Deadline to submit receipts for 2011:  

December 30, 2011

Click here for the form to submit Flexible Spending Account receipts for reimbursement. 

For Health-Care & Dependent-Care Expenses

The Flexible Spending Plan is a program that allows you to have a designated dollar amount of your paycheck put aside and held in an account until you need to use it for out-of-pocket healthcare or dependent-care expenses. The money is deducted before taxes are paid, allowing you to apply 100 percent of the money you earn and put aside toward eligible expenses. 

Click here for the Flexible Spending Plan Summary

Out-of-pocket eligible expenses

• Co-pays (physician, prescription, etc.)
• Dental expenses (co-pays or non-covered expenses)
• Vision expenses (glasses, contacts, lasik eye surgery)
• Day-care expenses (This can be more advantageous than the child-care tax credit now offered by the IRS. Other expenses are also eligible.)

More complete information about eligible expenses is available on the Manley Services web site, the organization that manages the district’s flexible spending plan.

Flexible Spending Account (FSA) FORMS:

FSA Reimbursement Form (to submit receipts if you're already enrolled)

FSA Enrollment Form (enrollment restricted to first 30 days of benefitted status or FSA enrollment period Aug 15 - Sept 15 for upcoming plan year -- for plan year October, 2011 through September, 2012 the enrollment form is due to HR by September 15, 2011.

FSA Change Form (to update contact information or change dependent care contribution amount) Only Dependent Care amounts may be changed mid-year if you experience a qualifying status change (QSC) event. Health Care amounts CANNOT be changed under any circumstances.

FSA Direct Deposit Form (to authorize Manley to deposit reimbursements into your bank account)

Estimation Worksheet (helps you estimate how much to set aside)

Examples of Eligible Healthcare Expenses (also notes some exclusions)
Note: Insurance premiums are NOT eligible for reimbursement.