your spending account dallas, tx your spending account dallas, tx

Your Spending Account! A Flexible Spending Account (FSA) allows you to save money by using "before-tax" dollars to pay for certain health care and dependent care expenses. And free to you. 0 LOCATION. "b!bULZX |fX3X6{. 2.3k. 0000050266 00000 n __g 5j(]c;,mKK{x FG[ojl5kzW|S^}gdhg7_/b3-. You cannot submit claims for services received after your departure date. This benefit allows you to deduct money from your paychecks for: For additional information, please visit the Public Employees Benefits Cooperative (PEBC)website atwww.pebcinfo.com. 0000003548 00000 n The IRS also allows catch-up contributions of $1,000 if you are age 55 or older. 0000029339 00000 n No fees at TCCU ATM's. Spend your days in paradise or spend some love to a special someone. In the United States, a flexible spending account (FSA), also known as a flexible spending Paper forms or an FSA debit card may be used to access the account funds. Generally, large pharmacies, grocery stores, and box stores (i.e. Search for the document you need to design on your device and upload it. A TexFlexSM health care flexible spending account (FSA) is available to benefits-eligible employees not enrolled in Consumer Directed HealthSelectSM. % Dallas, TX. Details. See how we can help you reduce benefit costs, while delivering the best possible benefits experience. <<345A0DA70B0308418CEB8C1CDDA1C003>]/Prev 332151/XRefStm 1690>> Select the area where you want to insert your signature and then draw it in the popup window. Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202 Phone: (214) 653-7638 Fax: (214) 653-7608 The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. %PDF-1.6 % endstream endobj 71 0 obj <>stream TTY: 711 0000050612 00000 n Keep your receipts and invoices. It's free to use. Dallas County. 1 0 obj Your flexible spending account (FSA) balance is yours to spend through December 31st of each year. HTK \* cJe17ioL}[8j ('96&|2"O+"q3vc$0n$v{&[zkT[R3jd3IC%I+I6;zN>*OfqQm~8M(0gngV>S(P4P The maximum annual Limited-Purpose FSA election is $2,750. in interesting facts about sam houston. Smart-Choice The Woodlands, TX 77387 Health Savings Account administration Smart-Choice Accounts PO Box 64009 -4009 Human Resources Centre (HRC): 1-888-927-7700 BMO U.S. Benefits Enrolling and making changes to your annual . Here's what you'll learn: d How to access your account %PDF-1.4 % Search Spending accounts jobs in Dallas, TX with company ratings & salaries. 2 0 obj Additionally, any claim forms, communications or notices generated by YSA since the change have included the new address. It will help you learn more about your accounts and the reimbursement process involved with your financial activities. The Dependent Care FSA is used to reimburse you for certain expenses for children under age 13, or individuals unable to care for themselves. x]Ks7Ja{ S1T)(eY,':{PllMn`( h/[(hO;Vh]J(QKSVZW>Tztrp|Xo=ATteUGGyYvwx^.-nw)jfYY]s|36tQLi86lNiO77opzv~c*Tf6vZKjx=xC.-uiSJ[jl- 6ZVA>>q&jP6b}iR4iHd(Cpu\e_'? @=2 6 You cannot be claimed as a dependent on someone elses tax return. endstream endobj 70 0 obj <>stream 0000001858 00000 n VIEWS. Disability Coverage. 0000038345 00000 n 0000032931 00000 n Prescription Drugs Plan. _:1UDU endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 65]/Length 20/Size 70/Type/XRef/W[1 1 1]>>stream No monthly maintenance fees. 7,514 Flexible Spending Account jobs available in Dallas, TX on Indeed.com. 5 days ago. Your spending account is your checking account. Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at Dallas Independent School District. .Li{~y:^}I|fT;_5JCZcp|3!Sru~Z pMgVi5nmh9uz^n>"nx}ZgCNgug*dwFq*&L6Q{T0;`fdOw#0Lq]HG6MS9GtAlxDCqqe[:Ql:8yAf_R]-Tgr:`D:$1M"XhjOPdfw{Zh)X^a`i%P5/^boB5cwuy?dzaF81:ayBWIe'h#]TMd>mP0 &/6TkzHT=AVtQh/KV : jv4q>#Gz8vM)/ral0'IlN,wj{{_6iznq>C,9K{R\:OWmKhFvm EZu ph` F Dental Plan. Note: If you currently participate in the Medical Spending FSA and elect the HSA medical plan for 2022, your FSA funds will expire on December 31, 2021. >E *8x)R}3ABlVeIoB~YC7=g=_SId8X UZKX After that, funds in excess of $570 will be lost so be sure to use them while you can. Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at AT&T. Learn about AT&T Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former AT&T employees. endstream endobj 71 0 obj <>/Metadata 3 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 72 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 73 0 obj <> endobj 74 0 obj <> endobj 75 0 obj [/Separation/PANTONE#20137#20C 86 0 R<>] endobj 76 0 obj [/ICCBased 87 0 R] endobj 77 0 obj <>stream You cannot transfer funds between accounts or charge multiple accounts for the same expenditure. 42 0 obj <> endobj Ordinarily, these expenses are paid with after-tax money. Spending Account Claim Form TOLL FREE: 888.868.FLEX (3539) myameriflex.com uYou can submit this data via myameriflex. 0000238976 00000 n Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. 1.8k salaries reported, updated at February 15, 2023. Dallas County offers Flexible Spending Accounts (FSA) that allows you to use pretax salary dollars to pay for these expenses often at significant savings for your family. If you are not eligible for HSA contributions for example, if you are enrolled in Medicare the seed money contribution will go to an LP-FSA. 0000029844 00000 n 0000011883 00000 n by. Dallas, TX 75234 1 972-243-6191 ClubCorp on facebook; ClubCorp on instagram . Wb"77Su,1 U@k~l-[6rn20mn" =5ui{l; z|c8bz~'m>4#YWi)Ax0(a,j{Ut8i3{^H:}BWcBIa`V]_,SQ!oCC:{sa;Ua,MsNePg : N>O^Yc*:fIy ~DD&ugP}DZz$f\x.Afb2`FI`'FK1G`Ph=9/8bQom Fha\{^%t O2 I[nQx5y&bDiD6('S8SI44@gH{smBA*M:JO[ Yw7 yo6 2{dV Dependent Care FSA is for dependent daycare only. %%EOF Apply now for jobs that are hiring near you. Your Spending Account P.O. Open the email you received with the documents that need signing. Apply to Administrative Assistant and more! Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc Your Spending Accounts PO Box 661147 Dallas, TX 75266-1147 YSA will be sending official communication to members about the new address around during the first quarter of 2020. There are three variants; a typed, drawn or uploaded signature. This is called the "use it or lose it" rule. Is this useful? You are covered under an eligible high-deductible plan (like the HDP). To enroll, you elect an amount to be deducted pre-tax from your paycheck over 24 pay periods and deposited into your FSA. 0000021016 00000 n The PEBC HDP is an HSA-eligible plan. Traditional Health are Flexible Spending Account*); Deep integrations streamline the experience at every step. All rights reserved. &VkXHt9-@uO4,(+z(6 %% You may also call 214-671-6947,Option 1. Find the extension in the Web Store and push, Click on the link to the document you want to design and select. Questions regarding plan information for active/pre65: 214-556-0971. All claims must be submitted by March 31, 2023. Visit www.hsabank.com for a list of eligible expenses and to set up direct deposit for expense reimbursement. Select the area you want to sign and click. Posted 6 days ago Machine Operator Positions Futamura 3.2 Topeka, KS From $30 an hour Full-time Day shift + 2 endobj The health care FSA lets you set aside money on a pre-tax basisfor both you and your eligible dependentsto pay for eligible health, dental and vision expenses. Jj>`avp 78L` Search CareerBuilder for Flexible Spending Account Plan Jobs in dallas,TX and browse our platform. It will NOT hold Dependent Care funds. Make a difference with your change - lead with ingenuity! Responsible Office(s) Employee Benefits. Ohio Police & Fire Pension Fund. Unlike an FSA, there is no use it or lose it rule and it comes with triple-tax benefits: For 2023, you can contribute $3,850 through payroll deduction if you have individual coverage or $7,750 if you have family coverage. With an HCFSA, you use pre-tax dollars to pay for qualified out-of-pocket health care expenses. The information below outlines the two types of Flexible Spending (FLEX) Accounts provided to employees. your spending account (ysa) login your spending account hewitt ysa reimbursement phone number your spending account phone number at&t hra claim form Create this form in 5 minutes! 