The American Fidelity Assurance Company provides the City's Health Flexible Spending Accounts and Dependent Care Flexible Spending Accounts.
A Health FSA allows you to allocate money on a pre-tax basis to reimburse yourself for qualified medical expenses for you and your family. Qualified expenses include anything from co-payments, medical deductibles, prescriptions, and much more.
Minimum Annual Deposit: $120
Maximum Annual Deposit: $2,650 (for 2019)
Partial List of Eligible Expenses for Health FSA:
Prescription Drugs and Medicines
Eye Exams, Eyeglasses, Contact Lenses, Contact Lens Solution and Enzyme
American Fidelity will provide a Debit Card to all employees who elect to participate in a Health FSA. The debit card gives immediate, convenient access to Health FSA Funds at the point of sale for prescriptions, copays, and other common qualified medical expenses. This card can only be used for the Health FSA and is not available for the Dependent Care account.
A Dependent Care Account allows you to allocate money on a pre-tax basis to reimburse yourself for dependent care services such as after school care and dependent daycare centers.
Minimum Annual Deposit: $240
Maximum Annual Deposit: $5,000
Partial list of Eligible Dependent Care Expenses:
After-school care or extended day programs
Baby-sitter inside or outside participant's household
Custodial or elder care expenses if the qualifying individual still spends at least 8 hours each day in the employee's household
Dependent care center* expenses/pre-kindergarten/nursery school expense if primary purpose is to care for the child so the parent can work
Expenses paid to a non-dependent relative of participant
Summer day camp if the primary purpose of the expense is custodial in nature and not educational
*A dependent Care Center is a place that provides care for more than six persons (other than persons who live there) and receives a fee, payment or grant for providing services for any of those persons, regardless of whether the center is run for profit.
For a complete list of eligible expenses, visit https://americanfidelity.com .
Regardless of whether you participate in the dependent care plan under Section 125 or claim the credit on your income tax, you must provide the IRS with the name, address, and taxpayer identification number (TIN) or Social Security number of your dependent care provider(s) by completing either Schedule 2 of form 1040A or Form 2441 and attaching it to your annual income tax return. Be sure that you follow the current instructions given by the IRS for preparing your annual income tax return. Failure to provide this information to the IRS could result in a loss of the pre-tax exemption for your dependent care expenses.
AFmobileTM allows FSA participants to submit Health FSA, Dependent Day Care FSA claims while on the go! Our mobile app allows customers to:
Submit FSA claims by taking pictures of receipts,
Sign-up for Flex Direct Deposit, and
Create their Online Service Center accounts.
Look for AFmobileTM in the Apple App StoreSM or the Google PlayTM Store.
FSA participants can now file claims electronically through our secured Online Service Center! Submit your claim quickly and conveniently without the hassle of mailing or faxing a paper claim form.
Submit new Health FSA and Dependent Day Care FSA claims online.
Forward receipts to support debit card swipes online.
Easily manage and update account information.
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