Flexible Spending Account (FSA)

Flexible Spending Accounts (FSAs) are part of an IRS regulated, employer-sponsored benefit plan that allows participants to voluntarily contribute part of their compensation into tax-free benefits. Contributions made through FSAs are normally free of federal, state and Social Security taxes. The Healthcare Flexible Spending Account allows for certain out-of-pocket healthcare expenses to be paid for on a pre-tax basis. Participant contributions are payroll deducted and placed in a special account for reimbursements to be issued as claims are incurred.

• Flexible Spending Account Agreement Form
• Answers to FSA Frequently Asked Questions
• Aetna Direct Deposit Authorization Form
• Aetna FSA Claim Form
• Aetna Limited Purpose FSA Claim Form
• EBS Direct Deposit Authorization Form
• EBS Health Care FSA Claim Form
• EBS Limited Purpose FSA Claim Form
• EBS Dependent Care FSA Reimbursement Form
• Refer to IRS Publication 502 for information regarding medical, dental and health related expenses eligible for reimbursement through a Health Care FSA