Allows pre-tax deduction from your stipend, minimum of $10 per month up to 5,000 ($2,500 if you are married and file your taxes separately) each plan year, for you to use to pay for eligible day care expenses for your federal tax dependents so you, (and your spouse, if you are married) can work, look for work or attend school full-time. This contribution IS NOT for your dependent spouse’s or children’s healthcare expenses. Health Care Flexible Spending Account (HCFSA)
Allows pre-tax deduction from your stipend, minimum of $10 per month up to $2,550 each plan year, for you to use to cover certain eligible out-of-pocket medical, dental and vision expenses not covered or reimbursed by your insurance and incurred by you or your federal tax dependent(s).
Enrollment in a DCFSA or HCFSA must be completed within 31 days of a qualifying event, e.g. new hire, marriage, or birth of a child
or during the open enrollment period (generally held in April/May). Participation in the DCFSA and HCFSA IS NOT
automatic. You must re(enroll) during each open enrollment to begin or continue deductions. Enrollment is IRREVOCABLE.
Contributions are for the plan year (July 1-June 30th). However, for tax purposes you are responsible for tracking your total calendar year (January 1-December 31) contributions, including any contributions made by your spouse.
Carefully consider your contribution amount. The only way to access your money from one of these accounts is by filing a claim for reimbursement. If you set aside more money than you actually spend and submit receipts for, you will lose the unspent difference. When you or your qualified dependents(s) have an eligible DCFSA or HCFSA expense, submit the claim to Application Software, Inc., (ASI), the Flexible Spending Account Administrator, for reimbursement. Visit the ASI website at http://asiflex.com
to view eligible expenses, obtain claim form to request reimbursement, etc. Review the DCFSA and HCFSA information
. Select the "Cafeteria Plans" tab. (The only Cafeteria Plan options available to CU GME residents and fellows are the DCFSA and/or HCFSA.) Contact an Employee Services Benefits Counselor, 303-860-4200, if you have any questions regarding Flexible Spending Accounts. Remember, enrollment through Employee Services is for the HCFSA and/or DCFSA only. Your medical, dental, life and disability plans are through CU GME.
To enroll in the HCFSA and/or DCFSA:
1. Print the Benefits Enrollment/Change Form from the Employee Services website. From University Staff Benefits webpage, select "Forms" tab, then select MEDICAL & DENTAL. Scroll down to the "Benefits Enrollment/Change Forms: Faculty, Officers and University Staff".
2. On page 1, complete the ENROLLMENT TYPE and EMPLOYEE INFORMATION. (The HRMS Employee ID Number is your 6 digit CU ID number.)
3. On page 3, section 2, complete the information pertaining to your enrollment in the DCFSA and/or HCFSA.
4. Read, sign and date the Authorization and Signature portion of page 6.
5. On the top of pages 2-6, print your HRMS Employee ID number (6 digit CU ID number) and your name where indicated. Write “GME” in the top right hand corner. Write N/A across sections 1, 3, and 4 as these sections do not apply to you. The entire form must be submitted to Employee Services to complete your enrollment. Partial forms will not be processed.
6. Mail, fax or hand deliver your completed Benefits Enrollment /Change Form and supporting documents to the Employee Services office:
Location: 1800 Grant Street, Suite 400
Denver, Colorado 80203
Campus Box: 400 UCA (interoffice mail)
Fax number: 303-860-4299
Employee Services MUST receive your completed form by the prescribed deadline. No exceptions are made to enrollment deadlines.
NOTE: This is not an Employee Services document. If there are any discrepancies between this document and Employee Services policies and procedures, the relevant plan documents, Employee Services policies and procedures, and any applicable federal and state laws will govern.
Updated March 2015