Dependent Care FSA Toolkit

A) Enter your expected out of pocket health care expenses: (Skip this section for Dependent Care Only)

Complete the boxes below. You may want to review receipts from last year for health care expenses you paid out of your own pocket. Using these receipts and the worksheet, you can estimate the amount you want to elect for the Health Care FSA. Only budget for the expenses eligible for reimbursement through the Health Care FSA. Remember, eligible expenses include those for you, your spouse and your dependents.
Medical, dental, vision
Copayment / Coinsurance
The amount not paid by your health plan coverage
Expenses NOT covered by insurance plans
Prescription drugs $
Vision care $
Dental/orthodontic care $
Medical equipment $
Other eligible expenses (Click here for a list) $


What is a Flexible Spending Account (FSA)?
FSAs allow you to deposit pretax money in an account to pay for health care and dependent care expenses that you incur during the year. There are two separate accounts that allow you to set aside pretax money from your paychecks to pay for expenses you incurred for:
  • Health Care
  • Dependent child or elder day care
How does an FSA work?
Health Care Flexible Spending Account
A health care account allows you to pay for out-of-pocket health care expenses not covered by insurance with pre-tax dollars. You can request your company to set aside money from your paycheck before taxes are deducted. This amount will be deposited into your Health Care FSA. After you incur an eligible health care expense, simply submit your claim with your receipts. You will be reimbursed from your Health Care FSA.

Dependent Care Flexible Spending Account
A dependent care account allows you to pay for costs of dependent care that lets you and your spouse to work or attend school full-time. This account maybe used for costs associated with the care of a child under 13, a disabled spouse or other dependent such as an invalid parent, who needs care.
Why should I participate if I have health coverage?
You could save a significant amount on your taxes. The amount you elect to contribute to a flexible spending account is deducted from your gross pay before taxes. To help estimate your individual savings, simply click on TRI-AD's savings calculator.

Actual savings will depend on many factors including your household income and tax filing status. In some cases, the federal dependent care tax credit may provide a greater benefit than the Dependent Care Flex Plan. You may be able to coordinate the federal dependent care tax credit with participation in the Dependent Care Flex Plan for expenses not reimbursed through the plan.
Who are eligible dependents for the Dependent Care FSA?
You can submit expenses for your spouse*, dependent child(ren) or all who are:
  • age 26 or younger
  • over age 26 and developmentally disabled or physically handicapped, living with the participant or in an institution, unable to work, and depending primarily upon the participant for support
When can I enroll?
During your company's enrollment period each year.
Special enrollment periods for new hires and other employers who first become eligible during the coverage period.
When you have a qualifying event such as marriage, birth of a child or adoption of a child.
When can I change my elections?
Once you enroll, your election will remain in effect for the entire plan year unless you have a qualifying event like marriage, birth or divorce. Election changes made because of a qualifying event must be consistent with the change. For example, you may increase your FSA contributions, not decrease if you have a baby.
How much money should I contribute?
Take into consideration last year's health-related and dependent care expenses as well as future medical and dental care costs that might not be covered under your medical plans. You may also want to consider any changes in your family status that might have an impact on health care and dependent care expenses.

Due to IRS regulations, any money left in your FSAs after all claims have been processed for that plan year must be forfeited. You cannot roll your money into the next plan year or be paid in cash.