Flexible Spending Accounts

A Flexible Spending Account (FSA) is a tax-free method for you to pay out of pocket eligible medical, dental and vision expenses, as well as eligible child care expenses. You can elect up to $2,700.00 for the Health FSA and up to $5,000.00 for the Day Care FSA. we will deduct the amount you elect on a pre-tax basis over the number of pay periods during the plan year.

The Health FSA provides you access to your annual election on the first day of the Plan Year, which begins January 1st of each year. You may withdraw more from the account than you have contributed, but never more than you elect. The Day Care FSA works like a bank account. You may only receive a reimbursement for as much as you have contributed at any time during the Plan Year.

• Insurance co-pays, co-insurance and deductible expenses
• Vision expenses, including Lasik surgery
• Prescriptions
• Eligible Over the counter items:
  • Contact Lens Solution
  • Band Aids
  • Thermometers
• Over the counter items that require a physician’s prescription:
  • Allergy Medicines
  • Stomach Upset Relievers
  • Pain Relievers
  • Cold Medicines
  • Antibiotic Ointments and Creams
• Orthodontia and non-cosmetic dental procedures
• For a complete listing of eligible expenses please visit www.naviabenefits.com

You may request reimbursement for eligible expenses by submitting a FSA Claim Form and include receipts or Explanation of Benefits from your insurance provider or you may use the Health FSA Debit Card to pay for eligible expenses. If you choose to submit a claim for reimbursement, you will receive your payment in the form of a live check mailed to your home address or the payment will be deposited directly into your bank account if your pay check is received via direct deposit.

A claim form is available on the Navia Benefit Solutions website for manual claim submission.

The Dependent Day Care FSA program works on a cash in, cash out basis (similar to a bank account) to pay for out of pocket expenses for the care of your children 12 to 13 years, a disabled spouse or dependent.

You and your spouse must be gainfully employed, actively looking for work or your spouse can be a full time student to qualify for this plan. Single parents are also eligible. There are special rules for divorced parents, so please review tax laws to be sure you qualify if you are divorced.

You will only be reimbursed for the expenses incurred up to the amount you have contributed at the time of your claim.

The maximum that a family can contribute during a calendar year is $5,000. This is a federal maximum that is not controlled by your employer or Navia Benefit Solutions.

Some eligible Dependent Day Care expenses:

• Day care provided in or outside the home
• Summer Day camps (not overnight)
• After school care
• Private preschool, custodial in nature

You may request reimbursement for eligible expenses by submitting a FSA Claim Form and include receipts from your day care provider. You will receive your payment in the form of a live check mailed to your home address or the payment will be deposited directly into your bank account if your pay check is received via direct deposit.

You may mail, fax, email or submit a claim online at naviabenefits.com or use the Consumer Online Portal (Username:  first name + last 4 of SSN  Password: last name + last 4 of SSN all lower case)

Proper receipt documentation for the Health FSA is defined as an itemized statement from a third party provider that includes date of service, service rendered or item purchased and the amount owed to the provider. For the Day Care FSA, the receipt should include the signature of the provider and the age of the dependent(s).

Some examples:

• Itemized statement from provider detailing date and type of service rendered
• Detailed receipt from pharmacy with date included
• Explanation of benefits from insurance provider

Your elections will remain in effect for the entire plan year and cannot be changed unless you have a qualifying event such as a birth of a child or a marriage. These accounts operate on a “USE OR LOSE” basis. Once you sign up for the plan, the dollars that are deducted pre-tax will remain in the designated accounts until you file claims for reimbursement.

Our FSA Administrator is Navia Benefit Solutions. Please visit their website: naviabenefits.com to view your account balance information.

Claims should be mailed to:

• Navia Benefit Solutions  PO Box 53250  Bellevue, WA 98015

Claims can be emailed as a pdf

Claims may be submitted online at naviabenefits.com.

To speak with a Navia Benefit Solutions customer care representative please call: or email