the eligible expenses they plan to use the funds for, and any other required details as specified by their employer.
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