1) Register or log into your employer's Spending Account website. Get Form /YRxFI. QFZ%us.7r?:7{7Zq u9s The entire annual amount you elect may be used at any time during the plan year and is available January 1. Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place the form before your itemized receipts and don't include a cover letter. You will have 90 days following your departure date to submit claims for expenses incurred before you left. You must be enrolled in a high-deductible health plan to participate. 102 0 obj <>stream Contact Us | Help | Privacy Policy | ADA Statement. 0000029666 00000 n Posted 11/22/2019 Other News Local: (614) 228-2975 Customer Service: 1-888-864-8363 Fax: (614) 628-1777 It comes complete with a debit card. Retirement Plan with Employer Match . 65 0 obj <> endobj Dependent care reimbursement for costs paid to day care and elder care providers. Start completing the fillable fields and carefully type in required information. :g5]0h>*4^"m$Ma}Y_n"a5Bz9ZKCN+1]UWTg^YzClC:wF2v sgT3jhxK.r1vt;;m>.#|cw[ZPj}:{+r&pCsaZzL)[_}P? . 77 0 obj <>/Filter/FlateDecode/ID[<7C0EF33EDAADE1C3B0D9FABD37FA2AA8>]/Index[42 61]/Info 41 0 R/Length 138/Prev 119686/Root 43 0 R/Size 103/Type/XRef/W[1 2 1]>>stream Download your copy, save it to the cloud, print it, or share it right from the editor. Members Report Fall Newsletter Now Available, OP&F Pre-Retirement Webinar video now available. Employees/Retirees can direct questions regarding benefits to the The Section 125 Flexible Spending Account plan is administered by United Health Care (UHC). Your Spending Account jobs Sort by: relevance - date 271,102 jobs Fast hiring You'll evaluate vendors and issue purchase orders for goods and services, while relying on your experience, training, and judgment to plan and accomplish goals. For new employees, these seed money contributions are available as soon as possible once your HDP becomes effective. 0000032172 00000 n 8,033 open jobs for Spending accounts in Dallas. 401 (k) Savings Plan. 125 0 obj <>stream Eligible expenses include deductibles, coinsurance and prescriptions. Austin, Texas 78701-2982. Phone: (214) 653-7638 Fax: (214) 653-7608. View all FAQs Savings Calculators As long as you maintain an account balance of $500 or more, you will not be charged the $1 monthly account maintenance fee. Once your account is opened, you will receive a Welcome Kit in the mail. 0000001416 00000 n 0000050880 00000 n |ihb0re:U6dU+!YV7Bo2^#[ IPBCP")[n$e`OLO=}o@1]Y~cWTSW;SX. Is this useful? 2) Select "Documents and Forms" from the left-hand navigation menu. hb``a``d`e`sXc`A3&0tt4 1Hx7@acq! ;LA(vrE3)!AQO!)^2c^" s? k&| Anb!uZ + 0 70 0 obj <> endobj By law, any money left in your FSA(s) at the end of the year must be forfeited. 0000006921 00000 n The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866) 353 -9839 (TTY:711). Dallas County is joined with a cooperative insurance group along with other city and county agencies. %%EOF <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The card will hold Medical Spending and/or Limited-Purpose funds. All Rights Reserved. The Medical Spending FSA, Limited Purpose FSA, and Dependent Care FSA are separate. The address for Your Spending Account (YSA), who handles the health care stipend reimbursements for OP&F retirees, has changed. .`9\Bs(|+p*l8=+)n'W=rj94 .E~u==&$b4lny^|l *DgN69pvhRk'[y|~^y,x1T`TM~7rn>:4ee&:.sX1&9EX!YT0rV)E^b,q$YcaSJT [0fURCQ"5Z Install the signNow application on your iOS device. Add the PDF you want to work with using your camera or cloud storage by clicking on the. :~va*$# R1M{D=AY[7A[-]#k Argentina Australia Belgi (Nederlands) Belgique (Franais) Brasil You are responsible for verifying your HSA was used for eligible medical expenses under the IRS tax code. Vision Plan. No minimum balance fees. ]A?