Flexible Spending Account Plans
The Mesa Choice Flexible Spending Account Plans offer you the opportunity
to set aside pre-tax dollars from your paycheck to pay for either health
care or dependent care (child or elder care) expenses that would normally be
paid out of pocket. Enrolling in the flexible spending
account program reduces your taxable
When enrolling in the Flexible Spending Account(s), especially for the
first time, estimate eligible expenses carefully. Any money
left in the FSA after the reimbursement deadline will be forfeited and
deposited into the Employee Benefit Trust Fund.
may not seek reimbursement for health care or dependent care
(child/elder care) expenses for Committed Partner or Committed
Partner children/elders under FSA accounts.
Health Flexible Spending Account
The Health Flex plan allows you to set aside up to $2,500 to pay
for eligible health care expenses that are not covered by your insurance.
This amount may change in future years.
These expenses include:
- Certain items not covered by insurance
Here is a helpful
tool to assist you in determining your eligible medical
Dependent Care Flexible Spending Account
The Dependent Care Flex Plan allows participants to set aside up to $5,000
to pay for eligible child or elder care services that are needed so that the
participant and spouse (if applicable) can work. Once a
qualifying child care expense is incurred, the receipts may be submitted to Employee
Benefits for reimbursement from this dependent care FSA. The claims will be reviewed
for eligibility and accuracy. Reimbursements made from this account will be
equal to the amount of the claim, but not more than the amount currently in
the dependent care FSA. This account is for day care expenses ONLY. Dependent medical/dental expenses
are not reimbursable through the dependent care flex account.
Dependent care arrangements which qualify, include:
- A Dependent (Day) Care Center, provided it complies with applicable
state and local laws if care is provided by a facility for more than six
- An educational institution for pre-school children
- For school-age children (Kindergarten through age 12), only expenses
for before and after school care are eligible. Tuition fees do not apply
- An "individual" who provides care inside or outside your home (who
is not your child under age 19 or anyone you claim as a dependent for
federal income tax purposes, i.e., spouse).
Reimbursement for Expenses
FSA expenses (Health and Dependent) for which a participant receives reimbursement are not eligible as a deduction for income tax purposes.
Claims may be submitted for reimbursement up to 90 days after the end of
a calendar year in which you are enrolled.
How to Enroll
- New employees may enroll in the FSA program upon hire
- New hires not electing FSA must wait until Open
Enrollment to enroll for the following calendar year
- All other employees may enroll
during the Annual Open Enrollment period for the following calendar year
- A change in status (as defined by the IRS) may qualify a
member to elect FSA mid-year *
**Due to Federal requirements, participants MUST re-enroll every year for FSA
*Examples of a change in status may
- Change in legal marital status, including
marriage, divorce, legal separation
- Change in number of dependents,
including birth, adoption, placement for adoption, or death
- Change in employment status or work schedule for either
you, your spouse, or your dependent child
- Change in dependent status due to attainment of the
maximum age as defined by the Plan
Please note: Mid-year FSA enrollments/changes must be made
within 31 days of the qualifying change.
information regarding Change in Status requirements may be found in the
How to submit FSA health claims
For more information on eligible and ineligible
expenses, please refer to the excerpt from the
To receive reimbursement on a health FSA:
- Participants receive an Explanation of Benefits (EOB)
form from Employee Benefits when the services billed have
been processed. The EOB is a very important document and should
be kept for future reference. It tells you how much of the billed charge was
allowed, how much the City Plan paid, and how much you owe.
- Send a copy of the EOB, along
with a completed FSA Health Care Claim Form to "Employee Benefits: Attention FSA." Make
sure to itemize the expenses on the FSA claim form, or it will be
returned to you.
you paid a copay for the health-related service you don't have to submit the claim to Employee Benefits
for processing under the health plan. Instead, complete the Health FSA Claim
Form, attach the receipts for your items, and send them to "Employee
Benefits: Attention FSA."
- If you want to be reimbursed for an eligible
over-the-counter medication, attach a copy of the doctor's prescription and cash register receipt that
itemizes the medication purchased along with the date and location to the
Health Care FSA Claim Form. If the cash register receipt doesn't show the
name of the medication, attach the packaging from the medication so we may
verify that it's an eligible medication expense.
Orthodontia claims require additional
documentation please contact Benefits for detailed
How to submit FSA dependent care claims
- Have your child's day care
provider give you a receipt showing the name of the day care
center, the tax identification number, the amount paid, and the
dates of service for which payment has been made. Private day care providers
must list their Social Security Number on the receipt.
- Submit the receipt along
with a completed Dependent Care FSA Claim Form to "Employee Benefits: Attention FSA."
- To be eligible for reimbursement, elder care expenses
must be for services rendered to a person who is claimed as
a dependent on the participant's Federal Income Tax return.
To submit claims, follow the dependent care guidelines, or
contact (480) 644-2299 for more information.
Your account balance will be
included on your Explanation of FSA Benefits whenever you receive a
reimbursement check. You may also
login at CHIP to view your FSA
account, or contact the Employee Benefits office at (480) 644-2299.
If you have a question on how a claim was paid, please send
an email to Benefits.Info@mesaaz.gov for the quickest response.
information about this program, please refer to FSA portion of the
Plan Document, or contact the Employee Benefits Office
at (480) 644-2299.
Main Street, Ste 600
Mesa, AZ 85201
Open Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax
Option 3: Claim Status
E-mail (password resets cannot be done via email)
Federally Mandated Notices