2017 Healthcare Flexible Spending Account (FSA)

The 2017 maximum annual contribution to the Healthcare FSA is $2,550.The Healthcare Flexible Spending account (FSA) enables you to pay eligible out-of-pocket health care expenses with before-tax dollars saving you 30% or more because you are not paying taxes on your FSA contributions.

How the Healthcare Flexible Spending Account Works

  • A set amount of money that you determine is taken out of each paycheck and deposited into an account. Federal Income and Social Security taxes will not be withheld from your contributions.
  • Your annual before-tax FSA contributions are deducted from your pay in equal amounts during the plan year of January 1, 2017 to December 31, 2017. The maximum annual contribution to the Healthcare FSA for 2017 is $2,550.  
  • Use the money in this account to pay for eligible out-of-pocket health care, dental and vision expenses for yourself, your spouse, your children or for any person you claim as a dependent on your federal income tax return. Expenses include deductibles, coinsurance and co-pays. See a list of eligible expenses below.
  • The debit card provides a convenient way to pay for eligible expenses, thus eliminating the need to pay out of pocket, file claims, and be reimbursed.  Fringe Benefit Group may request receipt documentation for your debit card transactions.  Remember to retain all receipts, per IRS guidelines. Not all providers accept the FSA debit card. For those providers who do not accept the debit card, you will pay at the time of transaction and complete a claim form to request reimbursement.
  • The IRS requires that any unused money in your account at the end of the plan year must be retained by your employer.  Be sure to use the entire amount of your FSA balance in order to avoid forfeitures.  Claims must be incurred within 2 ½ months following the last day of the plan year (by March 15, 2018) in order to be eligible for reimbursement.   All 2017 FSA claims must be submitted to the FSA administrator by April 30th, 2018 in order to be considered for reimbursement.

FSA Claims - How it Works

You will either use your FSA debit card to pay for claims at the point-of-service or submit a claim to the administrator for reimbursement. 

Debit Card Purchases

You will receive a debit card for your FSA plan which may be used to pay for eligible health care expenses.  Using the FSA debit card is a convenient way to pay for your FSA expenses.  Many pharmacies, physicians and hospitals accept the debit card.  When you use your debit card, the funds are pulled from your FSA account and paid to the pharmacy or health care provider directly.  This eliminates the need for you to pay out-of-pocket and file a claim to be reimbursed. 

Please remember to keep all FSA claim receipts, even if you use your debit card.  Some debit card claims will require you to provide a receipt to the plan administrator.  In the event the FSA administrator needs additional information from you, you will receive a letter requesting receipt(s).

Manual Claims

Not all vendors accept the debit card. Should you need to pay for an eligible expense and be reimbursed from your FSA, you will need to submit a claim to the address indicated on the claim form with the appropriate documentation.

pdf button Claim Form


Eligible vs. Ineligible Expenses

Examples of Eligible FSA Expenses
Examples of Ineligible FSA Expenses

Deductibles; copays from your medical; prescription drug;
dental or vision plans; acupuncture; birth control pills;
braces (orthodontics); dental expenses
(exams, cleanings, X-rays, root canals);
hearing aids and batteries; vision expenses
(eyeglasses, contact lenses or prescription sunglasses over the amount covered by the vision plan).

Healthcare FSA - List of Eligible Expenses

Non-medically supervised programs to stop smoking or lose weight
Non-medically necessary cosmetic surgery
Non-prescription sunglasses
Premiums for other medical plans
Dietary supplements and cosmetic remedies

Healthcare FSA - List of Ineligible Expenses

On-Line Member Tools

Once you are enrolled, you may access www.fbg.com and register as a member. You may access your balance and claims information, and view other important FSA plan information on this website.

pdf button Online and Member FSA Tools

Documents & Additional Information

Healthcare FSA Reimbursement Claim Form - This is the claim form – see note under Manual claims.

Direct Deposit Form - To receive your reimbursements directly into the account of your choice.


Contact Fringe Benefit Group (FBG)

For questions about the Healthcare Flexible Spending Account, contact the Benefits Service Center at 1-855-481-1489 or FBG at 1-800-447-6588 | www.fbg.com


FSA plan participants will pay a monthly administration fee of $4.95, which will be a separate payroll deduction post-tax. There are no duplicate fees if you are enrolled in both Healthcare and Dependent Care FSA.