~D-jF/aXdkut#F;u\#~,61'=mo/ di3{En. ,uFnPU5#kS_r,A'$$]3K ;> Create an account using your email or sign in via Google or Facebook. 0000268387 00000 n That insurance company is PEBC (Public Employee Benefits Cooperative). xYF+*FQvxJIa JOB DETAILS. 2023 Employees Retirement System of Texas. 0000029729 00000 n 0000003758 00000 n 0000010668 00000 n If youre are enrolled in Consumer Directed HealthSelect and are interested in setting aside money on a pre-tax basis for eligible dental and vision expenses, check out the TexFlex limited-purpose FSA. Paid Family Leave. Withdrawals made for qualified expenses are also income tax-free. But first, you must participate in at least one account in order to have access to YourSpendingAccount. 0000042266 00000 n 0000032520 00000 n The entire annual amount you elect may be used at any time during the plan year and is available January 1. An HSA will be opened with Optum Bank for all newly enrolled HSA participants. 7R=nq(C(k[B%xpi 21 y?|/zg}v6eU$7H-BA9Tc.^FLx9X}*O:#f#AHCG&z7F 5$Bw 85K2qEN/F&&pf .\4h`.K"$n> 8/NkWu5W[Y% BxBifZiKb[[3S,uStWy|Kt355e9mwg\ruuh:zv$3_}D4t0jx&]Lim&ad|yQ2B$z^v:JA%NQM$_jnRLZE,O!o4z9>PjVtUV2r?MXkoL`.`oQh JssY~GhOnjV(;3Q+ E5vOC^7KWui5/fXVEn::e[n=}e:x7QD:II{g#6/:^% Decide on what kind of signature to create. 0000005093 00000 n 2022 Medical, Dental, Vision and Prescription Active Employees. This is the place to take action with Your Spending Account. Apply. You may also call 214-671-6947, Option 1. Job Type All; Full-Time; Part-Time; Contractor; Contract to Hire; Intern; Seasonal / Temp; Gig-Work; Date Posted 24 hours . %%EOF Its county seat is Dallas, which is also the third-largest city in Texas and the ninth-largest city in the United States. See IRS Form 2441 Part III for details. For dependent care, you must submit the expense through www.hsabank.com or by mail. Apply to Customer Service Representative, Procurement Manager, Account Executive and more! FLEXIBLE SPENDING ACCOUNTS (FSA) The Flexible Spending Accounts (FSAs) allow you to pay for eligible healthcare and dependent care expenses using tax-free dollars - money taken out of your paycheck before income or Social Security taxes have been calculated. Old Red Museum of Dallas County History and Culture, Community Supervision and Corrections (Adult Probation), Department of Unincorporated Area Services, Office of Homeland Security and Emergency Management, Dallas County Unincorporated Area Strategy, Vehicle Registration - VTR 68-A Inspections, Dallas Area Rapid Transit (DART) Pass Program, Colonial Life Voluntary Supplemental Insurance, Public Employees Benefits Cooperative (PEBC). 3 0 obj %PDF-1.5 % New claims forms will also be sent that include updated information. Dependent Care FSA funds must be used by December 31, 2022, and all claims must be filed by March 31, 2023. 0000050141 00000 n 0000002001 00000 n 2023. %PDF-1.5 Box 661147 Dallas, TX 75266-1147 Tel: (888) 611-5500 (toll free) Monday through Friday: 8 a.m. - 6 p.m. CT . Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202Phone: (214) 653-7638 Fax: (214) 653-7608. Claims are normally reimbursed within a week of HSA Bank receiving the claim. A Health Care FSA (HCFSA) is a pre-tax benefit account that's used to pay for eligible medical, dental, and vision care expenses that are not covered by your health care plan or elsewhere. If you have a Your Spending Account online, you will be able to: 1500 Marilla Street | 4FN | Dallas, TX 75201 Tel: 214-670-3659 Financial Transparency default- Financial Transparency Home Page POSTED. Your Spending Account is a trademark . The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866)353-9839 (TTY:711). to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. Flexible Spending Accounts. kiL/o0[~A(V-+>%ieoUaooeyl \ Fax: (512) 867-7438. Search Spending account jobs in Dallas, TX with company ratings & salaries. h80%Em w0a Benefits Service Center1500 Marilla StreetRoom 1D-SouthDallas, Texas 75201Phone: 214-671-6947,Option 1Fax: 214-659-7098. endstream endobj 72 0 obj <>stream