Update: You May Change or Cancel Your 2020 FSA: June 11, 2020 - A revised IRS rule allows you more flexibility to change or cancel your Flexible Spending Account mid-year. For the 2020 plan year, you may drop your Dependent Care FSA and or Health Care FSA or decrease your FSA contributions. You may only decrease your annual election once during the plan year due to this revised rule.
Please note: You may only receive reimbursements for services incurred during periods when you made contributions to your FSA. When contributions end, the PayFlex debit card is inactivated and your account is expired.
Visit 2020 Flexible Spending Account Changes to review examples and instructions for completing the Request for Change in Status forms.
Flexible Spending Account Forms
- 2020 Health Care FSA and or Dependent Care FSA Enrollment Form - For accounts ending December 31, 2020
- 2021 Health Care FSA and or Dependent Care FSA Enrollment Form - This form is for new employees or newly eligible for benefits only. Faculty and staff eligible to participate in Open Enrollment should enroll in a 2021 FSA online during benefits Open Enrollment, October 19 - 30, 2020 (ends at 5:00 p.m. Friday). The Open Enrollment form for 2021 FSA enrollments will be available after 5:00 p.m. Friday.
- Health Care FSA Request for Change in Status
- Dependent Care FSA Request for Change in Status
- Dependent Care Provider's Identification and Certification
- PayFlex Health Care and Dependent Care FSA Claim Form
Flexible Spending Account Book
- 2020 Flexible Spending Account Book revised June 26, 2020; for accounts ending December 31, 2020.
- 2021 Flexible Spending Accounts - For accounts with effective dates from January 1 through December 31, 2021. The annual maximum limit for Health Care FSAs will increase to $2,750 for 2021. Remember that unlike other benefits, FSA enrollments do not carry over from year to year. According to IRS rules, you must re-enroll if you wish to participate in an FSA in 2021.
More Information on Flexible Spending Accounts
- What is an FSA?
- PayFlex Flexible Spending Account - A quick summary of health care and dependent care flexible spending accounts, administered by PayFlex.
- PayFlex FSA Card - A guide to using the PayFlex Card, your FSA debit card
- Stay Connected to Your PayFlex Account - Information on managing your account online, signing up for account notifications, and using the PayFlex Mobile® app.
- Learn how to use an FSA to pay for dental expenses
- PayFlex Claim Filing Guidelines