LIMITED-PURPOSE FSA
FSC LOGO GOES
HERE – REVERSED/
WHITE VERSION
welcometouhc.com
UnitedHealthcare
Insurance Company
UnitedHealthcare
Limited-Purpose
Flexible Spending Account
MasterCard® is a registered trademark of MasterCard Worldwide.
This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on
eligibility, tax treatment, and restrictions. Federal and state laws and regulations are subject to change.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by
United HealthCare Services, Inc., or their affiliates. A flexible spending account is not insurance.
100-7444 05/11
Consumer
© 2011 United HealthCare Services, Inc.
Combined with a health savings account, or HSA, a limited-purpose
FSA helps you stretch your health care dollars. You can save on taxes
and save for dental and vision expenses you expect to have.
Limited-purpose FSA
See the tax savings and smile with a
limited-purpose FSA.
If you open and contribute money to a health savings account, or HSA, you can save
even more tax dollars when you add a limited-purpose flexible spending account.
The limited-purpose flexible spending account, or FSA, lets you set aside money,
before taxes, to pay or reimburse yourself for eligible dental and vision expenses.
How the limited-purpose FSA works
1. Estimate your dental and vision expenses for the year. Then decide how much money
you want to set aside.
Why is it called a ‘limitedpurpose FSA’?
Federal regulations say that if
someone wants to open an HSA,
he or she must be covered by a
high deductible health plan on
the first day of the month and
cannot have any other health
coverage, except as permitted.
Permissible “other coverage”
includes an FSA “limited” to
paying for eligible dental or
vision expenses.
2. You will enroll in the limited-purpose FSA when you enroll in your other benefits.
You must re-enroll each year even if you are not making any changes to your
benefit choices.
3. Money will be set aside from each paycheck after the plan year starts and put into
your FSA. You pay no taxes on that amount.
4. As you pay for eligible dental and vision expenses, you reimburse yourself from your
FSA. The amount you save in taxes depends on how much you set aside and the
amount of your expenses.
welcometouhc.com
You can use the debit card to pay by phone, online or at any place that accepts
MasterCard. There’s no need to write checks or submit claim forms. See your
benefit plan documents to find out if the card is available to you.
Dental expenses may include:
• X-rays, fillings, extractions, dentures
and more
• Braces
• Orthodontic treatments
• Copayments and deductibles
Vision expenses may include:
Claims can be paid automatically.
• Glasses, frames and contacts
If you have a dental or vision plan, and those claims go through UnitedHealthcare,
they can be automatically paid or reimbursed from the FSA. For example, if you
pay a copayment, the FSA will automatically reimburse you. You don’t have to send
in any forms. You can turn automatic payment off at any time at myuhc.com.®
• Lasik eye surgery
With direct deposit, we deposit your FSA money directly into your personal
checking or savings account. It saves you time and paper, and your reimbursements
happen faster.
• Prescription sunglasses and goggles
• Safety and reading glasses
• Copayments and deductibles
A list of common eligible limitedpurpose FSA expenses can be found
at welcometouhc.com. Please see
your benefit plan documents to find
out what dental and vision expenses
can be reimbursed under your plan.
And, always keep your receipts in
case there’s a question about a claim.
andy’s tax savings
28% in federal income tax
$840
5% in state income tax
$150
$229.50
$1,219.50
For educational purposes only. Dollar amounts and savings will differ depending on your specific circumstances,
including income, other applicable taxes and other factors. Please contact a competent legal or tax professional
for personal advice on eligibility, tax treatment and restrictions.
2
The Health Care Spending Card Debit MasterCard® is an easy way
to pay.
You will get your money faster with direct deposit.
Andy is married with two children. Andy wears glasses and contact lenses. Both of
his children wear braces. Andy chooses to set aside $3,000 for the year in his limitedpurpose FSA.
His total tax savings for the year
There’s no waiting. The entire amount you elected to set aside will be available to
you on the first day of the plan year.
Most people have to spend their FSA by the end of their plan year. But you
may have extra time, called a “grace period,” if your employer allows. See your
employer’s plan document to find out if you have more time to spend your FSA.
Limited-purpose FSA savings example
7.65% in Federal Insurance Contributions Act (FICA) tax
(Social Security and Medicare)*
All FSA dollars are available the first day.
You get more time to spend your money.
Your FSA may also come with Health Care Spending
Card Debit MasterCard,® which makes it easy to pay
from your account.
andy Pays
Here are more reasons to enroll in a
limited-purpose FSA.
*This amount may be lower, depending on when Andy’s payroll deductions begin. The Tax Relief, Unemployment
Insurance Reauthorization, and Job Creation Act of 2010 reduced the FICA tax rate for employees in 2011 from
7.65 percent to 5.65 percent on gross earnings up to $106,800 by lowering the Social Security withholding rate
from 6.2 percent to 4.2 percent. FICA (or payroll tax) also includes a 1.45 percent Medicare tax.
The ‘use it or lose it’ rule.
Yes, it’s true. If you don’t spend your FSA dollars by the end of the plan
year or any grace period allowed by your employer, you will lose that
money. That’s why it’s important to take a few minutes to estimate what
dental and vision costs you will have to pay. Most people are able to
spend all the money they set aside.
welcometouhc.com
3
Limited-purpose FSA
See the tax savings and smile with a
limited-purpose FSA.
