Ordinarily, these expenses are paid with after-tax money. %%EOF .Li{~y:^}I|fT;_5JCZcp|3!Sru~Z pMgVi5nmh9uz^n>"nx}ZgCNgug*dwFq*&L6Q{T0;`fdOw#0Lq]HG6MS9GtAlxDCqqe[:Ql:8yAf_R]-Tgr:`D:$1M"XhjOPdfw{Zh)X^a`i%P5/^boB5cwuy?dzaF81:ayBWIe'h#]TMd>mP0 &/6TkzHT=AVtQh/KV : jv4q>#Gz8vM)/ral0'IlN,wj{{_6iznq>C,9K{R\:OWmKhFvm EZu ph` F To enroll, you elect an amount to be deducted pre-tax from your paycheck over 24 pay periods and deposited into your FSA. 0000032931 00000 n Search for the document you need to design on your device and upload it. The IRS also allows catch-up contributions of $1,000 if you are age 55 or older. Flexible Spending. . Dallas, TX 75234 1 972-243-6191 ClubCorp on facebook; ClubCorp on instagram . All rights reserved. 0000037849 00000 n In the United States, a flexible spending account (FSA), also known as a flexible spending Paper forms or an FSA debit card may be used to access the account funds. 3 0 obj endstream endobj 71 0 obj <>stream Job Type All; Full-Time; Part-Time; Contractor; Contract to Hire; Intern; Seasonal / Temp; Gig-Work; Date Posted 24 hours . If you have a Your Spending Account online, you will be able to: Flexible Spending Accounts. Create an account using your email or sign in via Google or Facebook. 0 The average salary for a account manager is $66,200 per year in Dallas, TX and $12,000 commission per year. When you enroll in the Medical Spending or Limited Purpose FSA, you will receive a debit card fromHSA Bank in the mail. 2023. Responsible Office(s) Employee Benefits. 0000001858 00000 n Its county seat is Dallas, which is also the third-largest city in Texas and the ninth-largest city in the United States. Withdrawals made for qualified expenses are also income tax-free. 0000238976 00000 n Build loyalty and strengthen relationships with a powerful lineup of industry-leading benefits solutions. 0000032520 00000 n The Medical Spending FSA, Limited Purpose FSA, and Dependent Care FSA are separate. $ bL4FMHjDS{=EnWPLDR*Z}TT#Z%YHg H-djcLYb-yBHMHVj6dg'W"XAHpFHicHF &?_$P $YlyEr,X)nCwew &(vIDk9@UUXWo59.AXVI&G{1Iu! Hs C:rtU* gq5M-SPLDIZ Get access to thousands of forms. 0000038905 00000 n 0000013089 00000 n Is this useful? Your Spending Account is a trademark . The annual maximum contribution to a Dependent Care FSA is $5,000 (or. 7R=nq(C(k[B%xpi 21 y?|/zg}v6eU$7H-BA9Tc.^FLx9X}*O:#f#AHCG&z7F 5$Bw 85K2qEN/F&&pf .\4h`.K"$n> 8/NkWu5W[Y% BxBifZiKb[[3S,uStWy|Kt355e9mwg\ruuh:zv$3_}D4t0jx&]Lim&ad|yQ2B$z^v:JA%NQM$_jnRLZE,O!o4z9>PjVtUV2r?MXkoL`.`oQh JssY~GhOnjV(;3Q+ E5vOC^7KWui5/fXVEn::e[n=}e:x7QD:II{g#6/:^% You cannot transfer funds between accounts or charge multiple accounts for the same expenditure. Medical Spending/Limited Purpose reimbursement requests, as well as debit card transaction documentation, can be sent electronically, by fax, or by mail to HSA Bank. in dallas,TX. 125 0 obj <>stream The maximum annual Limited-Purpose FSA election is $2,750. As of the 2010 census, the population was 2,368,139. Spending Account Claim Form TOLL FREE: 888.868.FLEX (3539) myameriflex.com uYou can submit this data via myameriflex. HlN1E+c'N^-TV3h/:L8cy Eligibility for the OP&F health care stipend: what to do when you have aQLE, Options available for retirement interviews, IRS using new versions of W-4P, W-4R for 2023 tax year, Member's Report Winter Newsletter Now Available. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 65]/Length 20/Size 70/Type/XRef/W[1 1 1]>>stream stream 0000029729 00000 n 70 56 That insurance company is PEBC (Public Employee Benefits Cooperative). . hb``a``d`e`sXc`A3&0tt4 1Hx7@acq! ;LA(vrE3)!AQO!)