New claims forms will also be sent that include updated information. When you elect this benefit, you will enjoy a tax savings because the money for these items is deducted before taxes. indicates you have dental insurance, proof HELPFUL HINTS If the receipt is handwritten, it must %PDF-1.3 0000059187 00000 n 0000240494 00000 n 3) After selecting "Documents and Forms" you will be directed to a screen that looks similar to the image below. Unlike Medical Spending FSAs and Limited- Purpose FSAs, Dependent Care FSAs may only reimburse expenses up to the amount you have contributed to date. The average salary for a account executive is $74,443 per year in Dallas, TX and $20,000 commission per year. Look through the document several times and make sure that all fields are completed with the correct information. in dallas,TX. 0. }@2D8inx%'\#d;aT n$M4IAWDHl|"I@*x/#28}}?Qoe?IU6b3hM v':H,! trailer The benefits service center is available by phone and email to assist you with your benefit questions. Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc Poll shows public support for police and fire, HB 512, OP&F hosts flag raising ceremony on Saturday Sept. 10, New app will help OP&F retirees manage Health Reimbursement Arrangement, Independent audit report shows OP&F is well run, Members Report Summer Newsletter now available, Thin Blue Line offers an ACA accredited plan that is stipend-eligible for OP&F retirees, OP&F letter to ORSC regarding HB 512 analysis, Aon rebranding to Alight Retiree Health Solutions, ORSC: OP&F outperformed own benchmarks and peers in 2021, Members Report Spring Newsletter Now Available. UT FLEX How to Use Your Flexible Spending Account. 0000041523 00000 n You can also make pretax contributions to your HSA, up to IRS limits, to help your account grow. Flexible Spending Accounts. endstream endobj 69 0 obj <>stream . $ bL4FMHjDS{=EnWPLDR*Z}TT#Z%YHg H-djcLYb-yBHMHVj6dg'W"XAHpFHicHF &?_$P $YlyEr,X)nCwew &(vIDk9@UUXWo59.AXVI&G{1Iu! Hs C:rtU* gq5M-SPLDIZ :Walgreens, Albertsons, Walmart) have IIAS capability. Share on Facebook . endobj 0000041865 00000 n 4 0 obj If the merchant does not accept the card, submit the expense through the HSA Bank website (www.hsabank.com) or by mail. The annual maximum contribution to a Dependent Care FSA is $5,000 (or. hbbbd`b`` f The plan helps you save money for health care and dependent care expenses. If you retire or otherwise leave City employment, your FSA funds will terminate on the date of your departure. According to Aon and YSA, any mail received at the old address is automatically forwarded to the new address. The average salary for a account manager is $66,200 per year in Dallas, TX and $12,000 commission per year. 0000050063 00000 n 0000050534 00000 n 0000014703 00000 n hb```V\af`0pHN@9(PsH 6s+s{}p=-z{FwYn^ (4hh@3V iq -tl2J870dNl`g*aQw\4uy4? UT Dallas; UT El Paso; UT Permian Basin; UT Rio Grande Valley; UT San Antonio; UT Tyler; Health Institutions. Build loyalty and strengthen relationships with a powerful lineup of industry-leading benefits solutions. Health care reimbursement for qualified out-of-pocket health care expenses that are not covered by insurance (i.e. Eligibility for the OP&F health care stipend: what to do when you have aQLE, Options available for retirement interviews, IRS using new versions of W-4P, W-4R for 2023 tax year, Member's Report Winter Newsletter Now Available. The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. Spend it on your own terms. 0000009380 00000 n 2a`bd r.#L^ HVnF|Wt8V`Hv^{PXfLOuuP@^,rOnEC'/\R@gg//hy<8 lN~N 0$xXOR~uJV:5y~DR s?gPo ;"U/|xu`VJ0|5wlrg8lU>?9x@7:H.>%e^q`{yu74u{~P@@' OLEB~(((N@K? FG U%KPc4WJ+ When you enroll in the Medical Spending or Limited Purpose FSA, you will receive a debit card fromHSA Bank in the mail. 0 Dallas, TX. <> 0000005496 00000 n All other questions that cannot be answered by either of <> hZrG}} Ey{S6` `$,?5VI&8O|=#dIn6%=3}vLEY0HeCtbLu*- HdUK!)S3*~ {Ucz$jRc4ZZ}Um2_%FnW.^?s10-5O]kZy\ R wYm0Tk+{S/lB! ;k`SEf?