Additional materials to help you make the most of your FSA.
Helpful Information – Just a Click Away
Welcome to your online resource page. Simply click the link for what you need below.
Forms and Worksheets
Capital Expense Worksheet (PDF) - Helps to determine if your expense is eligible
Dependent Care Tax Credit Worksheet (PDF) - Assists Dependent Care FSA participants in determining the best option between the federal tax credit and a Dependent Care FSA
Mileage Worksheet (PDF) - Helps to track mileage to and from a medical provider
Quick Reference Guides
Appeals Process (PDF) - Learn how the appeals process works regarding denied claims
Submitting Claims (PDF) - Know how to successfully complete an FSAFEDS claim form
Health Care Reform (PDF) - Check out how the health care reform legislation affected Health Care
Leave Without Pay (LWOP) (PDF) - Understand eligibility regarding a LWOP event
Orthodontia (PDF) - Know how to claim reimbursement for orthodontia expenses
Over-the-Counter (OTC) (PDF) - Learn which OTC expenses are eligible for reimbursement
Paperless Reimbursement (PDF) - Find out about the paperless reimbursement process, participating plans and how to enroll
Qualifying Life Events (QLEs) (PDF) - Understand which life events qualify as QLEs under an FSA, how they may affect your FSA election and how to let us know if you experience a QLE
Important Deadlines - View important dates and time frames for FSAFEDS
The Federal Flexible Benefit Plan (FEDFLEX) - The official plan document that governs FSAFEDS. This is a legal document that conforms to the IRS regulation that state a plan document must be available to participants. This is not a quick reference guide.
IRS Publication 502 (PDF) - Note: While insurance premiums are included in Publication 502, they are NOT reimbursable expenses for FSA purposes.
IRC Section 105 (PDF) - Information regarding Section 105 of the Internal Revenue Code and the treatment of medical expenses.
IRC Section 125 (PDF) - Information regarding Section 125 of the Internal Revenue Code covering cafeteria plans.
IRC Section 129 (PDF) - Information regarding Section 129 of the Internal Revenue Code and the exclusion of dependent care expenses.