Dependent Care Flexible Spending Account is a smart, simple way to save money while taking care of your loved ones so that you can continue to work. Dependent Care, also called “Day Care” FSA, allows employees to set aside pre-tax dollars to pay for eligible dependent care expenses for a child under age 13 or a disabled dependent of any age. Contributions offset taxable income, resulting in a tax savings for the employee. Use tax-free money to pay for your dependent day care expenses including senior daycare (if incapable of self-care), babysitter, nanny, summer day camp, before or after school daycare, nursery school and preschool.

You can contribute up to a maximum of: $2,500 per year if you are married and file a separate tax return or $5,000 per year if you are married and file a joint tax return or if you file as single or head of house-hold.

Mail the completed form (see link below) to the address provided or fax the completed claim form and supporting documentation to 877-390-4782.  For faster service and to file your claim online navigate to and hover over “Account Balance” and then click on “Flex” and then follow the prompts to file your claim online.   You also have the option to enter direct deposit information for a faster reimbursement turn-around time. 


Dependent Care FSA Forms

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