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 income. 

 

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.

 

FSA participants 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:

  • Deductibles
  • Coinsurance
  • Copayments
  • Certain items not covered by insurance

Here is a helpful tool to assist you in determining your eligible medical costs.

 

Dependent Care Flexible Spending Account

The Dependent Care Flex Plan allows participants to set aside up to $5,000 per household 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 individuals
  • 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 include: 

  • 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.

 

More information regarding Change in Status requirements may be found in the Plan Document.

 

How to submit FSA health claims

For more information on eligible and ineligible expenses, please refer to the excerpt from the Plan Document.

To receive reimbursement on a health FSA:

  1. 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.
  2. 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. 
  3. If 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."  
  4. 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. 
  5. Orthodontia claims require additional documentation please contact Benefits for detailed information.

 

How to submit FSA dependent care claims
  1. 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.
  2. Submit the receipt along with a completed Dependent Care FSA Claim Form to "Employee Benefits: Attention FSA."
  3. 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.

 

FSA Forms

FSA Enrollment FSA Health Care Claim Dependent Care Claim

 

Account Balance

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.

 

For more information about this program, please refer to FSA portion of the Plan Document, or  contact the Employee Benefits Office at (480) 644-2299.

  

 

Employee Benefits
20 E Main Street, Ste 600
Mesa, AZ 85201
Open Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax

Option 2: Medical/Dental Verify

Other Questions

Password Resets

Option 3: Claim Status

Option 4: Retiree Questions

Option 5: Flex Spending


E-mail (password resets cannot be done via email)

Forms

Federally Mandated Notices