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human resources
Flexible Spending Account (FSA) - Medical and Dependent Care
Calendar Year 2024
To enroll in a 2024 flexible spending account, please obtain a link for the online form from your location's office.
- Flexible Benefits Plan Participation and Form Directions
- Open Enrollment Video (link)
- Information: Medical Flexible Spending Account Guide
- Information: Limited Flexible Spending Account Guide (Used with HSA)
- Information: Dependent Care Flexible Spending Account Handout
- Information: Contribution Limits and Changes (Note: DOW-R minimum is $150/calendar year)
- Information: FSA Calculator Worksheet (link)
- Information: Accessing Flexible Spending Account Information Online
- Information: Accessing Flexible Spending Account Information Mobile
- Information: WEX Debit Card
- Information: How to file your claim online (link)
- Information: FSA Eligible Expenses (link)
- Information: FSA Claim Substantiation
- Form: FSA Enrollment (1/1/2024 - 12/31/2024) Form D-2 - new hires only
- Form: FSA Printable Claim Form for all claims not filed online
**This corresponds with Section D of the "Employee Benefits Guide."