Flexible Spending Accounts (FSA)

Flexible Spending Accounts

Our Health and Dependent Care Flexible Spending Accounts (FSA) allow you to use pre-tax dollars to reimburse yourself for a wide variety of health and/or dependent care expenses that are not covered under your other benefit plans. Your annual election is divided into equal amounts and deducted from each paycheck before federal, state and local income taxes are withdrawn.


  • Decide how much to contribute – Our plan year runs from January 1 through December 31 each year.  Be sure to estimate carefully as any money you don’t use will be forfeited (this is called the “use it or lose it” rule).
  • Pay your expense and file claims – When you pay for eligible expenses, save the receipts. Then, file a claim for reimbursement from the appropriate account.
  • Receive tax-free reimbursement – Once your claim is approved, you’ll be reimbursed with money from your account.

MyChoice Accounts User Guide

MyChoice Accounts Healthcare Flexible Spending Account Claim Form

MyChoice Accounts Dependent Care Request Form

MyChoice Accounts Letter of Medical Necessity

HealthCare Flexible Spending Account’s allow you to help pay for your eligible healthcare expenses on a pre-tax basis. The healthcare reimbursement account annual maximum for 2021 is $2,750. You can elect to contribute towards this account and your pretax deductions will be made bi-weekly. A debit card is available to help make the claim submission process easy. But, for some of us, we may still choose to use a good old fashioned claim form. It’s your choice. The following is a sample of what could be considered “eligible expenses”.

You can rollover a minimum of $100 and maximum of $550 to the next plan year. This will not offset your allowable maximum contribution. Any amount under $100 or over $550 will be forfeited.

As a reminder, some over-the-counter medications are eligible for reimbursement without a prescription under the Coronavirus Aid, Relief and Economic Security (CARES) Act. A complete list of eligible expenses can be found at https://www.businessolver.com/mychoice-accounts/participants/fsa-hra-eligible-expense

» Acupuncture» Dental expenses» Prescription drugs» Alcoholism and drug treatment center
» Dermatology» Smoking cessation programs» Artificial limbs and teeth» Eye exams, lenses, frames and contacts
» Weight loss programs for physician diagnosed obesity» Chiropractic care» Hearing aids
» Copays/coinsurance» Insulin» Deductibles» Laser eye surgery

You can contribute up to $5,000 each year on a pre-tax basis to help pay for care for your eligible dependents so that you (and your spouse if you’re married) can work or look for work. This limit will be reduced to $2,500 if you are married and filing a separate tax return.

Eligible Dependent for Dependent Care Spending Account 

  • Your children under age 13 whom you claim as dependents on your federal income tax return, or
  • Your spouse or other dependent who’s mentally or physically unable to care for themselves and who resides with you for more than half of the year.  For care provided outside the home, your spouse or dependent must spend at least eight hours per day in your home.
  • Care at a licensed nursery school, day camp, or daycare center. Claims for daycare must include a receipt which shows the caregiver’s tax ID number or Social Security Number.
  • Services from individuals who provide dependent care in or outside your home, excluding your spouse, your own children under age 19, or any other dependent;
  • After-school care for children under age 13;
  • Household services related to the care of an elderly or disabled adult who lives with you; and
  • Any other services that qualify as dependent care expenses under IRS regulations.