^2c^" s? k&| Anb!uZ + @=2 6 Jj>`avp 78L` hZrG}} Ey{S6` `$,?5VI&8O|=#dIn6%=3}vLEY0HeCtbLu*- According to Aon and YSA, any mail received at the old address is automatically forwarded to the new address. Seed money is not offered to those who add coverage in the high-deductible plan as a result of a mid-year qualifying event. If you are not eligible for HSA contributions for example, if you are enrolled in Medicare the seed money contribution will go to an LP-FSA. Wb"77Su,1 U@k~l-[6rn20mn" =5ui{l; z|c8bz~'m>4#YWi)Ax0(a,j{Ut8i3{^H:}BWcBIa`V]_,SQ!oCC:{sa;Ua,MsNePg : N>O^Yc*:fIy ~DD&ugP}DZz$f\x.Afb2`FI`'FK1G`Ph=9/8bQom Fha\{^%t O2 I[nQx5y&bDiD6('S8SI44@gH{smBA*M:JO[ Yw7 yo6 2{dV Start completing the fillable fields and carefully type in required information. 42 0 obj <> endobj VIEWS. Retirement Plan with Employer Match . hbbd``b`@H~7 1s=q_* RqYW$$cAb@D+A\/ H2e`bd =@a 0000041523 00000 n Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place this form before your receipts and don't include a cover letter. By law, any money left in your FSA(s) at the end of the year must be forfeited. 1.8k salaries reported, updated at February 15, 2023. All Rights Reserved. 2023 Employees Retirement System of Texas. For dependent care, you must submit the expense through www.hsabank.com or by mail. It comes complete with a debit card. Once your account is opened, you will receive a Welcome Kit in the mail. % No fees at TCCU ATM's. Spend your days in paradise or spend some love to a special someone. The grace period does not apply, and you may not roll these funds into a Limited Purpose FSA for 2022. Open the doc and select the page that needs to be signed. 0000020691 00000 n An HSA will be opened with Optum Bank for all newly enrolled HSA participants. 0000014230 00000 n 0000268387 00000 n . These benefits are available to full time employees only. indicates you have dental insurance, proof HELPFUL HINTS If the receipt is handwritten, it must 2) Select "Documents and Forms" from the left-hand navigation menu. The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866) 353 -9839 (TTY:711). Funds are available three business days after payroll deduction. To comply with HSA rules, your Limited- Purpose FSA may only be used to reimburse out-of-pocket dental and vision expenses for you, your spouse, and your dependents. Find the extension in the Web Store and push, Click on the link to the document you want to design and select. Your FSA funds may be used for qualified medical costs like copays and deductibles, prescriptions and some over-the-counter medicines, dependent care and more. 7,514 Flexible Spending Account jobs available in Dallas, TX on Indeed.com. 0000029844 00000 n HELPFUL INTS If the receipt is handwritten, it must include the service provider's signature. &VkXHt9-@uO4,(+z(6 %% To enroll, you elect an amount to be deducted pre-tax from your paycheck over 24 pay periods and deposited into your FSA. Ohio Police & Fire Pension Fund. Apply to Administrative Assistant and more! The Section 125 Flexible Spending Account plan is administered by United Health Care (UHC). 0000014703 00000 n your spending account (ysa) login your spending account hewitt ysa reimbursement phone number your spending account phone number at&t hra claim form Create this form in 5 minutes! You will have 90 days following your departure date to submit claims for expenses incurred before you left. Here's what you'll learn: d How to access your account :g5]0h>*4^"m$Ma}Y_n"a5Bz9ZKCN+1]UWTg^YzClC:wF2v sgT3jhxK.r1vt;;m>.#|cw[ZPj}:{+r&pCsaZzL)[_}P? Look through the document several times and make sure that all fields are completed with the correct information. 70 0 obj <> endobj xYF+*FQvxJIa 0000050141 00000 n }@2D8inx%'\#d;aT n$M4IAWDHl|"I@*x/#28}}?Qoe?IU6b3hM v':H,! If your account balance is $2,000 or more, you can choose to invest funds look for details in your Welcome Kit. Dallas County. No monthly maintenance fees. 0000038345 00000 n A Flexible Spending Account (FSA) allows you to save money by using "before-tax" dollars to pay for certain health care and dependent care expenses. This is the place to take action with Your Spending Account. <>>> 6{3]b If you have elected to contribute to an HSA in 2022, you may also enroll in a Limited-Purpose FSA, even though both accounts may reimburse dental and vision expenses. The card will hold Medical Spending and/or Limited-Purpose funds. 