100% Digital Open Enrollment Available

Need help? Come see us!

Medical Flexible Spending & Dependent Care

Need funds in Flex or Dependent Care?

Enroll online, even if you want the same amount as last year

Click here for Step by Step Flex Enrollment Guide

2021 Max Employee Contributions

Max out your contributions + Think Healthy flex dollars
Subtract Think Healthy flex dollars from your total
i.e., $2,750 - $150 = $2,550
PBA will add the flex dollars

Reminder: If your spouse has a flexible spending account, both can defer up to the maximum amount for Medical Only

Flex Rollover - Don't Lose Your Funds!

$50-$550 of 2020 contributions will rollover into 2021

Rollover funds available April 1, which gives you time to submit claims for 2020!


Claims for 2020 need to be incurred by Dec. 31, 2020 and received by PBA for reimbursement no later than March 31, 2021

Use your PBA Account OR the PBA Flex App to:
• Check your balance
• File Claims

Problems logging in or questions, please contact PBA customer service at 630.655.3755.

Need help? Come see us!

Digital meetings available too!

 

HR Department
hr@cityoflakeforest.com

DeSha Kalmar

847-810-3530

Amber Campbell

847-810-3532

Lauren French

847-810-3531

Flex Usage

Eligible/Ineligible Items PDF

This form details many items that are eligible to be taken from the FSA and contains a worksheet to help determine how much to withhold.

FSA Feds Searchable Eligible Expenses

Fsafeds.com lets you search FSA eligibility and lists if items need additional documentation to be eligible. Click here for link directly to FSA eligible expenses search.

Additional Resource:

FSAstore.com is an online marketplace for FSA-eligible products.

PBA Flex Medical Necessity Form

Certain items may be considered eligible expenses if deemed Medically Necessary by a prescribing physician. Have your provider completed this form. 

Flex Reimbursement

PBA Flex Claim Reimbursement Form

Complete this form to submit claims for unreimbursed medical/dental and dependent care expenses from your flexible spending account.

PBA Flex Dependent Care Reimbursement Form 

You can also submit claims online at www.pbaclaims.com or on the PBA Flex App. This is the recommended and fastest way to submit claims for reimbursement.

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