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. 

Contact Information:                  ConnectYourCare
Phone Number:                          1-844-226-1872
Fax Number:                                1-866-879-0812

Website:                                      www.connectyourcare.com

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.

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 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:

  • Deductibles
  • Coinsurance
  • Copayments
  • 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 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 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 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 event and must be consistent with the change. More information regarding Change in Status requirements may be found in the Plan Document.

**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 www.connectyourcare.com or contact them at 1-844-226-1872.

 
2014 FSA 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
Submit completed Health Care or Dependent Care FSA Reimbursement Claim Form(s) along with appropriate documentation via mail, hand delivered, interoffice, fax, or email:
 
Location:                    Employee Benefits Administration Office
                                    Mesa City Plaza
                                    20 E. Main St, Suite 600
                                    Mesa, AZ 85201

Mailing Address:       P O Box 1466, Mesa AZ 85211-1466

Phone Number:         (480) 644-2299

Fax Number:              (480) 644-4548

Email:                          Benefits.Info@mesaaz.gov


2014 FSA Forms
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FSA Enrollment

Health Care FSA Claim Dependent Care FSA Claim


2014 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 more 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.

  

 

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

Option 1: Medical Plan

Ameriben

-Verification & Coverage

-Claim Status

-Pre-certification

-Disease & Case Management

-Medical Appeals

-Request Medical/Prescription Card

Option 2: Prescription Plan

CVS Caremark

 -Prescription Coverage

-Authorizations

-Appeals

Option 3: Dental Plan

Delta Dental

-Verification & Coverage

-Claims

-Appeals

-Request Dental Card

Option 4: 2015 FSA

ConnectYourCare

-Claims

-FSA Balance

-Request FSA Card

-Appeals

Option 5: Eligibility - Active Employees 

-New Hires

-COBRA

-Qualifying Events

Option 6: Eligibility - Retired Employees

-Premium Information

-Qualifying Events

-COBRA

 Option 7: General Questions

Option 9: 2014 FSA- Benefits Office


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

Forms

Federally Mandated Notices