0. The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866)353-9839 (TTY:711). Employee Assistance Program. Which plans are eligible for the OP&F stipend? HlTI0qgd{i*1%Mi9FzyJhTPISs7B YkO%G, (^q =75@y8)z;$|$[PTf^ kD9J #zn_1_[nF N /qR41>_,C69"YE-[akck}Ut\(:"jYMQGCPk9rtEua? =7XA2|{.X0i)i <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 108 0 obj <>stream ]A?~D-jF/aXdkut#F;u\#~,61'=mo/ di3{En. ,uFnPU5#kS_r,A'$$]3K ;> Your Spending Account P.O. 0000059187 00000 n 0000002974 00000 n Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202. 2.3k. 4 0 obj Install the signNow application on your iOS device. >E *8x)R}3ABlVeIoB~YC7=g=_SId8X UZKX :Walgreens, Albertsons, Walmart) have IIAS capability. 90 0 obj <>/Filter/FlateDecode/ID[]/Index[65 44]/Info 64 0 R/Length 111/Prev 468601/Root 66 0 R/Size 109/Type/XRef/W[1 2 1]>>stream <> .`9\Bs(|+p*l8=+)n'W=rj94 .E~u==&$b4lny^|l *DgN69pvhRk'[y|~^y,x1T`TM~7rn>:4ee&:.sX1&9EX!YT0rV)E^b,q$YcaSJT [0fURCQ"5Z You may also call 214-671-6947, Option 1. 0000014112 00000 n 5 days ago. %PDF-1.6 % If youre are enrolled in Consumer Directed HealthSelect and are interested in setting aside money on a pre-tax basis for eligible dental and vision expenses, check out the TexFlex limited-purpose FSA. Dallas, TX. 0000002001 00000 n Flexible Spending Accounts. Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202Phone: (214) 653-7638 Fax: (214) 653-7608. 0000050024 00000 n Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at AT&T. Learn about AT&T Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former AT&T employees. 0000050063 00000 n % 0000005496 00000 n You are not covered by another medical plan (unless it is an HDP) or a general-purpose FSA. Your flexible spending account (FSA) balance is yours to spend through December 31st of each year. endstream endobj startxref Eligible expenses include deductibles, coinsurance and prescriptions. Questions regarding plan information for active/pre65: 214-556-0971. 0000006921 00000 n Posted 11/22/2019 Other News Local: (614) 228-2975 Customer Service: 1-888-864-8363 Fax: (614) 628-1777 This guide will help you get started with Your Spending Account (YSA) a website you can use to manage your retiree Health Reimbursement Account (HRA) whenever and wherever it's most convenient for you. 0000021016 00000 n Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place the form before your itemized receipts and don't include a cover letter. QFZ%us.7r?:7{7Zq u9s Toll-free: (877) 275-4377 hb```V\af`0pHN@9(PsH 6s+s{}p=-z{FwYn^ (4hh@3V iq -tl2J870dNl`g*aQw\4uy4? O;T For new employees, these seed money contributions are available as soon as possible once your HDP becomes effective. 0000003723 00000 n Search Spending account jobs in Dallas, TX with company ratings & salaries. Your Spending Account! However, there is a grace period ending March 15, 2023to use your 2022Medical Spending FSA or Limited Purpose FSA dollars on eligible expenses. 0000021079 00000 n these need to be directed to hrbenefits@dallascityhall.com. 0000003548 00000 n h80%Em w0a Skip to Content Jobs Upload/Build Resume . hbbd``b`q@ xsWF0+X D*@ !H N] !R D,X m7@D.P $,Av$dAV _:1UDU 102 0 obj <>stream prescription and office visit co-pays, lab fees, glasses, contacts, dental services, over-the-counter products, etc.). Argentina Australia Belgi (Nederlands) Belgique (Franais) Brasil stream 1) Register or log into your employer's Spending Account website. Fax: (512) 867-7438. 0000328120 00000 n Box 64030 The Woodlands, TX 77387-4030 If faxing, be sure to place this form before your receipts and don't include a cover letter. Box 661147 Dallas , TX 75266-1147 Effective January 1, 2020, the paragraph Titled Agent for Services of Legal Process in the LOCATION. HVnF|Wt8V`Hv^{PXfLOuuP@^,rOnEC'/\R@gg//hy<8 lN~N 0$xXOR~uJV:5y~DR s?gPo ;"U/|xu`VJ0|5wlrg8lU>?9x@7:H.