Flexible Spending Accounts (FSA)

Flexible Spending Accounts (FSAs) provide a pretax way for you to pay for out-of-pocket health and/or dependent daycare expenses. The annual amount you elect to contribute to an FSA is deducted from the number of remaining paychecks through the end of the calendar year. Your election is in effect for the entire year. Changes can be made only if you experience a qualified life event mid-year.

Please note that an FSA plan is a ‘Use It or Lose It’ plan. This means that if you don’t have enough expenses to claim by the end of the year, you will forfeit any remaining balance left in the account.

General Purpose FSA (GPFSA)

You can use the money in your GPFSA to pay for most medical expenses for you and your eligible dependents, including eligible services and supplies not covered by your medical, dental, or vision plans. Refer to IRS Publication 502 for a complete list of eligible expenses. For the 2017 plan year, you can contribute between $25 and $2,550 to the GPFSA. You can enroll in this FSA if your medical plan is the Traditional PPO, Kaiser HMO or the HSA PPO without the Health Savings Account (HSA).

Limited Purpose FSA (LPFSA – for HSA Enrollees)

This plan allows you to pay for qualified out-of-pocket dental and/or vision expenses for you and your eligible dependents. You may enroll in this FSA if your medical plan is the HSA PPO with the HSA. Due to IRS regulations, out-of-pocket medical and prescription drug healthcare expenses are not qualified expenses under the Limited Purpose FSA and can be reimbursed through your HSA only. Refer to IRS Publication 502 for a complete list of eligible expenses. For the 2017 plan year, you can contribute between $25 and $2,550 to the LPFSA.

Rollover

The GPFSA and the LPFSA offer a rollover option of up to $500. If you have a GPFSA or LPFSA balance at the end of the calendar year, your balance, up to the IRS limit of $500, will be rolled over into a Flexible Spending Account for claims incurred the following plan year. For a complete list of eligible and ineligible expenses set by the federal government, see IRS Publication 502. Amounts greater than $500 that have not incurred an expense by the end of the calendar year will be forfeited per IRS guidelines.

Dependent Care FSA (DCFSA)

The Dependent Care FSA lets you reimburse yourself with tax-free dollars for eligible out-of-pocket expenses to pay for licensed care for your child(ren) (under the age of 13), disabled spouse, elderly parent or other dependent incapable of self-care while you and/or your spouse work or go to school full time. For the 2017 plan year, you can contribute between $25 and $5,000 to the DCFSA. If you are married and filing separate tax returns, the maximum you can contribute is $2,500 each.

FSA Dates

Below are the required dates for claims to be reimbursed for the plan year:

FSA Claim Dates

Expenses Must Be Incurred Through Expenses Must Be Submitted for Reimbursement By
GPFSA and LPFSA December 31st of current calendar year March 31st of the following year
Dependent Care FSA December 31st of current calendar year March 31st of the following year

FSA Restrictions

  • FSA contribution limits for highly-compensated individuals may be impacted mid-year based on IRS discrimination rules.
  • FSAs require annual elections, your elections will not carry over year after year.
  • Due to IRS rules, domestic partners and children of domestic partners are not eligible dependents for any Health Care FSA or Dependent Care FSA under your name, unless they are your legal tax dependents.
  • Certain expenses may not be reimbursed per IRS rules. Refer to IRS Publication 502 for a complete list of eligible expenses.

Reimbursement

The plan administrator for VMware’s FSA plans is TRI-AD. Upon enrollment in the GPFSA or the LPFSA, you will receive a TRI-AD BenefitCard. The TRI-AD BenefitCard works at eligible providers where Visa® is accepted and can be used whenever you incur a qualified expense. You may also pay out-of-pocket and file a claim with TRI-AD for reimbursement (see below for filing instructions).

For the Dependent Care FSA, you must pay your bill first and then submit documentation for the claim. You may submit the claim in 3 ways:

  1. Use the mobile app for Android or iOS devices, Benefits by TRI-AD
  2. Log into TRI-AD through Workspace ONE Single Sign On (SSO) [VMware network access required]
  3. Log into TRI-AD’s website directly

Be sure to retain all itemized receipts for the plan year, as you may be asked to substantiate your claims to TRI-AD.  If substantiation of claims is required, you will need the following documentation:

  • Description of services
  • Date of service
  • Person for whom it was incurred
  • Provider name
  • Amount

You can log into your medical, dental or vision insurance provider’s website and get an explanation of benefits (EOB) for the item that needs to be substantiated.  EOBs have all five (5) IRS required items on it for an FSA administrator to approve.

For more information on VMware’s FSA plans, please refer to the Summary Plan Description.

 

Contact Us

Benefit Center
Phone 1-888-VMWARE8, option ‘US Benefits’
hrbenefitadmin@vmware.com


TRI-AD
Phone 1-888-844-1372
flexmail@tri-ad.com
Visit website

Resources

FSA Summary Plan Description
Health Savings Account vs. Flexible Spending Account New Hire Benefit Byte Video [VMware network access required]
IRS Publication 502
IRS Publication 503
TRI-AD BenefitCard
TRI-AD Filing an FSA Claim
TRI-AD Mobile App
TRI-AD Reimbursement Claim Form