UPHS_Enrollment_Flipbook_Print_Version

If you are married and filing a joint tax return, your contributions combined with your spouse’scontributions to a Dependent Care FSA, cannot exceed $5,000* for the calendar year (January 1through December 31), regardless of your or your spouse’s plan year.*Beginning July 1, 2011, employees making $110,000 or more will only be able to contribute amaximum of $1,700 this plan year to a Dependent Care FSA to meet IRS regulations.Important Rules• You must re-enroll every year in order to participate in an FSA.• If you participate in the Health Care FSA, any unused funds left after September 15, 2012, willbe forfeited. You can submit expenses until December 31 after the end of the plan year.• If you participate in the Dependent Care FSA, any unused funds left after June 30, 2012, will beforfeited. You can submit expenses until September 30 after the end of the plan year.• Expenses paid through the Spending Account can’t be claimed as a tax deduction on yourfederal income tax return.• Hold on to your receipts. The administrator has the right to request receipts for the moneyspent using your Health Care Flexible Spending Account Card.Eligible Health Care ExpensesYou can use your Health Care FSA to be reimbursed for:• Medical and dental deductibles and copays,• Out-of-pocket costs for hospital or physician care,• Non-reimbursed prescriptions and copays,• Dental care, including orthodontia,• Vision care, including exams, eyeglasses and contact lenses,• Hearing aids, and• Other expenses considered eligible by the IRS.Effective January 1, 2011, over-the-counter medications and drugs (such as pain relievers,antacids and allergy and cold medicines) are only eligible for reimbursement if you have aprescription from your doctor.Expenses that are not eligible for reimbursement include:• Health insurance contributions,• Health insurance premiums under your spouse’s plan,• Most cosmetic surgery procedures, and• Dietary supplements/vitamins, cosmetics, toiletries and sundry items.For a complete list of eligible expenses, visit www.enrollone.com/uphs.You can be reimbursed for up to the amount you elected to deposit for the plan year, even if youhave not yet made the full contribution for your FSA.18