Flexible Spending Accounts

For your reference: 

Forms:

Dependent Care Verification Form
Direct Deposit Authorization Form
Flexible Spending Account Claim Form

Medical Reimbursement Account (MRA)

The City offers its employees a Medical Reimbursement Account (MRA) in accordance with IRS Sections 125/129. Normally, out-of-pocket healthcare expenses are paid with money that has already been taxed. However, using the MRA program, out-of-pocket expenses can be reimbursed from a trust account funded with pre-tax deductions from the employee’s paycheck. This reduces taxable income so City employees will pay less in taxes and have more money to spend and save. The 2024 maximum contribution is $3,050. The 2025 maximum contribution is $3,200. 

Dependent Care Assistance Plan (DCAP)

The City offers its employees a Dependent Care Assistance Program (DCAP) in accordance with IRS Sections 125/129. Normally, dependent care is paid for with money that has already been taxed. However, using the DCAP program, out-of-pocket expenses can be reimbursed from a trust account funded with pre-tax deductions from the employee’s paycheck. This reduces taxable income so City employees will pay less in taxes and have more money to spend and save.  The 2024 & 2025 maximum contribution is $5,000. ($2,500 if you are married and filing separately)

Please note: Due to IRS regulations, employees enrolling in an FSA who earn $155,000 or more may be limited in their contribution amount elections. The contribution amount limit will be determined by testing during the plan year. I understand and agree that if my election is over the limit, the City will reduce my election in order for the plan to pass IRS testing.

Important Note Regarding Flexible Spending Account Debit Cards:

P&A Group only issues FSA debit cards once during the initial enrollment and then every 3 years. They do not re-issue debit cards every year when employees re-enroll. If you have lost your debit card and need a replacement card issued, you must call P&A Group at (800) 688-2611.

Eligibility

All Full and Part-time benefited employees are eligible to participate in these programs.

Please Note:

  • Employees must re-enroll in FSA every year during open enrollment. Contributions do not rollover automatically.
  • Flexible Spending Accounts are USE IT OR LOSE IT.  Debit cards will be deactivated upon separation and and unused balances are forfeited if the participant does not elect COBRA or is not fully vested (contributed total pledge for plan year) upon separation. 

Cost

There is a $2.50 monthly administrative fee for participating in one or both of the City’s Flexible Spending Accounts which is paid for by participants.

Contact

For more information about Flexible Spending Accounts, contact Human Resources - Employee Benefits at HRBenefits@sanjoseca.gov.

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