Flexible Spending Account Forms and Documents

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

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