Flexible Spending Account (FSA) Forms and Documents

A Flexible Spending Account is a special account through which pretax money is deducted from your paycheck to use to pay for eligible out-of-pocket health care costs such as office visit co-pays, deductibles or prescription co-pays.

FSA Documents

Flexible Spending Account Brochure 2018

Important Information for 2018

How To Submit Claims

FSA  Use it or Lose it ... Not Anymore!!

Flex Administrators FSA FAQ

Eligible Health Care Expenses (IRS Publication 502)

FSA Forms

FSA Reimbursement Form (Health and Dependent Care)

Flex Dependent Care Mandatory Statement

FSA Direct Deposit Form and Instructions

My Source Card FSA Debit Card


If you do not find the information you are looking for please contact the HR Benefit Department.