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

2022 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

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)

Lauren French

847-810-3531 (email)

2021 EXPENSES & CARRYOVER

Cares Act Update
- This year only - 
No Limit On 2021 Carryover!
$50 carryover minimum still applies

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.