The Flexible Spending Account (FSA) program administered by PayFlex allows regular employees to pay for out-of-pocket health care, dependent care and personally paid health insurance premiums with pre-tax dollars. At enrollment, new participants designate the FSA election amount for the coming year. This annual amount is deducted from the employee’s paychecks in equal installments, on a pre-tax basis, from January through December, and credited to the employee’s FSA account(s). Requests for reimbursement of eligible expenses are submitted to and paid by PayFlex (a third party administrator). The employee does not pay income or social security taxes on FSA contributions.
Federal law prohibits any change in a FSA during the calendar year unless the participant or his or her dependent(s) experiences a qualifying “life event,” such as marriage, divorce or legal separation, birth, adoption or death of a dependent, or a change in the participant’s or the spouse’s employment status.
FSA contributions must be re-elected during the annual open enrollment period in order to continue into the next year.
PayFlex Reimbursement Forms
- PayFlex Reimbursement Accounts Claim Filing Guidelines (PDF)
- PayFlex Reimbursement Account Claim Form (English) (PDF)
- PayFlex Reimbursement Account Claim Form (Spanish) (PDF)
- PayFlex Direct Deposit Authorization Form (PDF)
- PayFlex Letter of Medical Necessity Form (PDF)
- PayFlex Mobile App Guide (PDF)
For further information, please contact: