Helpful Information – Just a Click Away

Welcome to your online resource page. Simply click the link for what you need below.

Forms and Worksheets

Form Description Download (PDF)
Capital Expense Worksheet Helps to determine if your special equipment or home improvements are eligible expenses.
Dependent Care Tax Credit Worksheet Assists Dependent Care FSA participants in determining the best option between the federal tax credit and a Dependent Care FSA.
Mileage Worksheet Helps to track mileage and parking costs for multiple visits to and from your health care providers.

Quick Reference Guides

Form Description Download (PDF)
2021 Consolidated Appropriations Act Learn how these changes impact your FSAFEDS account.
Appeals Process Learn how the appeals process works regarding denied claims.
Submitting Claims Know how to successfully complete an FSAFEDS claim form.
Leave Without Pay (LWOP) Understand eligibility regarding a LWOP event.
Orthodontia Know how to claim reimbursement for orthodontia expenses.
Paperless Reimbursement Find out about the paperless reimbursement process, participating plans and how to enroll.
Qualifying Life Events (QLEs) Understand which life events qualify as QLEs under an FSA, how they may affect your FSA election and how to let us know if you experience a QLE.
Important Deadlines View important dates and time frames for FSAFEDS.

Supplement Information

Form Description Download (PDF)
The Federal Flexible Benefit Plan (FEDFLEX) The official plan document that governs FSAFEDS. This is a legal document that conforms to the IRS regulation that state a plan document must be available to participants. This is not a quick reference guide.
IRS Publication 502 Note: While insurance premiums are included in Publication 502, they are NOT reimbursable expenses for FSA purposes.
IRC Section 105 Information regarding Section 105 of the Internal Revenue Code and the treatment of medical expenses.
IRS Publication 503 Information regarding Publication 503 of the Internal Revenue Code covering child and dependent care expenses.
IRC Section 125 Information regarding Section 125 of the Internal Revenue Code covering cafeteria plans.
IRC Section 129 Information regarding Section 129 of the Internal Revenue Code and the exclusion of dependent care expenses.