Eligible Expenses

2020 and 2021 Plan Year Information

Health Care FSADependent Day Care FSALimited Purpose FSA
What Can the FSA Money Be Used For?
  • Medical
  • Prescription drugs
  • Dental
  • Vision

Funds for:

  • Child care
  • Elder care
  • Preschool
  • Afterschool

NOTE: Funds apply to eligible expenses for eligible dependents age 13 and under or disabled or elderly dependents.

  • Dental
  • Vision

The Health Care and Dependent Day Care FSAs are administered by UnitedHealthcare (UHC). The Limited Purpose FSA is administered by Your Savings Account.

List of Eligible Expenses

A complete list of eligible FSA expenses is available in IRS Publications 502 and 503 at irs.gov.

How to Pay with FSA Funds

Medical Plan Options A and B:

    If you are enrolled in Medical Plan Option A or Option B for medical coverage, there are two ways to pay for eligible out-of-pocket medical expenses from your Health Care FSA administered by UnitedHealthcare (UHC):

    1. If you participate in the Firm’s Medical, Dental or Vision Plans, you may elect automatic reimbursement for your eligible out-of-pocket health care expenses for in-network services. Elect this feature on the Benefit Center website when you make your elections. Note: Automatic reimbursement is not available for out-of-network services, HMSA or Kaiser HMO participants or for expenses relating to your domestic partner.
    2. To submit expenses for out-of-network services, complete an FSA Claim Form (available on the Benefit Center website) and attach an itemized bill or receipt, or the Explanation of Benefits from your medical, dental or vision Plan administrator.
    Beginning in 2021, you may elect to roll over up to $550 of your unused Health Care FSA balance to the following year. If you enroll in Medical Plan Option C in a subsequent year, your rollover amount will be forfeited.

Medical Plan Option C:

    To pay for eligible Limited Purpose FSA expenses, use the Smart YSA debit card to pay at the time of service or purchase. Eligible expenses will automatically be debited from the correct account—either the HSA or the Limited Purpose FSA—depending on which account the purchase is eligible for.

Use It or Lose It

By law, any money in your Dependent Day Care or Limited Purpose FSA that you do not use by the end of the year, or submit a claim for by April 30 of the following year, will be forfeited.

Beginning in 2021, you have the option to roll over up to $550 of your unused Health Care FSA funds for use in the following year. Any rollover amount elected will be forfeited if you enroll in Medical Plan Option C for the following year.

Estimate your projected health care and dependent day care expenses and potential tax-savings with the FSA Calculator on the Benefit Center website.