How it Works
- Determine how much money you will spend for out-of-pocket health and daycare expenses within the calendar year. You can use the Expense Estimation Worksheet (PDF Format, 89KB)* to help you determine your expenses. Remember, the accounts are separate and funds cannot be commingled between the health care and dependent care spending accounts. Also, if you do not use all the money you set aside, you will lose it; it does not get reimbursed to you nor does it roll over to the next year. Leftover funds will be used to offset administrative expenses. For the Dependent Care FSA, you will only be reimbursed for the amount you have currently contributed so you may be doubling up on your expenses at first.
- Complete the FSA enrollment form (PDF Format, 120KB)* and submit it to SDSURF Human Resources within 31 days of your hire date or during Open Enrollment. This election will be in effect for the entire year unless you have a qualified life status change. (Note: you must re-enroll each year to continue participating.)
- Your annual election will be divided equally among the remaining pay periods throughout the year, and deducted from your pay check.
- You or your dependent incurs expenses.
- Submit your claim for reimbursement.
- For the Health Care FSA only, you may use TRI-AD's FlexCard on the spot for immediate payment. TRI-AD may contact you within a few weeks of purchase for a copy of your receipt. If you do not respond to TRI-AD or can't provide receipts, your FlexCard may be inactivated and/or you may be required to repay the plan. For an additional FlexCard, complete the Dependent Card Authorization Form.
- Mail or fax a FSA Reimbursement Request Form (PDF Format, 229KB) to TRI-AD along with your receipt including the description, date, and cost of the service as well as the service provider.
- Your claim will be reviewed for eligibility and approved or not approved for payment.
- If you submit a manual claim, you will be reimbursed by direct deposit or check, whichever you elect. Reimbursements are mailed every week on Friday. Keep all receipts for TRI-AD's request for verification and for tax purposes. Please note: FSA reimbursement checks indicate that they should be cashed within 180 days of receipt.
- You will be able to track the status of a claim and your account balances on TRI-AD's website.
FlexCard Co-Pay Match
If you use your Flex Card to pay office visit or prescription co-pays, you may not need to submit receipts to TRI-AD. The IRS clarified that the co-pay match has been expanded to allow multiples up to five times the co-pay for office visits and medications with no additional substantiation (receipts), as long as the merchant uses the correct merchant code.
Examples of transactions where no proof of purchase (receipt) will be required:
- Office Visit Example
- Office co-pay = $15 per visit, per person
Sarah uses her FlexCard to pay $45 at the doctor's office for services for herself, and her two children.
- Office co-pay = $15 per visit, per person
- Prescriptions Examples
- Kaiser Prescription co-pay = $10 for generic medications, $35 for brand name
Deborah uses her Flexcard at Kaiser's pharmacy and purchases 4 generic medications for herself and her family for a total of $40 ($10 x 4 = $40). - Health Net Prescription co-pay = $10 for generic medications, $25 for brand name, $50 for non-formulary medications
Bob is enrolled in Health Net and uses his FlexCard through CVS/Caremark to purchase 3 generic drugs ($10 x 3 = $30) and 2 brand name drugs ($25 x 2 = $50) for himself and his family, for a total of $80 ($30 + $50 = $80).
- Kaiser Prescription co-pay = $10 for generic medications, $35 for brand name
Examples of transactions where proof or purchase (receipts) will be required:
- Steve is enrolled in Kaiser and uses his FlexCard to purchase 2 brand name drugs ($35 x 2 = $70) and eligible over-the-counter products, ($7) totaling $77. The $77 does not exceed the maximum transaction amount, but it is not a multiple of the combination of Steve's prescription drug co-pays. A receipt will be required for the full transaction amount.
Use it or Lose it Rule
Plan your estimated expenses wisely. If you contribute more in the plan year than you claim for reimbursement, any amount left in your account at the end of the plan year will be forfeited and used to offset administrative expenses. For employees in this situation, SDSURF has adopted a grace period and a run out period so you can maximize your contributions for health related expenses.
Grace and Run Out Periods
The FSA plan year is from January 1 - December 31. If services are not incurred by this date for the Dependent Care FSA, left over contributions will be forfeited and used to offset administrative expenses. You will have until March 31, of the following calendar year, to submit Dependent Care FSA claims for the previous plan year.
SDSURF has adopted an extended Grace Period for the Health Care FSA, and you will have until March 15, to continue to receive services under the previous year's Health Care FSA balances. You will have until March 31 to submit Health Care FSA claims for the previous plan year and corresponding Grace Period. Between January 1 and March 31, claims submitted against the previous plan year and corresponding Grace Period will be processed on a first in, first out basis (see below).
FSA claims submitted after March 31, for the previous year will not be processed, and any unexpended balances will be forfeited.
Example of First In, First Out Claim Payment for the Health Care FSA
As of 1/1/2012
- 2011 remaining balance is $600
- 2012 election is $2,000
| Claim | How Paid |
|---|---|
| Balance at end of 2011 | $600 |
| 2012 election | $2,000 |
| 1/10/12: Submit claim for $400 dental bill incurred on 12/14/11 | $400 paid from remaining 2011 balance |
| 2/1/12: Submit claim for $300 dental bill incurred 1/15/12 | $200 paid from remaining 2011 balance $100 paid from new 2012 elected amount |
| 2/10/12: Submit claim for $500 dental bill incurred 11/15/11 | The claim will be denied. TRI-AD will not reprocess claims to move them from one plan year to the other. |
View a list of Frequently Asked Dependent Care FSA Questions.
* Note: Documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view. Download Adobe Acrobat Reader.
* Note: Documents in Word format (DOC) require Microsoft Viewer, download Microsoft Word Viewer ..