>%e^q`{yu74u{~P@@' OLEB~(((N@K? FG U%KPc4WJ+ 0000014590 00000 n Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202 Phone: (214) 653-7638 Fax: (214) 653-7608 The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. Apply to Customer Service Representative, Procurement Manager, Account Executive and more! Ordinarily, these expenses are paid with after-tax money. If you have specific questions about your benefits, please contact the Human Resources Department at(214) 653-6579or(214) 653-6161. 1500 Marilla Street | 4FN | Dallas, TX 75201 Tel: 214-670-3659 Financial Transparency default- Financial Transparency Home Page Members Report Fall Newsletter Now Available, OP&F Pre-Retirement Webinar video now available. You may be required to submit documentation of your expenditures. All other questions that cannot be answered by either of |ihb0re:U6dU+!YV7Bo2^#[ IPBCP")[n$e`OLO=}o@1]Y~cWTSW;SX. Select the document you want to sign and click. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. 414. It is the second-most populous county in Texas and the ninth-most populous in the United States. 0000008111 00000 n Is this useful? Real Est, Argonne Retirees | Argonne National Laboratory, A health reimbursement account (HRA) will be established to help reimburse you for the BlueCross BlueShield of Illinois claim form or International claim form. The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. A TexFlexSM health care flexible spending account (FSA) is available to benefits-eligible employees not enrolled in Consumer Directed HealthSelectSM. 0000042266 00000 n Your Spending Account jobs Sort by: relevance - date 271,102 jobs Fast hiring You'll evaluate vendors and issue purchase orders for goods and services, while relying on your experience, training, and judgment to plan and accomplish goals. 0000001416 00000 n in interesting facts about sam houston. The information below outlines the two types of Flexible Spending (FLEX) Accounts provided to employees. 5y0eKL0A8+CN"Hs8vWb5x4\fG^xU"8Aj0'+jmh9C:ZL:P5#pD_W@`ain&b@$bu? There are three variants; a typed, drawn or uploaded signature. W\[m{f-h9P6pqU+&]Usv8/ |_Y6~^bN#d5Z) fw%jmQ!l*z5wjb`Xxkn`q=g x_b2MDWwHrnFI*h;~'?v`y+gh17e And free to you. Sending Your Claim to Your Spending Account Send this form and your documentation to Your Spending Account by fax or mail. Elevate your benefits and create more value for your customers. plans offer two major different flexible spending accounts focused on medical and dependent care expenses. (512) 499-4200. 0000032172 00000 n Unlike Medical Spending FSAs and Limited- Purpose FSAs, Dependent Care FSAs may only reimburse expenses up to the amount you have contributed to date. Smart-Choice The Woodlands, TX 77387 Health Savings Account administration Smart-Choice Accounts PO Box 64009 -4009 Human Resources Centre (HRC): 1-888-927-7700 BMO U.S. Benefits Enrolling and making changes to your annual . endstream endobj 70 0 obj <>stream endobj Old Red Museum of Dallas County History and Culture, Community Supervision and Corrections (Adult Probation), Department of Unincorporated Area Services, Office of Homeland Security and Emergency Management, Dallas County Unincorporated Area Strategy, Vehicle Registration - VTR 68-A Inspections, Dallas Area Rapid Transit (DART) Pass Program, Colonial Life Voluntary Supplemental Insurance, Public Employees Benefits Cooperative (PEBC). Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc 0000010668 00000 n HTK \* cJe17ioL}[8j ('96&|2"O+"q3vc$0n$v{&[zkT[R3jd3IC%I+I6;zN>*OfqQm~8M(0gngV>S(P4P Draw your signature or initials, place it in the corresponding field and save the changes. 