FSA Brochure

Flexible Spending Accounts Plan Today for Tomorrow’s Costs. With medical costs continuing to rise, tools to help manage out-of-pocket medical expenses can be a popular choice. One option is a Healthcare Flexible Spending Account (HCFSA). Healthcare FSAs allow you to set aside money tax-free for eligible medical costs, such as doctor visits, prescription drugs, prescription contact lenses, and dental procedures. Additionally, your entire election amount is available to you at the beginning of your plan year. Here’s How It Works AF mobile® Select the amount you Make an eligible Snap a photo of your Submit Success! wish to elect from your medical purchase itemized receipt a reimbursement Receive funds via paycheck each month claim electronically direct deposit Learn how to file reimbursement claims at americanfidelity.com/fileaclaim Paycheck Savings Example Earnings & Hours Without FSA With FSA In the example to the right, Jane makes Gross Pay $2,000 $2,000 $2,000 per paycheck and is paid twice a Health Insurance -$150 -$150 month. By participating in an HCFSA, Health FSA Contribution N/A -$150 she would save $82.96 a month. Taxable Income $1,850 $1,700 Taxes (Federal & State @ 20%) -$370 -$340 That’s a savings of $995.52 a year. Less Estimated FICA (7.65%) -$141.53 -$130.05 Out-of Pocket Medical Expenses -$150 N/A To calculate your possible savings, visit americanfidelity.com/s125-calculator Take Home Pay $1,188.47 $1,229.95 Examples of Eligible Expenses Over-the-counter Prescription contacts Asthma treatments Eye exams/eyeglasses drugs and Prenatal care Dental services Physical therapy medicines without a Copays/Co-insurance Laser eye surgery Deductibles prescription Physical exams Chiropractic care Menstrual products For a list of eligible expenses visit americanfidelity.com/eligible-expenses