=M5D3:NL[- Y%l2r. It is the second-most populous county in Texas and the ninth-most populous in the United States. your spending account dallas, tx. Select the document you want to sign and click. 6{3]b However, there is a grace period ending March 15, 2023to use your 2022Medical Spending FSA or Limited Purpose FSA dollars on eligible expenses. xref Life and Accident Plans. KY"X_Th[[TEe-wW Fax: 1-888-211-9900 Mail: Your Spending Account P.O. Benefits Service Center1500 Marilla StreetRoom 1D-SouthDallas, Texas 75201Phone: 214-671-6947, Option 1Fax: 214-659-7098. This guide will help you get started with Your Spending Account (YSA) a website you can use to manage your retiree Health Reimbursement Account (HRA) whenever and wherever it's most convenient for you. All rights reserved. If you have specific questions about your benefits, please contact the Human Resources Department at(214) 653-6579or(214) 653-6161. Your Medical Spending FSA may be used to reimburse out-of-pocket medical expenses for you, your spouse, and your dependents. stream xH&c$CNRKW3suU/gz_?];7}>xrkUeh]~e6kPU+Wqv88[w]=wg]]^~pQU:HK)\xwv};Co]qo_ h`3V}s"_G02(JH(gS^mHF*J6ic$QhneP_28|( 9RNRMU&iL\Tk+#zwV" If you have elected to contribute to an HSA in 2022, you may also enroll in a Limited-Purpose FSA, even though both accounts may reimburse dental and vision expenses. You can deposit funds in an HSA if: If you enroll in the HDP with an HSA, be sure to save receipts. 0000014737 00000 n Draw your signature or initials, place it in the corresponding field and save the changes. 0000001690 00000 n Health Spending Accounts. hb``0a``K0D800 @1CKxGC/C` |FE_,sUl/001 *^#v F )" ,/+Y2Pu 0000013089 00000 n 414. endobj HlN1E+c'N^-TV3h/:L8cy 0000000016 00000 n hbbd``b`@H~7 1s=q_* RqYW$$cAb@D+A\/ H2e`bd  =@a 0000014230 00000 n Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place this form before your receipts and don't include a cover letter. startxref Benefits of Using YourSpendingAccount. HlTI0qgd{i*1%Mi9FzyJhTPISs7B YkO%G, (^q =75@y8)z;$|$[PTf^ kD9J #zn_1_[nF N /qR41>_,C69"YE-[akck}Ut\(:"jYMQGCPk9rtEua? =7XA2|{.X0i)i Employer Name: Employee Name: SSN: Phone: Email: Medical Expense Claims (FSA, or Employer funded HRA) Dependent Day Care Claims Account Type FSA HRA Date Expense Incurred Name of Person Receiving Medical Service Provider Name endstream endobj 43 0 obj <> endobj 44 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 45 0 obj <>stream . Skip to Content Jobs Upload/Build Resume . Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008 All other questions that cannot be answered by either of these need to be directed to hrbenefits@dallascityhall.com. hbbd``b`q@ xsWF0+X D*@ !H N] !R D,X m7@D.P $,Av$dAV Take a look inside. W\[m{f-h9P6pqU+&]Usv8/ |_Y6~^bN#d5Z) fw%jmQ!l*z5wjb`Xxkn`q=g x_b2MDWwHrnFI*h;~'?v`y+gh17e Document Type. Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008. 0000014590 00000 n (512) 499-4200. Get access to thousands of forms. 4 0 obj You may be required to submit documentation of your expenditures. how do i choose my seat on alaska airlines? Learn about Dallas Independent School District Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former Dallas Independent School District employees. 5y0eKL0A8+CN"Hs8vWb5x4\fG^xU"8Aj0'+jmh9C:ZL:P5#pD_W@`ain&b@$bu? If your account balance is $2,000 or more, you can choose to invest funds look for details in your Welcome Kit. 2022 Medical, Dental, Vision and Prescription Active Employees. 0000021193 00000 n Your Spending Account P.O. Which plans are eligible for the OP&F stipend? Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. 0000002974 00000 n HELPFUL INTS If the receipt is handwritten, it must include the service provider's signature. 0000003723 00000 n Use professional pre-built templates to fill in and sign documents online faster. endstream endobj startxref Real Est, Argonne Retirees | Argonne National Laboratory, A health reimbursement account (HRA) will be established to help reimburse you for the BlueCross BlueShield of Illinois claim form or International claim form.