IntroductionIn order to assist you with your out-of-pocket medical and dependent care expenses, Southern Tier Environments for Living offers a Flexible Spending Account (FSA, A.K.A Cafeteria Section 125 Plan) administered by Beneflex. Employee contributions to FSA Accounts are made through a pre-tax, payroll deduction. General InformationThird Party Administrator: Beneflex, Inc. 1030 State Street, Suite 2 Erie, PA 16501 814-453-3107 - Customer Service https://www.wealthcareadmin.com/Participants/login.aspx Account Access FSA Account TypesMedical Care Account. This account allows you to pay for certain qualified ,out-of-pocket, medical expenses. The maximum contribution allowed per year is $2,500. See the Summary Plan Descriptions for more details. The medical account allows for a $500 "carry over" from one plan year to another. All remaining funds above $500 in your account at the end of the plan year will be forfeited. Dependent Care Account. This account allows you to pay for qualified child care expenses. The maximum contribution allowed per year is $5,000, or $2,500 for married persons filing separately. Examples of qualified expenses are day care, certain after school programs, and certain summer camps. The dependent care account is a “use or lose it” plan. All remaining funds in your account at the end of the plan year will be forfeited. Adoption Assistance. This account allows you to pay for adoption expenses on a pre-tax basis. The maximum contribution allowed per year is $12,970. The adoption assistance account is a “use or lose it” plan. All remaining funds in your account at the end of the plan year will be forfeited. The FSA is a “use or lose it” plan. All remaining funds in your account at the end of the plan year will be forfeited. FSA CalculatorThe FSA calculator link below is provided by a third party, use at your own risk. This calculator should give you a good estimate how FSA contributions can save you money by paying for medical/dental/vision, dependent care and adoption costs with "pre-tax" money. Important Documents & Forms |
Benefits >
Flexible Spending Accounts
File name | Description | Size | Rev. | Time | User |
---|
Selection | File type icon | File name | Description | Size | Revision | Time | User |
---|
Selection | File type icon | File name | Description | Size | Revision | Time | User |
---|---|---|---|---|---|---|---|
Ċ | View Download |
F.A.Q. FSA/HRA Debit Card | 11k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark | |
Ċ | View Download |
2014 FSA Open Enrollment Letter from Beneflex | 140k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark | |
Ċ | View Download |
FSA Medical Account Eligible Expenses | 17k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark | |
Ċ | View Download |
FSA Medical Account Expense Worksheet | 13k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark | |
Ċ | View Download |
FSA Medical Account OTC Expense List | 9k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark | |
Ċ | View Download |
FSA F.A.Q.'s | 70k | v. 2 | Jul 9, 2015, 11:22 AM | Wasiewicz, Mark |
Selection | File type icon | File name | Description | Size | Revision | Time | User |
---|---|---|---|---|---|---|---|
Ċ | View Download |
FSA Reimbursement Form | 18k | v. 2 | Jul 9, 2015, 11:02 AM | Wasiewicz, Mark |
Selection | File type icon | File name | Description | Size | Revision | Time | User |
---|---|---|---|---|---|---|---|
Ċ | View Download |
FSA Enrollment Form | 140k | v. 2 | Jul 9, 2015, 11:21 AM | Wasiewicz, Mark |
Selection | File type icon | File name | Description | Size | Revision | Time | User |
---|---|---|---|---|---|---|---|
Ċ | View Download |
FSA 2014 Plan Ammendment -IMPORTANT | 61k | v. 2 | Jul 9, 2015, 11:23 AM | Wasiewicz, Mark | |
Ċ | View Download |
FSA Summary Plan Description | 65k | v. 2 | Jul 9, 2015, 11:23 AM | Wasiewicz, Mark |