Flexible Spending Plans


Health Care Flexible Spending Account (HCFSA)

This voluntary benefit plan offers eligible employees the ability to pay for eligible out-of-pocket health care expenses with pre-tax dollars for you, your spouse and qualified tax dependents such as medical, dental, vision, hearing, and prescription drugs cost. Your entire annual election will be made available to you on January 1st, for eligible medical services provided in that year. The money you set aside is not subject to federal or social security taxes.

Enrollment Information

  • Enroll by completing Enrollment FormPDF and returning to Human Resources within 30 days of hire or eligibility. The Effective date will be determined by the date the form is submitted to Human Resources within the 30 day period. 
  • Employee may contribute from $260 to $5,000 each plan year to this account.
  • Contributions are deducted from pay before federal, state and Social Security (FICA) taxes.
  • Employee must re-enroll during the annual open enrollment period during the month of September to participate during following calendar year. Contribution amount may be changed at that time.
  • Once the plan year has begun, you cannot make changes (increase, decrease, or stop deduction) in your authorization unless there has been a change in your status as defined by the Internal Revenue Services (IRS).  Refer to 2012 FSA Program BrochurePDF.

Over-the-Counter Items That Are No Longer Eligible Without a Prescription

  • Acid controllers
  • Anti-itch medicines
  • Antihistamines
  • Baby rash ointments/creams
  • Cold sore remedies
  • Cough medicines
  • Digestive aids
  • Laxatives
  • Motion sickness products
  • Pain relievers
  • Respiratory treatments
  • Sleep aids

Over-the-Counter Items That Will Remain Eligible

  • Bandages
  • Braces and supports
  • Contact lens supplies/solutions
  • First aid supplies
  • Insulin
  • Reading glasses
  • Thermometers
  • Walkers
  • Wheelchairs

Submitting a Claim Form

File claim for reimbursement by completing Claim Form,PDF attaching documentation and mailing to: HEALTH CARE FLEXIBLE SPENDING ACCOUNT (HCFSA) PROGRAM CLAIMS FORM 40 Rector Street, 3rd Floor, New York, NY 10006.

  • Expenses eligible to be reimbursed must be:
    • medically necessary,
    • incurred by an employee, employee’s spouse, or eligible dependents (including domestic partner), and
    • not covered by the employee’s own or another insurance plan.
  • Refer to 2012 FSA Program BrochurePDF for a list of reimbursable and non-reimbursable expenses.
  • Any money left in employee’s account after expenses have been paid for the year is forfeited.

More Information

Dependent Care Assistance Program (DeCAP)

The Dependent Care FSA is generally used for reimbursing out-of-pocket childcare expenses for dependents under the age 13. Eligible expenses include daycare, pre-school, or babysitting expenses incurred so that you can attend work, or, if married, you can work and your spouse can work, looking for work or be a full-time student. Dependent Care FSA funds can also be used to pay for elder care expenses for older dependents incapable of self-care. The annual maximum is set at $5,000 per household ($2,500 if married and not filing a joint tax return) and funds are available as they are contributed for services provided in 2012.

Enrollment Information

  • Complete Enrollment FormPDF and return to Human Resources within 30 days of hire or eligibility. The Effective date will be determined by the date the form is submitted to Human Resources within the 30 day period. 
  • Employee may contribute from $500 to $5,000 each plan year to this account.
  • Deducted from pay before federal, state and Social Security (FICA) taxes.
  • Employee must re-enroll during the annual open enrollment period during the month of September to participate during following calendar year. Contribution amount may be changed at that time.
  • Once the plan year has begun, you cannot make changes (increase, decrease, or stop deduction) in your authorization unless there has been a change in your status as defined by the Internal Revenue Services (IRS).  Refer to 2012 FSA Program BrochurePDF

Submitting a Claim Form

  • File claim for reimbursement by completing Claim Form,PDF attaching documentation and mailing to: Dependent Care Assistance Program (DeCAP) CLAIMS FORM 40 Rector Street, 3rd Floor, New York, NY 10006.
  • For expenses to be eligible:
    • Dependent must be child under 13 for whom employee or spouse is entitled to claim dependent status on income tax return, or spouse who is unable to care for him/herself, or a financially dependent member of employee’s household; and
    • Care must be required in order for employee to be gainfully employed and, if married, spouse also must be employed or actively looking for work.
  • Refer to 2012 FSA Program BrochurePDF for additional eligibility rules.
  • Any money left in employee’s account after expenses have been paid for the year is forfeited.

More Information

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