Request for Reimbursement Form: Complete the Dependent Care section of the Request for Reimbursement Form and have your daycare provider sign and date.
– Receipt: The receipt must include the following information:
– Name, address and Tax Identification # of provider
– From/through dates of service
– Amount of charge
You can use pre-tax dollars to cover eligible work-related dependent care expenses for qualified dependents, or if you are married, while you and your spouse work or your spouse attends school full-time.
You may set aside pre-tax dollars to cover eligible medical expenses that are not covered by any other type of insurance. The account helps you budget for planned expenses such as deductibles, co-payments and prescriptions. You may refer to the FSA eligible expenses tool on this site for a list of eligible and ineligible expenses.
On October 31, 2013, the U.S. Department of the Treasury changed the “Use It or Lose It” rule, providing employers the ability to offer a Carryover option which allows for up to $500 of FSA balances remaining at the plan-year end to carry over for use during the next plan year. The Carryover option is available with healthcare and limited purpose FSAs.
A limited purpose FSA can only be used for vision and dental expenses. It is intended to work in conjunction with an HSA. A healthcare FSA covers all eligible medical expenses.
