Medical Flexible Spending & Dependent Care
Need funds in Flex or Dependent Care?
Enroll online, even if you want the same amount as last year
2023 FLEX CONTRIBUTIONS CAPS
Max out your contributions + Think Healthy flex dollars
Subtract Think Healthy flex dollars from your total
i.e., $2,850 - $150 = $2,700
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 Usage
Need help? Come see us!
Digital meetings available too!
HR Department
hr@cityoflakeforest.com
Amber Campbell
847-810-3532 (email)
Brina Diaz
847-810-3530 (email)
Zenaida Cabrera
847-810-3531 (email)
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.