Human Resources

Flexible Spending Accounts

2016

Flexible Spending Accounts (Medical and Dependent Care)

www.flex125.com
Ameriflex Customer Service 888-868-3539

AMF Code: AMFMOWEST

FSA – Your election amount is typically fixed for the entire plan year (unless you have a qualifying event). Any funds you are unable to submit valid claims for at the end of the claims run out period will be forfeited, so estimate your expenses carefully and set money aside accordingly.

Medical – This program allows you to pay for certain IRS-approved medical care expenses not covered by your insurance plan with pre-tax dollars. The annual maximum you are eligible to contribute for 2016 is $2,550. (2017 = $2,600)

Dependent Care – This program allows you to use pre-tax dollars towards qualified dependent care such as caring for children under the age of 13 or caring for elders. The annual maximum you are eligible to contribute for 2016 is $5,000. (2017 = $5,000)

Extended Period – Participants will be able to incur expenses and use remaining 2016 monies through 3/15/2017 and submit claims through 3/31/2017.

Termination of Employment
A participant has 30 days after termination (last day worked) to submit receipts that were incurred prior to the termination date. All receipts must have dates of service prior to the termination date. All expenses must be incurred prior to or on the date of termination. Medical FSA’s will be offered COBRA.

Ameriflex FSA Claim Form

Ameriflex Letter of Medical Necessity Form

Ameriflex Direct Deposit Form

Ameriflex Contact Information

Ameriflex Web Access Directions for EE

Over The Counter Drug Authorization Form

IRS Qualified Expenses

2017

Discovery Benefits

www.discoverybenefits.com

Member Services 866-451-3399

FSA Frequently Asked Questions

FSA Employee Guide