0000009380 00000 n Traditional Health are Flexible Spending Account*); You cannot submit claims for services received after your departure date. If you enroll in the HDP during annual enrollment, your employer will make a one-time cash deposit to your HSA in January. Document Type. endobj Dental Plan. Download your copy, save it to the cloud, print it, or share it right from the editor. 0000005093 00000 n JOB DETAILS. HELPFUL HINTS If the receipt is handwritten, it must include the service provider's signature. The average salary for a account executive is $74,443 per year in Dallas, TX and $20,000 commission per year. Disability Coverage. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. An HSA is a savings account that you can use to help cover qualified health care expenses. 0 Posted 6 days ago Machine Operator Positions Futamura 3.2 Topeka, KS From $30 an hour Full-time Day shift + 2 Dallas County is a county located in the U.S. state of Texas. FLEXIBLE SPENDING ACCOUNTS (FSA) The Flexible Spending Accounts (FSAs) allow you to pay for eligible healthcare and dependent care expenses using tax-free dollars - money taken out of your paycheck before income or Social Security taxes have been calculated. Go to the Chrome Web Store and add the signNow extension to your browser. Search Spending accounts jobs in Dallas, TX with company ratings & salaries. %%EOF 0000050266 00000 n The Dependent Care FSA is used to reimburse you for certain expenses for children under age 13, or individuals unable to care for themselves. HdUK!)S3*~ {Ucz$jRc4ZZ}Um2_%FnW.^?s10-5O]kZy\ R wYm0Tk+{S/lB! ;k`SEf?=M5D3:NL[- Y%l2r. zkeok:JWKmDAP#]5JGa:1Xptvoe"`lDX,RPF@\is T)0s_(,fI5"TYa-bYepFKdLH_b48 7T?CNO&>t".]0&? Life and Accident Plans. your spending account dallas, tx. As long as you maintain an account balance of $500 or more, you will not be charged the $1 monthly account maintenance fee. Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc startxref After that, funds in excess of $570 will be lost so be sure to use them while you can. You are covered under an eligible high-deductible plan (like the HDP). Your Spending Accounts PO Box 661147 Dallas, TX 75266-1147 YSA will be sending official communication to members about the new address around during the first quarter of 2020. __g 5j(]c;,mKK{x FG[ojl5kzW|S^}gdhg7_/b3-. 0000014737 00000 n Dallas County is joined with a cooperative insurance group along with other city and county agencies. KY"X_Th[[TEe-wW UT FLEX How to Use Your Flexible Spending Account. Generally, large pharmacies, grocery stores, and box stores (i.e. xH&c$CNRKW3suU/gz_?];7}>xrkUeh]~e6kPU+Wqv88[w]=wg]]^~pQU:HK)\xwv};Co]qo_ h`3V}s"_G02(JH(gS^mHF*J6ic$QhneP_28|( 9RNRMU&iL\Tk+#zwV" It's free to use. Your spending account is your checking account. After submission, you will be asked which method of reimbursement you prefer (electronic transfer, check, etc.). how do i choose my seat on alaska airlines? When you elect this benefit, you will enjoy a tax savings because the money for these items is deducted before taxes. Use professional pre-built templates to fill in and sign documents online faster. Claims are normally reimbursed within a week of HSA Bank receiving the claim. 0000029339 00000 n 0000000016 00000 n The maximum annual Medical Spending FSA election is $2,750. The entire annual amount you elect may be used at any time during the plan year and is available January 1. 6,804 open jobs for Spending account in Dallas. Decide on what kind of signature to create. You may also call 214-671-6947,Option 1. Benefits of Using YourSpendingAccount. endstream endobj startxref All rights reserved. 