2024 FLEXIBLE SPENDING HEALTH AND DEPENDENT CARE ACCOUNT ENROLLMENT FORM

** ALL OPTION CHANGES AND ELECTIONS WILL BECOME EFFECTIVE

JANUARY 1, 2024**

The period from October 23 to November 11, 2023, has been designated as the Annual Flexible Spending Health and Dependent Care Open Enrollment period during which employees who desire to enroll in a 2024 Flexible Spending Account (FSA) may do so.

**FSA Form attached below**

Flexible Spending Account FSA

The Flex Benefits Plan (Flexible Spending Account & Dependent Care-FSA) is administered by Aetna, Inc. and can result in true pre-tax dollar savings for you and your family! Here’s how it works:

The County’s Flexible Benefits Plan enables you to set aside pre-tax dollars to pay for many out-of-pocket health care and dependent care related expenses not covered by your insurance provider. By determining what your annual expenses for these items will be, and having pre-tax dollars deducted from your paycheck, you will realize significant savings for the calendar year.

The projected maximum contribution for the plan in 2024 is $3,200 for Health Care and $5,000 for Dependent Care if filing joint federal income tax return and $2,500 for Dependent Care if married and filing separate federal income tax returns. (Note: For a child to qualify for Dependent Care, he/she would have to be a tax dependent of yours who is under age 13 when the dependent care services are rendered.)

The minimum contribution is $500 combined for both plans. (For example: $100 for Health Care and $400 for Dependent Care.)

Nassau County will be participating in the Grace Period Option as it relates to unused funds in your FSA health account. This means that you will have until March 15, 2025 to incur qualified expenses that can be reimbursed from any unused contributions made in 2024; and until March 31, 2025 to submit your claims.

Please be reminded that any unused amount remaining in your 2023 Health Care FSA as of March 15, 2024, or as of the date your employment terminates, will be forfeited. Therefore, please carefully consider the amounts you would like to contribute to your 2024 FSA accounts and complete the attached application form. You should submit the completed form to your HR representative no later than November 11, 2023.

If this is your first-year enrolling in HealthCare FSA, please note that at the top of your form so that we can expedite processing of your Flex card.

Representatives from Payflex/Aetna will be on-site on the following days between 10:00 a.m. and 2:00 p.m. to answer questions you may have: