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SHEAKLEY FLEXIBLE BENEFITS DIVISION HEALTH CARE REIMBURSEMENT CLAIM FORM Part 1: Employee Information: Employee Name: (First) (Last) Social Security Number: - - Work Phone: Employer Name: E-mail:.

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For 2023, participants may contribute up to an annual maximum of $3,050 for a HCFSA or LEX HCFSA. The Dependent Care FSA (DCFSA) maximum annual contribution limit did not change for 2023. It remains at $5,000 per household or $2,500 if married, filing separately.

For the most part, your FSA card should work where it makes sense: at locations like pharmacies, vision centers, doctor and dentist offices, and so on. But if you try to use your card at a restaurant or bike shop, even if that bike shop happens to sell FSA eligible bandages, chances are your card won't work.

The Use-It-Or-Lose-It Rule If the employee fails to incur enough qualified expenses to drain his or her FSA each year, any leftover balance generally reverts back to the employer. However, there are two exceptions to the use-it-or-lose-it rule. An FSA plan can allow a grace period of up to 2 1/2 months.

What Happens if I Use My FSA Incorrectly? If the benefits card is accidentally or intentionally utilized for ineligible expenses, you are responsible for reimbursing your account. You will be notified if you have an ineligible expense, and your benefits card may be deactivated until your account is reimbursed.

While FSA funds are deducted by the employer during payroll, the benefits vendor administering the FSA is responsible for verifying the receipts rather than the employee.

Employers are not allowed to ask for money back that you spent from your FSA if you quit or retire. This is due to the Uniform Coverage rule which ensures that your Flexible Spending Account funds are available to you in full as soon as your plan year starts. Any FSA amount you don't use is returned to your employer.

4. Can I use my Health Care FSA to reimburse outstanding medical expenses from the prior year? No, expenses must be incurred during the current plan year.

If the FSA is overspent, the annual election amount may be adjusted, and the per-pay-period deduction amount is increased to make up for the missed contributions. Either way, you would be able to submit manual claims for reimbursement for eligible expenses incurred while the garnishment was in place.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232