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/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/flexible-spending-account-era/resources/Health-Care-FSA-Flyer.pdf

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Health Care FSA Flier

Health Care FSA Flier - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, UWHC Open Enrollment, Flexible Spending Account (ERA), Resources





A Health Care Flexible Spending Account (FSA) allows you to set aside tax-free dollars each year for
health care expenses not covered by insurance. You may use these funds to pay for eligible health care
expenses incurred by you, your spouse, and your qualified dependents.*

What are the benefits? How does it work?
ξ Pre-tax contributions reduce your taxable
income.
ξ Easiest way to pay for everyday out-of-pocket
eligible health care expenses with tax-free
money.
ξ Your total annual Health Care FSA contribution
amount is available immediately at the start of the
plan year.
ξ You can carry over up to $500 remaining in your
account from one plan year to the next, so there
is minimal “use-it or lose-it” risk.
ξ Multiple self-service tools available to easily
manage your TASC Account and TASC Card
transactions.
ξ Use the tax-savings calculator or annual expense
estimate worksheet to help determine how much
you should contribute per year.
ξ Your annual contribution is deducted pre-tax from
your paycheck in equal amounts throughout the
plan year and deposited into your TASC Account.
ξ As eligible health care expenses are incurred, you
can either use your TASC Card to pay at the point
of purchase or submit a request for reimbursement.
ξ Manage your account 24/7 via the TASC Benefits
mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee.
Enrollment Eligibility
ξ Most full-time or part-time state and university employees are eligible to participate in a Health Care FSA.
ξ Note: Employees who are classified as fellows, scholars, and research assistants in the University of Wisconsin
System, as well as limited term employees, student hourlies, per diems, and other temporary employees are not
eligible.
ξ Note: Employees who are enrolled in a High Deductible Health Plan (HDHP) are not eligible. If you are enrolled in
an HDHP, see the Health Savings Account Enrollment Brochure and Limited Purpose Flexible Spending Account
flyer for information about benefit options.
Important Considerations
ξ The It’s Your Choice Health Plan imposes an annual deductible of $250 individual/ $500 family, office visit copays
and an annual out-of-pocket limit of $1,250 individual/ $2,500 family on most illness or injury related services. These
expenses can be reimbursed through this account.
ξ Remaining LPFSA funds over $500 do not carry over. It is important to be conservative in making elections
because any unused funds over $500 left in your LPFSA at the close of the plan year are not refundable to you.
ξ It is a participant’s responsibility to read and adhere to the TASC Card terms and conditions. By accepting and
using your TASC Card, you agree to the Cardholder Agreement. You are obligated to satisfy any documentation
requirements and to retain those documents and records for tax purposes or in the event of an IRS audit. Refer to
the TASC Card Section of the Employee Reimbursement Account (ERA) Participant Guide for more information.
ξ You may change your Health Care FSA elections during the plan year only if you experience a qualified life change
event, such as, a marriage or divorce, birth or adoption of a child, or a change in employment status. Refer to the
Change in Status During the Year Section in the ERA Participant Guide for more information.

Annual Health Care FSA Limits 2017 2016
Individual Health Care FSA Limit $2,550 $2,550
Annual Health Care FSA Carryover Max $500 $500 Note: The $2,550 contribution limit applies on an employee-by-employee basis. Thus,
$2,550 is the limit each employee may make per plan year, regardless of the number
of other individuals (spouse, dependent, etc.) whose medical expenses are
reimbursable under the employee’s Health Care FSA. If two spouses are eligible for a
Health Care FSA, each spouse may elect to make contributions of up to $2,550 to his
or her Health Care FSA, even if both participate in the same Health Care FSA
sponsored by the same employer.

This is the amount the Internal Revenue Service (IRS) allows
to be contributed to a Health Care FSA.

*Refer to the Health Care FSA – Qualified Dependents Section of the ERA Participant Guide for more
information.