If you open and contribute money to a health savings account, or HSA, you can save
even more tax dollars when you add a limited-purpose flexible spending account.
The limited-purpose flexible spending account, or FSA, lets you set aside money,
before taxes, to pay or reimburse yourself for eligible dental and vision expenses.
How the limited-purpose FSA works
1. Estimate your dental and vision expenses for the year. Then decide how much money
you want to set aside.
Why is it called a ‘limitedpurpose FSA’?
Federal regulations say that if
someone wants to open an HSA,
he or she must be covered by a
high deductible health plan on
the first day of the month and
cannot have any other health
coverage, except as permitted.
Permissible “other coverage”
includes an FSA “limited” to
paying for eligible dental or
vision expenses.
2. You will enroll in the limited-purpose FSA when you enroll in your other benefits.
You must re-enroll each year even if you are not making any changes to your
benefit choices.
3. Money will be set aside from each paycheck after the plan year starts and put into
your FSA. You pay no taxes on that amount.
4. As you pay for eligible dental and vision expenses, you reimburse yourself from your
FSA. The amount you save in taxes depends on how much you set aside and the
amount of your expenses.
welcometouhc.com
You can use the debit card to pay by phone, online or at any place that accepts
MasterCard. There’s no need to write checks or submit claim forms. See your
benefit plan documents to find out if the card is available to you.
Dental expenses may include:
• X-rays, fillings, extractions, dentures
and more
• Braces
• Orthodontic treatments
• Copayments and deductibles
Vision expenses may include:
Claims can be paid automatically.
• Glasses, frames and contacts
If you have a dental or vision plan, and those claims go through UnitedHealthcare,
they can be automatically paid or reimbursed from the FSA. For example, if you
pay a copayment, the FSA will automatically reimburse you. You don’t have to send
in any forms. You can turn automatic payment off at any time at myuhc.com.®
• Lasik eye surgery
With direct deposit, we deposit your FSA money directly into your personal
checking or savings account. It saves you time and paper, and your reimbursements
happen faster.
• Prescription sunglasses and goggles
• Safety and reading glasses
• Copayments and deductibles
A list of common eligible limitedpurpose FSA expenses can be found
at welcometouhc.com. Please see
your benefit plan documents to find
out what dental and vision expenses
can be reimbursed under your plan.
And, always keep your receipts in
case there’s a question about a claim.
andy’s tax savings
28% in federal income tax
$840
5% in state income tax
$150
$229.50
$1,219.50
For educational purposes only. Dollar amounts and savings will differ depending on your specific circumstances,
including income, other applicable taxes and other factors. Please contact a competent legal or tax professional
for personal advice on eligibility, tax treatment and restrictions.
2
The Health Care Spending Card Debit MasterCard® is an easy way
to pay.
You will get your money faster with direct deposit.
Andy is married with two children. Andy wears glasses and contact lenses. Both of
his children wear braces. Andy chooses to set aside $3,000 for the year in his limitedpurpose FSA.
His total tax savings for the year
There’s no waiting. The entire amount you elected to set aside will be available to
you on the first day of the plan year.
Most people have to spend their FSA by the end of their plan year. But you
may have extra time, called a “grace period,” if your employer allows. See your
employer’s plan document to find out if you have more time to spend your FSA.
Limited-purpose FSA savings example
7.65% in Federal Insurance Contributions Act (FICA) tax
(Social Security and Medicare)*
All FSA dollars are available the first day.
You get more time to spend your money.
Your FSA may also come with Health Care Spending
Card Debit MasterCard,® which makes it easy to pay
from your account.
andy Pays
Here are more reasons to enroll in a
limited-purpose FSA.
*This amount may be lower, depending on when Andy’s payroll deductions begin. The Tax Relief, Unemployment
Insurance Reauthorization, and Job Creation Act of 2010 reduced the FICA tax rate for employees in 2011 from
7.65 percent to 5.65 percent on gross earnings up to $106,800 by lowering the Social Security withholding rate
from 6.2 percent to 4.2 percent. FICA (or payroll tax) also includes a 1.45 percent Medicare tax.
The ‘use it or lose it’ rule.
Yes, it’s true. If you don’t spend your FSA dollars by the end of the plan
year or any grace period allowed by your employer, you will lose that
money. That’s why it’s important to take a few minutes to estimate what
dental and vision costs you will have to pay. Most people are able to
spend all the money they set aside.
welcometouhc.com
3
LIMITED-PURPOSE FSA
FSC LOGO GOES
HERE – REVERSED/
WHITE VERSION
welcometouhc.com
UnitedHealthcare
Insurance Company
UnitedHealthcare
Limited-Purpose
Flexible Spending Account
MasterCard® is a registered trademark of MasterCard Worldwide.
This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on
eligibility, tax treatment, and restrictions. Federal and state laws and regulations are subject to change.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by
United HealthCare Services, Inc., or their affiliates. A flexible spending account is not insurance.
100-7444 05/11
Consumer
© 2011 United HealthCare Services, Inc.
Combined with a health savings account, or HSA, a limited-purpose
FSA helps you stretch your health care dollars. You can save on taxes
and save for dental and vision expenses you expect to have.