Flexible Spending

The Flexible Savings Account (or Health Care Savings Account) is a voluntary employee benefit plan which permits employees to pay for certain eligible expenses with pre-tax dollars. This benefit allows an employee to direct a portion of his or her salary on a pre-tax basis to an account to be used to pay for medical, dental vision care, or other health-related expenses that are not covered or reimbursed under any other plan. By doing this, an employee may realize tax savings on the amount set aside. The amount saved is dependent on the individual's tax rate. If you are on the MBI PPO or MBI Dental Plan, and claims are submitted to PayFlex by you or your doctor, you may automatically be reimbursed the amount for which you are responsible. Be sure to keep receipts and other supporting documentation related to your FSA expenses and reimbursement requests. Per IRS regulations, PayFlex may be required to request itemized receipts to verify your FSA expenses.

What expenses are eligible

To view a list of currently eligible expenses, see the "Eligible Expense Items" list on the PayFlex web site at payflex.com. These items may change from year to year, and the key to making the most of your FSA is knowing about the wide variety of eligible expenses. Common eligible expenses include co-pays and deductibles, bills for doctor or dental visits, medical tests, prescriptions, over the counter health care items such as bandages and thermometers (excluding most over the counter medicine unless prescribed by a doctor), eyeglasses or contacts, orthopedic, chiropractic, and nursing care, and more.

How much should be set aside?

You may set aside up to $2,750 during 2020 in your Flexible Spending Account. To help determine how much to set aside, you can use the online calculator tool at payflex.com or download the worksheet below.

Forms and Additional Information

To request additional information, contact Erica Loring

Please note that any instructions regarding PayFlex Debit Cards in the material below do not apply.

Flexible Spending Reimbursement Worksheet 

Claim Form

Claim Filling Instructions

Human Resources Office