Health Care FSA

2021 and 2022 Plan Year Information

Health Care FSAs

Health Care Flexible Spending Accounts (FSAs) allow you to set aside before-tax money to use for certain eligible expenses not covered by your health plans.

Benefits in Brief

Save an average of 30% on health care costs with an FSA.

  • Use before-tax dollars to pay for doctor and dentist visits, X-rays, prescription drugs, eyeglasses, contacts and more.*
  • Your full-year contributions are pre-funded and available January 1.
  • Up to $550 of unused funds will automatically carry over from 2021 to 2022.*
  • Did you know? Employees enrolled in Medical Plan Options A and B, as well as those not enrolled in any other Firm benefits, may contribute to an FSA.

* If you have elected Medical Plan Option C, you may contribute to a Limited Purpose FSA to pay for dental and vision costs only – and unused funds do not carry over into the next year.

Health Care FSA Eligibility

All U.S. benefits-eligible employees, with the exception of employees enrolled in Option C coverage under the Medical Plan, are eligible to set aside money in a Health Care FSA on a before-tax basis to pay for eligible health-related expenses.

Health Care FSA
Who Can Enroll?

All employees not enrolled in Medical Plan Option C, even those who are not enrolled in any other Firm benefits

How Much Can I Contribute? (determined by the IRS each year)

Between $100 and $2,750

What Can the FSA Money Be Used For?
  • Medical
  • Prescription drugs
  • Dental
  • Vision
What Are the Deadlines?


  • Incur expenses by December 31, 2020.
  • Submit expenses by April 30, 2021.


  • Incur expenses by December 31, 2021.
  • Submit expenses by April 30, 2022.
    You may roll over up to $550 of your remaining 2021 Health Care FSA balance to the following Plan year as long as you remain enrolled in a Health Care FSA for 2022 and are not enrolled in Medical Plan Option C.

How to Pay with FSA Funds

Medical Plan Options A and B:

    If you are enrolled in Medical Plan Option A or Option B for medical coverage, there are two ways to pay for eligible out-of-pocket medical expenses from your Health Care FSA administered by UnitedHealthcare (UHC):

    1. If you participate in the Firm’s Medical, Dental or Vision Plans, you may elect automatic reimbursement for your eligible out-of-pocket health care expenses for in-network services. Elect this feature on the Benefit Center website when you make your elections. Note: Automatic reimbursement is not available for out-of-network services, HMSA or Kaiser HMO participants or for expenses relating to your domestic partner.
    2. To submit expenses for out-of-network services, complete an FSA Claim Form (available on the Benefit Center website) and attach an itemized bill or receipt, or the Explanation of Benefits from your medical, dental or vision Plan administrator.

Health Care Flexible Spending Account: Rollover of up to $550

If you participate in the Health Care FSA, IRS regulations permit the forfeiture of any unused funds remaining in the account at the end of the Plan year. However, a maximum of $550 of your remaining health care FSA funds may automatically roll over into your account for the next plan year. The balance up to $550 will automatically roll over into your Health Care FSA for 2022 assuming you make an active election to participate in a Health Care FSA and do not enroll in Medical Plan Option C for coverage.

You have until April 30 of the following year to request reimbursement for eligible expenses incurred during the current plan year.