Flexible Spending Account

Contact

Discovery Benefits | 866-451-3399

Fax: 866-451-3245 | www.discoverybenefits.com

Flexible Spending Account (FSA)

For those of you who have elected a DriveTime Flexible Spending Account (FSA); either Medical and/or Dependent Care:

You may use the FSA reimbursement form below for any doctor visits or other claims you incur while your Flexible Spending Account is pending.

FSA Reimbursement Form

Send your claim to:

PO Box 2926; Fargo ND 58108-2926

Fax: 1-866-451-3245

Overview:

Flexible spending accounts (FSAs) are a tax-saving way to set aside money for health car and dependent care expenses you would typically pay for out-of-pocket. FSAs let you pay these expenses with pre-tax dollars which reduces your taxable income.

You have the option of submitting FSA claims for reimbursement or using the FSA debit card. Some exclusions apply to the debit card. Please review the information below to understand more about your Flexible Spending Accounts.

Important Information about your Flexible Spending Account:

 

A Guide to your Benefits Debit Card

Instructions for Ordering Additional Cards

FSA Claim Reimbursement Request Form

"Use It or Lose It" Rule

Please plan accordingly to use all of your FSA funds by December 31. If you have funds remaining in your account after this date, then the funds will be forfeited, as required by the IRS regulations. It is very important you plan carefully when estimating the amount of your FSA contributions.

Health Care FSA

Beginning in 2013, the maximum annual election for the Health Care FSA is $2,600.

The Health Care Flexible Spending Account allows you to elect an annual election amount through pretax payroll deductions to pay for eligible nonreimbursed medical, dental, and vision expenses.

The Health Care Flexible Spending Account is administered by Discovery Benefits and available in full at the beginning of the year. You may elect to particpate in this option independent of any other benefit options you make during your enrollment period. Both are governed by IRS forfeiture rules, which you should know about before deciding to enroll.

For a list of eligible expenses visit the IRS website at:

http://www.irs.gov/publications/p502/index.html

Dependent Care FSA

The maximum annual election for the Dependent Care FSA is $5,000.

The Dependent Care Flexible Spending Account allows you elect an annual election amount through pretax payroll deductions to pay for eligible dependent care expenses. Please note: dependent care expenses refers to day care, not medical expenses for dependents.

Dependent Care FSA Recurring Form

Please Note: Dependent Care FSA funds are available after they have been deducted from your paycheck.