Medical FSA Tab

Use the Medical FSA tab to view your current Medical FSA contribution.

You can also enter new annual contribution amounts on this tab. You must enter 0.00 in the New Contribution fields if you opt not to participate in Medical FSA plans.

Contents

Field	Description
I do not want to enroll in a Medical Flexible Spending Account (FSA)	Select this check box if you do not want any deductions for a Medical FSA. When you select this check box, the screen will populate the New Contribution amount fields with 0.00 which will eliminate the need to enter the amount manually.

Annual Limit

Field	Description
New Contribution	This field displays the yearly limit for the Medical FSA for your new contribution.
Current Contribution	This field displays the yearly limit for the Medical FSA for the current year.

Annual Amount

Field	Description
New Contribution	If you want to participate in the medical FSA plan, or if you want to change your annual contribution amount, enter the annual amount in this field. You may enter an amount up to 7500 in this field. When you enter an amount in this field, the application automatically calculates and adjusts the New Contribution value for each pay period deduction frequency. Alternatively, you can enter amounts on the FSA Worksheet tab and click Use Estimate. If you do not want to participate in Medical FSA plans, enter 0.00 in this field.
Current Contribution	This field displays your current annual medical FSA contribution.

<Frequency> Amount

The label of this field is based on pay frequency ("Monthly," "Semi-Monthly," "Bi-Weekly," or "Weekly").

Field	Description
New Contribution	If you want to participate in the medical FSA plan, or if you want to change your annual contribution amount, enter your desired medical FSA contribution per pay period deduction. Alternatively, you can enter amounts on the FSA Worksheet tab and click Use Estimate. If you do not want to participate in Medical FSA plans, enter 0.00 in this field.
Current Contribution	This field displays your current medical FSA contribution based per pay period deduction frequency.
Limited Purpose	This check box indicates if the currently elected medical FSA has been designated as a limited purpose FSA.
I certify that this is a limited purpose FSA and will only be used to reimburse vision and dental expenses.	Select this check box to designate the FSA as limited purpose. A limited purpose FSA reimburses only vision and dental expenses. This allows you to also enroll in a health savings account (HSA) if you have elected a high deductible medical plan.