HEALTH SAVINGS
ACCOUNT
Annual Health Care FSA
Contribution Limits
HEALTH CARE FSA

Eligible Health Care FSA Medical Expenses

Below is a partial list of eligible expenses that are reimbursable through a Health Care FSA. Eligible expenses can
be incurred by you, your spouse, or qualified dependents. For more information, see your ERA Participant Guide.
For the complete list of eligible and ineligible expenses, visit www.IRS.gov and see IRS Publication 502.
Medical Expenses Dental Expenses
ξ Acupuncture
ξ Ambulance services
ξ Birth control/contraceptive devices
ξ Birth classes/Lamaze1
ξ Blood pressure monitor
ξ Blood sugar test kits/test strips
ξ Chiropractic therapy/exams/adjustments
ξ Co-payments
ξ Crutches1
ξ Flu shots
ξ Hearing aids and batteries1
ξ Incontinence supplies
ξ Insulin and diabetic supplies
ξ Infertility treatments
ξ Laboratory fees
ξ Lactation expenses
ξ Legal sterilization
ξ Physical exams
ξ Physical therapy1
ξ Sleep apnea services/products1
ξ Smoking cessation programs
ξ Treatment for alcohol or drug dependency
ξ Vaccinations
ξ Wrist supports/elastic straps
ξ X-ray fees

1: Restrictions may apply. See IRS Publication 502 for more details.

ξ Cleanings and exams
ξ Crowns and bridges
ξ Dental plan co-pays
ξ Dental surgery
ξ Dental x-rays
ξ Dentures
ξ Diagnostic services
ξ Fillings
ξ Orthodontia
ξ Root canals
Vision Expenses
ξ Contact lenses and
lens solution
ξ Diagnostic services
ξ Eye exams
ξ Eye surgery
ξ Laser eye
surgery/LASIK
ξ Optometrist/
ophthalmologist fees
ξ Prescription
eyeglasses and
sunglasses
ξ Seeing eye dog
(buying, training, and
maintaining)
ξ Vision plan co-
insurance
ξ Vision plan deductible

OTC Medicines and Drugs
Over-the-counter (OTC) medicines and drugs, except for
insulin, require a prescription from your physician to be
reimbursable with your Health Care FSA. The prescription
must be included with each request for reimbursement.

ξ Calamine lotion
ξ Cold medicines
ξ Diaper rash ointments
ξ First Aid supplies
ξ Hemorrhoid
treatments
ξ Indigestion
medications
ξ Nicotine patches
ξ Pain relievers
ξ Pain relieving creams
ξ Sinus medications
How to Enroll Following Enrollment
ξ Annual It’s Your Choice Open Enrollment period:
October 17 – November 11, 2016
ξ Benefit Period: January 1 – December 31, 2017
ξ Deadline for New Hire Enrollment is within 30
days from hire date. Contact your human
resources/benefit office for details.
ξ Deadline for Qualified Life Change Event
Enrollment or Changes is within 30 days from
the date of the qualified life event. Contact your
human resources/benefit office for details.
ξ Visit www.etf.wi.gov/IYC2017 for enrollment
information, or contact your human
resources/benefit office for enrollment
instructions.
ξ Note: Must re-enroll in a Health Care FSA each
year. Elections do not carry forward from year to
year.

Once you have enrolled, you will receive:
ξ Welcome Brochure
The ERA Welcome Brochure will provide you with
information on how to manage your Health Care
FSA, set-up your TASC Online account, your
responsibilities, and key dates. It will also provide
you more information about the multiple self-
service tools available to easily manage your TASC
Account and TASC Card transactions.
ξ TASC Card
Your TASC Card allows you to conveniently pay for
eligible medical expenses. Be sure to review the
Cardholder Agreement included with your TASC
Card.
o Note: If you are a current TASC participant,
you will not be issued a new TASC Card. You
will continue to use your current TASC Card.

TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com