Flexible Spending Accounts for
Unreimbursed Medical and Dependent Care Expenses
USBAFlex: (877) 872-2125
Click here for a link to the USBAFlex website
Click here for a link to the USBAFlex YouTube video
(return completed forms to Christine D'Agostino at the BOE office)
Flexible Spending Account - Summary Plan Description
This is the plan description for the Washington Twp. Board of Education Flexible Spending Accounts.
Flexible Spending Account - Plan Outline for Medical FSA & Dependent Care FSA
This is a brief outline of both FSA accounts, including minimums, maximums and timelines.
USBAFlex FSA Brochure
Flexible Spending Account Enrollment Form
- Use this form to enroll in either (or both) flexible spending accounts.
- Be sure to indicate whether you are a 10-mo. or 12-mo. employee, the amount you want taken out per pay period (10-mo. employees have 20 pay periods and 12-mo. employees have 24 pay periods), and the reimbursement method you want (debit card, direct deposit, etc.).
Flexible Spending Account - List of Eligible and Non-Eligible Medical Expenses/Products
This is a list of eligible, reimbursable expenses as it appears on the USBAflex website.
Flexible Spending Account - Dependent Care Worksheet
You can use this worksheet, provided by USBAFlex, to decide whether you will save more money by participating in the Dependent Care FSA or by taking the Dependent Care Tax Credit when filing your income taxes.
USBAFlex AxisPlus Debit Card Brochure
USBAFlex AxisPlus Card Enrollment Agreement
You must complete this form if you'd like an AxisPlus MasterCard Debit Card to use for qualifying FSA services/products (i.e., you can swipe your card to pay for your prescription co-pay at most pharmacies, as long as they accept MasterCard).
Please Note: There may be places where you cannot use the debit card and you will have to submit your claims either by mail or email to USBAflex. They will either reimburse you via check or by direct deposit (if you complete the form below).
USBAFlex Direct Deposit Authorization Form
You must complete this form if you'd like to have USBAFlex reimburse your claims via direct deposit rather than by check.