Annual maximum contribution per employee $2,550+$500 rollover. Can be used for
- Deductibles, copays, and coinsurance
- Prescription drug costs
- Dental and vision
- Non-covered medical expenses
- See a complete list by visiting www.allegianceflexadvantage.com
- Entire yearly contribution becomes accessible the 2nd paycheck of January.
- $500 rollover not available until after 120 day run-out period beginning January 1 to claim previous year's expenses.
- $120/year minimum for both types of FSA
- $2.26/month fee for one or both types of FSA
- $1/month fee for debit card
- Click HERE to learn how this minimum applies to the rollover.
Medical FSA Worksheets
These worksheets can help you decide how much to select for Medical & Dependent Care FSAs. Review your Explanation of Benefits (EOB) to get an idea of how much your spent in the last 12 months on health care. The amount you select is taken from your paychecks in 24 installments—first from any unused state share, and then from your gross pay (before taxes)—and deposited into your FSA.
|Common Medical Expenses
|Estimated medical (deductibles, copays, coinsurance)
|Estimated dental costs
|Estimated vision costs
|Estimated prescription costs
|Total estimated 2016 Medical FSA