The Flexible Spending Account (FSA) is a way for employees to save money!   FSAs provide a vehicle for employees to reduce their payments for out-of-pocket medical, dental, vision or dependent care expenses without paying federal, state, or FICA taxes.  This means employees can put money aside each pay period on a pre-tax basis in a;    

HealthCare (medical) Reimbursement Account
Dependent Day Care Reimbursement Account 

 Eligible and Ineligible Expenses under the FSA

Important Changes Effective January 1, 2013:  Cigna will be administering the FSA plan for The Williamson County Benefit Program effective January 1, 2013. The maximum allowable election will be $2,500.00 for medical and $5,000.00 for dependent care.

 How do you enroll:  Employees have the opportunity to enroll as a new hire, during open enrollment, or if a qualifying event occurs.  Complete the appropriate enrollment form and return it to the Williamson County Benefits Department.  If enrolling in both medical and dependent daycare, you will need to complete a separate enrollment form for each.

FSA Medical Enrollment Form

FSA Dependent Day Care Enrollment Form

Annual Plan Election: At time of enrollment, you will need to indicate your annual plan election. Your annual plan year election is the estimated eligible expenses that you will incur and spend between your effective date and December 31^st.   On the enrollment form(s) you will indicate this annual election.  The Benefits Department will calculate your per pay period deduction based on the annual election you choose. * See below per pay period guidelines. 

Effective January 1, 2013 the maximum allowable election can be:

• $2,500 for medical and/or
• $5,000 for dependent day care
•  

Cigna Flexible Spending Account Debit Card:  As a convenience, participants enrolled in the medical FSA will receive a Cigna Flexible Spending Account debit card (additional cards can be requested).  This card can be used to pay for medical expenses allowed under IRS guidelines during the plan year.  When using this card all transactions are subject to an audit and a valid receipt can be requested for any reason at anytime.  A valid receipt may be the Explanation of Benefits from the insurance company or an actual paper detailed receipt from the vendor the card was used.  It is advised that you keep all receipts or EOB’s so that if you are requested by the administrator to provide this information you can access them easily and not receive tax implications at the end of the plan year.                  ** This card cannot be used for childcare expenses.

                                     Cigna Flexible Spending Account Health Care Debt Card

How to file for reimbursement when not using the Debit Card or need reimbursement for Childcare:

To file for reimbursement from your flexible spending account, you must complete a FSA Reimbursement Request Form.  The completed reimbursement request form with receipts and other required documents can be faxed to (423)553-8953 OR Mail to: CIGNA, P.O. Box 182223, Chattanooga, TN 37422-7223  Please remember to sign this form before you send it in.

FSA Medical Reimbursement Request Form

 FSA Dependant Care Reimbersment

 What if I have not used all of my money by December 31^st?  You have until March 15^th of the following year to incur expenses to use your election Due to IRS guidelines, unused funds must be forfeited.  The deadline for filing for reimbursement is April 30^th of the following year.

Participants enrolled in the Flexible Spending Account for the Plan year 2012:  All questions related to the medical or dependent daycare FSA for the plan year 2012 need to be directed to Renee Spicer.  To elevate confusion with open enrollment all 2012 enrollment forms have been deleted from the Williamson County website.  If you need an enrollment form or qualifying event form for an effective date prior to December 31, 2012, please e-mail or call Rene Spicer at .

If you need reimbursed for funds in your 2012 FSA, go to the forms and documents page of this website and click on FSA Claim Form for 2012 or contact Renee Spicer.

 If you have questions regarding the Flexible Spending Account program please contact:

                                                Renee Spicer:               (615)595-1268

                        Cigna Customer services:                    1-800-244-6224 /  1.800Cigna24

*Per Pay Period Guidelines

Board of Education Professional and Classified 12 month Employees, the benefit is deducted out of twenty-four (24) pay periods starting with the first payroll check in January through the December 31st payroll.

Board of Education Classified 11 month Employees, the benefit is deducted out of twenty-two (22) pay periods starting with the first payroll check in January through the June 30th payroll and the August 15th payroll through the December 31st payroll.

Board of Education Classified 10 month Employees, the benefit is deducted out of twenty (20) pay periods starting with the first payroll check in January through the June 15th payroll and the August 31st payroll through the December 31th payroll.

Government Employees, the benefit is deducted out of twenty-six (26) pay periods starting with the first payroll in January through the last payroll in December.