Section125 Health FSA Plan Document

Employees Save up to $1,280*; Employer Saves Up To $320*

Health FSA Plans are special tax-free accounts that allow employees to use up to $3,200 in 2024 in pre-tax dollars to pay for out of pocket medical, dental and vision care expenses not covered by other insurance.
$350 one-time fee in PDF via email for the Health FSA
$50 Optional Deluxe Binder Mailed via USPS
$120 Optional Dependent Care FSA Module

What is a Health Flexible Spending Account (FSA)?

A Health Flexible Spending Accounts allow employees to use pre-tax dollars to pay for medical bills not covered by their insurance. The Health FSA plans can also be offered in conjunction with a POP and/or a Dependent Care FSA. The FSA is a budgeting tool that can help take care of out-of-pocket expenses such as dental and optical care, insurance deductibles, co-pays, and prescription drugs. Like a POP, the FSA helps pay for itself by increasing employee take-home pay while decreasing employer payroll taxes.

Here’s how it works:

An employee decides how much of their salary should be set aside before taxes are calculated.

This amount is automatically deducted from their paycheck every pay period, just like any other payroll deduction, and is deposited into their Health FSA account.

The employees would pay their out-of-pocket expenses up-front, then submit a claim and documentation and a reimbursement is made from their own account.

Out-of-pocket expenses include:
Eyeglasses and contact lenses
Medical insurance deductibles
Prescriptions
Co-payments
Orthodontia
Chiropractic services
Dental treatments
X-ray and laboratory services
Over the counter items

The flexibility of an FSA plan makes it the best option for small to medium sized businesses.

Carryover options include up to $640 in 2024 of unused funds to the next Plan Year, or choose the 2.5 month extension option into the next Plan Year to claim unused funds.

The Health FSA is covered by a separate Plan Document for only $350 in PDF version, and only $400 in the Deluxe Binder version that also includes the PDF email version. Other discounts apply if combined with a Premium Only Plan or Dependent Care FSA Plan.

• $3,200 Maximum X up to 40% payroll taxes = up to $1,280 savings per employee
• $3,200 Maximum X up to 10% in Matching Taxes, WC & Unemployment = $320 savings to the employer per employee