Complete a Flexible Spending Account (FSA) Claim Form and submit a receipt for each expense incurred.Submit claims using ASIFlex's free mobile app.Submit your claim online through ASIFlex, State of New Hampshire's FSA administrator.Click here for an ASIFlex Debit Card FAQ. including: your medical, dental and vision care expenses that are not covered by your. Pay for eligible health care expenses directly using your ASIFlex FSA debit card. classified as eligible expenses according to IRS rules. You have four options for submitting your Health Care FSA claims: Your newly elected annual amount upon Open Enrollment will be available on January 1st of the new plan year. The effective date of coverage for a newly hired employee will be the 1st day of the month following completion of one full month of employment. You can logon to the ASIFlex website to view your account balance at any time. You have until April 30 of the next plan year to submit claims incurred through March 15 for reimbursement. Any remaining unused dollars prior to March 15 of the next plan year will be forfeited.Click here for some Tips on How to Use the ASIFlex Debit Card. Payment can be made directly to providers using your ASIFlex debit card. Elect wisely as any unused funds will only carry over until March 15 of the next plan year. Elect to have the State of New Hampshire withhold an annual amount which will be withheld in equal amounts from your pay on a pre-tax basis for reimbursement of these expenses.Review ASIFlex's listing of Eligible Expenses. Keep in mind the State of New Hampshire limit for the amount of pre-tax money that you may contribute to your Health Care FSA is $2,750 for the 20 plan years. Use ASIFlex's Tax Savings Estimator/Calculator or Paper Worksheet. Determine the amount of unreimbursed eligible health care - medical, prescription drugs, dental, orthodontia and vision - expenses you (and where applicable, your eligible family members) will likely incur during the plan year.Must be made EVERY year during Open Enrollment. Important Note: FSA enrollments do not auto-renew and a new election Newly hired employees have a 45 day window in which to apply for this benefit.Įlect to participate within 45 days of being newly hired during the annual openĮnrollment period or within 30 days of a qualifying life event (such as marriage,Īnd submitting it to your agency benefit representative within the specified time period. Health Care Flexible Spending Account benefits are available to all State of New Hampshire employees who work a minimum of 30 hours per week. The State of New Hampshire limit for the amount of pre-tax money that you may contribute to your Health Care FSA is $2,750 for the 2022 plan year and $3,050 for the 2023 plan year. You can use this account to pay these expenses for yourself and your dependents, even if your dependents are notĬovered by a State of New Hampshire health care plan. The Flexible Spending Accounts are managed Orthodontia and vision expenses not covered by your health care plans. Plan Information for Health Care FSA benefitsĬontribute pre-tax dollars to the Health Care FSA to pay for eligible medical, dental, prescription drugs,
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