What is the FSA Program?
The FSA Program is permissible under Internal Revenue Code (IRC) Section 125 and consists of
several programs.
They are:
• the Health Care Flexible Spending Account (HCFSA) Program,
• the Dependent Care Assistance Program (DeCAP),
• the Medical Spending Conversion (MSC) Health Benefits Buy-Out Waiver Program, and
• the Medical Spending Conversion (MSC) Premium Conversion Program.
You are encouraged to read this brochure carefully. It covers the major features of the FSA Pro-
gram’s applicable rules and regulations. Also, included in this brochure are HCFSA and DeCAP
worksheets (Pages 13 and 14), which may assist you with the calculation of your contributions to
each FSA Program for Plan Year 2010.
HCFSA is a way to help pay for eligible out-of-pocket medical expenses, while reducing your tax-
able income.
Note: HCFSA is covered under the Health Insurance Portability and Accountability Act (HIPAA).
This means that the FSA Program is required by law to safeguard a participant’s and eligible health
care recipients’ personal information, including Protected Health Information (PHI). In order for us
to release personal information to third parties, the participant and eligible health care recipients
must complete the HIPAA PHI Authorization Form
DeCAP is a way to help pay for expenses to care for your child(ren) or other eligible dependents,
thereby reducing your taxable income, while you and your spouse work or attend school full-time.
By enrolling in HCFSA and/or DeCAP, not only do you plan for anticipated health and dependent
care expenses, contributions are deducted from your paycheck before federal and Social Security
taxes are calculated, thereby reducing your gross income for federal and Social Security tax
purposes.
MSC Health Benefits Buy-Out Waiver Program enables eligible employees who have non-City group
health coverage to waive their City health benefits in return for an annual cash incentive payment.
MSC Premium Conversion Program enables eligible employees to pay for their health plan contribu-
tions on a before-tax basis, thereby reducing their gross income for federal and Social Security tax
purposes.
If you are eligible, you may participate in all of the programs. Participation in any of the programs,
except the MSC Premium Conversion Program, is on a voluntary basis.
Who is Eligible to Enroll?
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