NOTE:  Employees paid monthly will have 12 deductions in 2023. Bi-Weekly employees will have 24 deductions with no deductions withheld from the third paycheck of the two three check months.

Eligible employees are allowed to enroll in increments of $100, up to $3,200 annually. Participants enrolled in the Healthcare FSA will be provided with a pre-loaded debit card with your annual target amount for your use throughout the Plan Year. Payroll deductions are made in equal payments throughout the year, but you have access to the full contribution at the beginning of the Plan Year. The deduction is made before taxes, thus making the spending account dollars tax-free. To access the money in your account, you can either use your FSA Debit Card at the time of service, you can file a paper claim requesting reimbursement for eligible, out-of-pocket expenses, or you can file a claim and upload supporting documents online at www.dbsbenefits.com.

Eligible Healthcare FSA expenses include:

• Health insurance deductible
• Copays and coinsurance for medication or pharmacy expenses 
• Dental insurance deductible
• Dental expenses such as exams, cleanings, fillings, crowns, x-rays
• Orthodontia
• Vision expenses such as frames, lenses, contact lenses
• Over-the-Counter (OTC) medications such as allergy and anti-inflammatory, cold and flu, pain relievers, cough suppressants

View a more detailed list of health care expenses that may or may not qualify for reimbursement.

You may receive tax-exempt reimbursements for the care of certain individuals in your household, which includes your dependent children age 12 or younger and any other individuals who reside with you and who rely on your for at least half of their support or are physically or mentally unable to care for themselves. The IRS states that if you are married, both you and your spouse must be employed in order to utilize the Dependent Care FSA. You must file manual claims directly with DBS to be reimbursed. A debit card is not issued for the Dependent Care FSA.

Eligible Dependent Care Account expenses include:

• Day-care costs
• Schooling costs, not including food and clothing, for either private or public schools, for children not yet in kindergarten
• If expenses for food and clothing cannot be separated from the total cost of child care, then they are eligible expenses
• Before/after-school care
• Babysitting and licensed day-care center costs
• Housekeeping services in your home that include daycare
• Elder care if dependent is claimed on your tax return

Costs of transportation, overnight camping, nursing care facilities, and the schooling costs of children in the first grade or above are generally ineligible expenses.

You must determine an annual target amount (maximum limits apply) to be withheld by forecasting your out-of-pocket health care and/or dependent care expenses for the entire plan year (January 1 -December 31). If you enroll in the FSA, you will be provided with a Debit Card that is pre-loaded with your elected amount to use throughout the Plan Year. Dependent Care participants must file manual claims.

Your annual target is then deducted from your paycheck in equal installments. The deduction is made before taxes are computed, thus making the spending account dollars tax-free. There is no tax liability on the money put into either the health care or dependent care spending account or on the money reimbursed through these spending accounts.

Use this worksheet to estimate your out-of-pocket expenses. Remember that IRS regulations state that if all the money in the account is not used by the end of the Plan Year, the remaining balance must be forfeited (known as the “Use-it-or-Lose-it rule”).

To access the money in your account, you can either use your FSA Debit Card at the time of service, or you can file a claim requesting reimbursement for eligible, out-of-pocket expenses. Please see Online Claims Filing Instructions for more information. Please be aware that reimbursement checks issued from DBS have a 180-day expiration date.

Reimbursements for Dependent Care expenses can be accessed by mailing/faxing claim forms to DBS, submitting claim information online or submitting via the DBS mobile phone application.

You can only make mid-year changes to these accounts if you experience a qualifying event as defined by the IRS.

There will be a grace period immediately following the end of the Plan Year for both Health Care and Dependent Care Spending Accounts. This extension will provide participants additional time to incur expenses for reimbursement from the previous year's account. The grace period will be available after the end of the Plan Year from January 1st through March 15th. All claims incurred during the grace period must be filed no later than April 15th.

Diversified Benefit Services

1-800-234-1229

VISIT DIVERSIFIED BENEFIT SERVICES

 

FSA Resources

Flexible Spending Account Election Form

COVID-19 IMPACT IN DEPENDENT CARE

ONLINE CLAIMS FILING INSTRUCTIONS

FSA DIRECT DEPOSIT FORM

FSA CLAIM FORM

HOW TO FILE A CLAIM

PREPAID BENEFITS CARD INFORMATION

PREPAID BENEFITS CARD FAQ