100% Digital Open Enrollment Available
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Medical Flexible Spending & Dependent Care
Need funds in Flex or Dependent Care?
Enroll online, even if you want the same amount as last year
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
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.