0000050534 00000 n Deep integrations streamline the experience at every step. 2022 Medical, Dental, Vision and Prescription Active Employees. You can also make pretax contributions to your HSA, up to IRS limits, to help your account grow. %PDF-1.4 % Search CareerBuilder for Flexible Spending Account Plan Jobs in dallas,TX and browse our platform. /YRxFI. Learn about Dallas Independent School District Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former Dallas Independent School District employees. Short term detention pending investigation as a consequence wisconsin form, How Do I Sign Vermont Finance & Tax Accounting Document, Help Me With Sign Vermont Finance & Tax Accounting Document, How Can I Sign Vermont Finance & Tax Accounting Document, Can I Sign Vermont Finance & Tax Accounting Document, How To Sign Vermont Finance & Tax Accounting Document. 8,033 open jobs for Spending accounts in Dallas. New claims forms will also be sent that include updated information. 447 Flex Spending Account jobs available in Dallas, TX on Indeed.com. 2a`bd r.#L^ 2 0 obj Dependent Care FSA funds must be used by December 31, 2022, and all claims must be filed by March 31, 2023. trailer This benefit allows you to deduct money from your paychecks for: For additional information, please visit the Public Employees Benefits Cooperative (PEBC)website atwww.pebcinfo.com. No minimum balance fees. Dallas, TX. Box 661147 Dallas, TX 75266-1147 Tel: (888) 611-5500 (toll free) Monday through Friday: 8 a.m. - 6 p.m. CT . Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at Dallas Independent School District. Add the PDF you want to work with using your camera or cloud storage by clicking on the. << /Length 5 0 R /Filter /FlateDecode >> %PDF-1.5 0000266869 00000 n hbbbd`b`` f See IRS Form 2441 Part III for details. UT Dallas; UT El Paso; UT Permian Basin; UT Rio Grande Valley; UT San Antonio; UT Tyler; Health Institutions. Then, you may request reimbursement from the account when eligible expenses are incurred. The address for Your Spending Account (YSA), who handles the health care stipend reimbursements for OP&F retirees, has changed. Select the area you want to sign and click. The health care FSA lets you set aside money on a pre-tax basisfor both you and your eligible dependentsto pay for eligible health, dental and vision expenses. 0000021193 00000 n It will help you learn more about your accounts and the reimbursement process involved with your financial activities. :~va*$# R1M{D=AY[7A[-]#k If the expense will be considered for insurance reimbursement, try to wait until you receive the Explanation of Benefits (EOB) from the insurance company to be sure that the debit card transaction is for the correct out-of-pocket amount. 3) After selecting "Documents and Forms" you will be directed to a screen that looks similar to the image below. x]Ks7Ja{ S1T)(eY,':{PllMn`( h/[(hO;Vh]J(QKSVZW>Tztrp|Xo=ATteUGGyYvwx^.-nw)jfYY]s|36tQLi86lNiO77opzv~c*Tf6vZKjx=xC.-uiSJ[jl- 6ZVA>>q&jP6b}iR4iHd(Cpu\e_'? You cannot be claimed as a dependent on someone elses tax return. 65 0 obj <> endobj Employer Name: Employee Name: SSN: Phone: Email: Medical Expense Claims (FSA, or Employer funded HRA) Dependent Day Care Claims Account Type FSA HRA Date Expense Incurred Name of Person Receiving Medical Service Provider Name All claims must be submitted by March 31, 2023. The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. "b!bULZX |fX3X6{. Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. 0 A Flexible Spending Account (FSA) allows you to save money by using "before-tax" dollars to pay for certain health care and dependent care expenses. 0000029666 00000 n Vision Plan. 0000003758 00000 n The PEBC HDP is an HSA-eligible plan. %%EOF The new address for YSA is: YSA will be sending official communication to members about the new address around during the first quarter of 2020. endstream endobj 66 0 obj <>>> endobj 67 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 68 0 obj <>stream endstream endobj 43 0 obj <> endobj 44 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 45 0 obj <>stream Paid Family Leave. 0000021304 00000 n kiL/o0[~A(V-+>%ieoUaooeyl \ This is the place to take action with Your Spending Account. 