Regular (not temporary) employees are eligible for enrollment in a FSA if they

• Are currently expected to work 30 hours per week or more

To enroll, please complete a EBC FSA Enrollment Form or Formulario de inscripción EBC FSA (español) and return it to a Benefits Specialist

Flex Spending Accounts are offered 

• Within 30 days of hire, if hired into a benefit eligible position

• Within 30 days of a change in assignment to a benefit eligible position or increase in hours to meet eligibility

• Within 30 days of a HIPAA qualifying life event (See Life Changing Events page for more information)

• Annually during open enrollment in fall for access to funds beginning on January 1 

Coverage is effective first of the month following the start/change/life event date. 

EBC FSA Plan Document

EBC FSA Plan Description

My Company Plan: Summary

Healthcare FSA Maximum is $3,300  
Dependent Care FSA Maximum is $5,000

How a FSA Works

• Choose a specific amount of money to contribute each pay period, pre-tax, to one or both accounts.

• The amount is deducted from your pay at the same level each pay period. 

How to use your Healthcare FSA (HCFSA) to pay for a claim

• You can use your EBC Benny Card to pay at the point of service or purchase

• You can use the Benny Card as a form of payment if you are billed for a service

Note: Please save your receipts when using your Benny Card as EBC may ask for supporting documentation

• If you pay out of pocket, you can submit and substantiate your claim via the EBC Account Assistant

HCFSA funds are available to you, in full, the first day of the plan year or your effective date.

How to use your Dependent Care FSA (DCFSA) to pay for a claim

Submit a Daycare Expense Form. DCFSA requires documentation from the daycare provider showing: dates of care, charges and the daycare providers signature.

DCFSA funds must be deposited into your account before you can be reimbursed

Important rules to consider

• The IRS has a strict "use it or lose it" rule. If you do not use the full amount in your FSA, you will lose any remaining funds. MCPASD does have a 2 1/2 month grace period for the Healthcare FSA, giving you more time to incur expenses.

• Once you enroll in a FSA, you cannot change your contribution amount during the year unless you experience a qualifying life event.

• You cannot transfer funds from one FSA to another.

• Re-enrollment is required each year. 

Please plan your FSA contributions carefully as any funds not used by the end of the year will be forfeited.

Enrollment Guide

Participant Election Worksheet

EBC FSA Educational Videos

Informational Brochures

Benny Card Brochure

Benny Card Transaction Dispute Form

Dependent Care FSA Eligible Expenses or Gastos elegibles para la FSA por cuidado de dependientes (español) 

Standard Health FSA Eligible Expenses or Gastos elegibles estándar de salud FSA (español) 

FSA Store

EBC Account (Online access and App)

Enrollment Guide or Guía de Inscripción (español)

How to Submit and Substantiate Claims

My Account Assistant Brochure

Participant Election Worksheet

How to Submit Year End Claims

Year End Claims Process Webinar

How to Submit Claims (Online or App)

Forms

Claim Form

Daycare Expenses Claim Form

Direct Deposit Authorization Form

Enrollment Form

Letter of Medical Necessity

Medical Mileage Expense Form

Orthodonic Care Expense Claim

Participant PHI Authorization Form

Permitted Elections Change Form

Special Food Expense Form

Unpaid Leave of Absence Form