Payroll and Benefits » FSA (Health) and DCSA (Dependent Care) Information/Forms

FSA (Health) and DCSA (Dependent Care) Information/Forms

Please go to our Health Benefits Website for more information.
The 2022 plan is administered with PrimePay
For any questions contact them directly at 877-769-3539
  • Your elections to the health FSA cannot exceed $2,850.
  • Elections to the DCA may not exceed $5,000.
Please feel free to contact your PrimePay Service team with any questions at 877-769-3539.  Use this website for purchases anytime.  It will identify all the eligible items that can be purchased without a prescription or doctor's note.  

This is an annual election that you must enroll in annually.

A Flexible Spending Account (FSA) is an IRS-approved benefit that allows you to set aside money on a TAX-FREE basis to pay for unreimbursed healthcare or dependent care expenses. There are two types of FSAs:

1.  Healthcare FSA allows you to use pre-tax dollars for out-of-pocket medical, dental, and vision expenses. You can use your Health FSA dollars to pay for qualified medical, prescription drug, dental and vision expenses. 

2.  Dependent Care FSA (DCSA) allows you to use pre-tax dollars to pay for the child, adult, or disabled dependent daycare services so you can work. 

You can enroll in both FSAs, but you cannot use funds in one to pay for expenses in the other. Pre-tax contributions are deducted from your pay in equal amounts throughout the

More About the Healthcare FSA
To participate, you simply need to complete the online enrollment form and determine your annual election. Once enrolled in the FSA, you and all of your tax dependents are automatically included.

You will have a convenient debit card to use for qualified healthcare expenses for you and your eligible dependents. The debit card is linked to your FSA. 

At any time during the year, you have a qualifying expense, you can use your entire Healthcare FSA annual election.

How does Your FSA Plan Work?
Your FSA period is January 1st thru December 31st. Any eligible purchases you make during the plan year are reimbursable. You have until approximately March 31st of the following year to request reimbursement for expenses incurred in the plan year beginning on January 1st. This is your run-out period.

Important: Your FSA benefit does have a 75 day Grace Period at the end of the plan year. This will allow you to incur new expenses up thru approximately March 15th, after the end of the plan year, and use any remaining funds from the previous plan year. Any unused funds will be forfeited. This is due to the IRS “use it or lose it” rule.


When using your mySource, debit card, it is important that you save all of your receipts for medical, Rx, dental, and vision-related expenses that you pay for with your card. While many expenses will “auto-substantiate” when you swipe your debit card, many don’t base upon provider-related data supplied. Federal regulations require that every claim is substantiated, so watch for emails that will indicate if supporting documentation needs to be submitted.

This benefit will be available to all employees that are entitled to health coverage ONLY.