401 (k) Savings Plan. Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008. 0000021227 00000 n by. Your Medical Spending FSA may be used to reimburse out-of-pocket medical expenses for you, your spouse, and your dependents. Select the area where you want to insert your signature and then draw it in the popup window. Keep your receipts and invoices. Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008 All other questions that cannot be answered by either of these need to be directed to hrbenefits@dallascityhall.com. You must be enrolled in a high-deductible health plan to participate. 952 salaries reported, updated at January 29, 2023. Austin, Texas 78701-2982. Note: If you currently participate in the Medical Spending FSA and elect the HSA medical plan for 2022, your FSA funds will expire on December 31, 2021. <<345A0DA70B0308418CEB8C1CDDA1C003>]/Prev 332151/XRefStm 1690>> 0000002565 00000 n xref hWn6wQd(eI%nWI3rq(Crn`f&bB(fbb l0\09NPL&1GA2ibt#RDK.V($;ER6``B?Cos[4#-`cng`d=ldKT-,l][`b]h|Y1&~W;F8K?8$MIL\/f`f,v[pjRI5[,fj Benefits Service Center1500 Marilla StreetRoom 1D-SouthDallas, Texas 75201Phone: 214-671-6947, Option 1Fax: 214-659-7098. POSTED. With an HCFSA, you use pre-tax dollars to pay for qualified out-of-pocket health care expenses. Details. If you use the card at an Inventory Information Approval System (IIAS) merchant, the transaction will be approved at the point of sale. Prescription Drugs Plan. endstream endobj 72 0 obj <>stream Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. This is an IRS rule. endobj Apply. following: Questions regarding plan information for active/pre65: 214-556-0971. See how we can help you reduce benefit costs, while delivering the best possible benefits experience. 0000014814 00000 n 0000050612 00000 n Additionally, any claim forms, communications or notices generated by YSA since the change have included the new address. SHARES. Make a difference with your change - lead with ingenuity! 0000050880 00000 n Fax: 1-888-211-9900 Mail: Your Spending Account P.O. The entire annual amount you elect may be used at any time during the plan year and is available January 1. Flexible Spending Accounts (FSA) for Medical Expenses and/or Dependent Care. Click here to view the 2023 Active Employee Benefitspresentation. Box 64030 The Woodlands, TX 77387-4030 If faxing, be sure to place this form before your receipts and don't include a cover letter. 0000001690 00000 n The plan helps you save money for health care and dependent care expenses. A Health Care FSA (HCFSA) is a pre-tax benefit account that's used to pay for eligible medical, dental, and vision care expenses that are not covered by your health care plan or elsewhere. endstream endobj 71 0 obj <>/Metadata 3 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 72 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 73 0 obj <> endobj 74 0 obj <> endobj 75 0 obj [/Separation/PANTONE#20137#20C 86 0 R<>] endobj 76 0 obj [/ICCBased 87 0 R] endobj 77 0 obj <>stream 1 0 obj Visit www.hsabank.com for a list of eligible expenses and to set up direct deposit for expense reimbursement. Dependent care reimbursement for costs paid to day care and elder care providers. Read our response. Contact Us | Help | Privacy Policy | ADA Statement. Take a look inside. <> Health care reimbursement for qualified out-of-pocket health care expenses that are not covered by insurance (i.e. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. The benefits service center is available by phone and email to assist you with your benefit questions. Your Spending Account P.O. Dependent Care FSA is for dependent daycare only. 77 0 obj <>/Filter/FlateDecode/ID[<7C0EF33EDAADE1C3B0D9FABD37FA2AA8>]/Index[42 61]/Info 41 0 R/Length 138/Prev 119686/Root 43 0 R/Size 103/Type/XRef/W[1 2 1]>>stream . Share on Facebook . Health Spending Accounts. 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