Page 13 - 2019 Sharks Benefits V6.1

Flexible Spending Accounts

Employees have access to three convenient flexible spending accounts (FSA’s) designed to help you
stretch your dollars by paying for certain health care, dependent care, and transportation expenses
on a pre-tax basis. Your participation in these accounts is voluntary. If you choose to participate, you
will reduce your taxable income which ultimately results in you having more money to spend! For
more details about the plan, please refer to your Summary Plan Description (SPD). Our plans are
administered by BASIC Pacific (Basic).

Website: BASICPACIFIC.COM

If you decide to enroll, you may contribute to:

• Health Care FSA – up to $2,700 each year
• Dependent Care FSA – up to $5,000 each plan year per household
• Commuter Benefit Plan (132 Transportation) – see list below for the specific amounts per month

How Do Health Care and Dependent Care FSA’s work?

Here’s a brief overview of how the Health Care and Dependent Care FSA’s work:

• You estimate your health care and/or dependent care expenses for the coming year and decide
how much to set aside in one or both accounts.
• Contributions from your paycheck to your Health Care and/or Dependent Care account(s) are on
a pre-tax basis.
• Because your taxable income is lowered, your Social Security and income taxes are reduced.

• You incur eligible expenses and pay for them as usual or with a debit card provided to you by our
FSA administrator.
• You submit a claim by mail, email, fax, or use the online claims entry service the FSA
administrator, along with any receipts or bills.
• You are reimbursed for those expenses through your Health Care and/or Dependent Care
account(s) with your own tax-free dollars. And, you won’t owe any income taxes on those dollars
ever!
Medical Flexible Spending Account (FSA)

The Medical Expense FSA allows you to set aside tax-free dollars that will reimburse you for
“qualified” medical, dental and vision expenses “incurred” during the plan year. “Incurred” means the
service must be performed during the plan year. “Qualified” expenses include most medically
necessary (meaning not cosmetic) out-of-pocket medical, dental, and vision related expenses.
Insurance premiums of any kind, including Medicare, individual health insurance, long-term care,
warranties, or membership fees that are not directly related to care are not eligible for
reimbursement through the Medical FSA.

You can carry forward a balance of up to $500. This means that if you under-estimate your expenses
in 2019, you can use up to $500 in the following (2020) year.

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