FSA

(Flexible Spending Account)

SUMMARY
A health flexible spending arrangement (FSA) allows employees to be reimbursed for medical
expenses. FSAs are usually funded through voluntary salary reduction agreements with your
employer.

Health FSAs are employer-established benefit plans. These may be offered in conjunction with other
employer-provided benefits as part of a cafeteria plan. Employers have complete flexibility to offer
various combinations of benefits in designing their plan. You do not have to be covered under any
other health care plan to participate.

Self-employed persons are not eligible for an FSA.

Certain limitations may apply if you are a highly compensated participant or a key employee.

Highlights

What can you contribute to the Health FSA?

• The 2021 maximum salary deferral contribution is at $2,750.

What are the benefits of a Health FSA?

You may enjoy several benefits from having an FSA.

• No employment or federal income taxes are deducted from the contributions.
• Withdrawals may be tax free if you pay qualified medical expenses.
• You can withdraw funds from the account to pay qualified medical expenses up to your annual
election amount, even if you have not yet placed the funds in the account.
• Reimbursements are processed weekly. The Date of Service is the incurred date.

What are the benefits of a Dependent Care FSA?

You may enjoy several benefits from having an FSA.

• No employment or federal income taxes are deducted from the contributions.
• Withdrawals may be tax free if you pay qualified dependent day care expenses.
• You can withdraw funds from the account to pay qualified dependent day care expenses up to
the amount you have deposited into the account.
• Reimbursements are processed weekly.
 FSA
(Flexible Spending Account)

To file a manual claim:

• Manual Claims can be filed by completing a claim form and attaching any relevant receipts.

• Claim forms are available from your HR department.

• The claim forms and receipts can be mailed, faxed or emailed.

Mailing Address: GPA, Inc., 12770 Merit Drive, Suite 200, Dallas, TX 75251

Fax Number: (972) 238-7853

Email Address: melissaw@gpatpa.com

To pay using the Wex Health card:

• Use the Wex Health card at any IIAS or 90% Merchants participating vendors. You can
find the current list on-line at GPATPA.com under your Benefit Informatics log-in.

• When using the Wex Health card, if asked “Debit” or “Credit”, choose “Credit”.

• Keep your receipts. This is an IRS requirement.

• Keep your Wex Health card, it is a re-loadable card and will be used for up to 5 years.
There is a $10.00 charge, billable directly to your account, to replace it if it is lost,
destroyed or stolen.

• Each participant automatically receives two (2) cards, both with the participant’s name.

• Additional cards are available for a cost of $10.00, billable directly to your account.

• You may receive a letter requesting copies of receipts for certain charges that cannot be
immediately substantiated. These can be mailed, faxed or emailed, to the same
address, fax number and/or email addresses above. Please include a copy of the letter.