Flexible Spending Accounts (FSA)

Flexible Spending Accounts (FSAs) provide a pre-tax 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.

Below are the Flexible Spending Account options:

FSA Plan Comparison

	Limited Purpose FSA*	General Purpose FSA	Dependent Care FSA
Eligible Expenses**	Reimburses you for eligible dental and vision expenses	Reimburses you for eligible medical, prescription drug, dental, and vision expenses.	Reimburses you for eligible out-of-pocket expenses to pay for licensed care for select dependents.***
Your Contributions	You can contribute any amount between $25 and $2,850 annually.	You can contribute any amount between $25 and $2,850 annually.	You can contribute any amount between $25 and $5,000 annually.****
Do funds roll over?	Any amount up to $570 will automatically be rolled over into the the next plan year.	Any amount up to $570 will be automatically rolled over into the next year plan.	Not applicable.

*You may enroll in the LPFSA if your medical plan is the HSA PPO with the HSA.
Refer to IRS Publication 502 for a complete list of eligible Medical and Dental expenses.

***Eligible dependents include: child(ren) under the age of 13, disabled spouse, elderly parent or other dependent incapable of self-care while you and your spouse work or go to school full time.
****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 31^st of current calendar year	March 31^st of the following year
Dependent Care FSA	December 31^st of current calendar year	March 31^st 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 Medical and Dental expenses.
Refer to IRS Publication 503 for a complete list of eligible Child and Dependent Care 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. Refer to IRS Publication 503 for a complete list of eligible Child and Dependent Care Expenses.

You may submit the claim in 3 ways:

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

Contact HR Source [VMware network access required]
ASK HR [VMware network access required]
Phone: 1-888-869-2738

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

Enroll in TRI-AD Direct Deposit

Save time by enrolling in TRI-AD direct deposit. When you submit a manual claim, TRI-AD will direct deposit the reimbursement to the account of your choosing.