Pretax dollars are used to pay for certain medical expenses and dependent day care costs. The plan allows you to avoid taxation on a portion of your income. You save taxes on every dollar you deposit.
You elect to deposit a portion of your salary pretax into a Cafeteria account. This account is used to reimburse you for eligible expenses. You determine how much money you will spend on a an annual basis and elect to take a monthly salary reduction for those expenses. The funds are placed into a special account that you may withdraw when eligible claims are submitted and processed. The reimbursement is completely tax free for the covered expenses. Plan your expenses carefully, you may roll over up to $500 at the end of the plan year. Funds in excess of $500 will be forfeited.
For inquiries on a claim, please contact Professional Benefit Services at 1-800-982-2012.
Marion County's group ID# for Professional Benefit Services is PROMARION.
2018 FSA Enrollment Form
2017 FSA Enrollment Form
Direct Deposit Authorization - Complete and send form to Professional Benefit Services.
Employee Worksheet - Use to plan your expenses and to estimate your tax savings.
- Enrollment is only during open enrollment
for the following tax year, unless for a qualified status change.
Life events that allow a status change include:
- Adding or deleting a dependent
- Job status change
- Starting or stopping daycare (for dependent care account)
Medical Claim Form - Complete and send form to Professional Benefit Services
Medical Eligible Expenses
reimbursement for eligible daycare expenses for children under the age of 13, or for adult daycare expenses for a disabled spouse or IRS tax
dependent. The maximum annual deduction is $5000 (or $2500 if married
and filing separately)
Dependent Care Claim Form - Complete and send form to Professional Benefit Services
Dependent Care Eligible Expenses