Flexible Spending Account Plans
The City of Mesa has contracted with a third party administrator (TPA)
ConnectYourCare, to deliver the FSA program.
Members may contact ConnectYourCare customer service 24 hours a day 7
days a week via phone or by visiting the member portal. The portal can be used
to view the status of your FSA claims submissions, account balances and a
host of helpful health and dependent care related information.
The City of Mesa Flexible Spending
Plan offers 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. FSA is a use it or lose it program.
Beginning 1/1/2015 there will be a new $500 Rollover plan
feature on the health FSA. With this feature you can rollover up
to $500 of your unclaimed balance to the following plan year for
your use in that plan year, in addition to whatever you have
elected for that plan year. This $500 will not be subject to the
"use-it-or-lose-it" rule from year to year, however all other
balances will be.
Any money left in the account after the 90-day deadline will be
forfeited to 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 out-of-pocket health care expenses that are not covered by your insurance.
This amount may change in future years.
Examples of these reimbursable expenses include:
- Certain items not covered by insurance
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 CYC for
reimbursement from the dependent care FSA. All 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 current balance in
the dependent care FSA. This account is for day care
expenses ONLY. Dependent medical/dental/vision expenses are not
reimbursable through the dependent care flex account.
Examples of 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
spouse, child under age 19 or anyone you claim as a dependent for
federal income tax purposes).
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 *
*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 event and must be
consistent with the change. More
information regarding Change in Status requirements may be found in the
**Due to Federal requirements,
participants MUST re-enroll every year for FSA if they wish to
continue participation for the following calendar year **
2015 FSA Claims
For information on how to submit FSA
claims please visit the third party administratior website at
or contact them at 1-844-226-1872.
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.
2014 FSA Claims
FSA Reimbursement Claim Form(s) along with
appropriate documentation via mail, hand delivered, interoffice,
fax, or email: Location:
Mesa City Plaza
20 E. Main St, Suite 600
Mesa, AZ 85201
Mailing Address: P O Box
1466, Mesa AZ 85211-1466
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.
information about the 2014 FSA program, please refer to FSA portion of the
Plan Document, or contact the Employee Benefits Office
at (480) 644-2299, Opt 5.
Main Street, Suite 600
Mesa, AZ 85201
Office hours: Mon -Thurs 7am-6pm
(480) 644-2299 - Phone
(480) 644-4548 - Fax
-Disease & Case
Option 2: Prescription Plan
-Request FSA Card
Eligibility - Active Employees
Eligibility - Retired Employees
FSA- Benefits Office
E-mail (password resets cannot be done via email)
Federally Mandated Notices