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Limited Purpose Flexible Spending Arrangement (FSA)
The Limited Purpose FSA allows you to set aside pretax money from your paycheck to pay for out-of-pocket dental and vision costs. HCA contracts with Navia Benefit Solutions to process claims and provide customer service for PEBB members.
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A Limited Purpose Flexible Spending Arrangement (FSA) is offered only to PEBB benefits-eligible employees who work at state agencies, higher-education institutions, and community and technical colleges.
It is intended for employees enrolled in a consumer-directed health plan (CDHP) with a health savings account (HSA). By providing pretax funds for dental and vision expenses, it allows you to further reduce taxable salary and save more of your HSA funds for medical expenses. If you are not enrolled in a CDHP, the Medical FSA is a better fit for you.
You cannot enroll in a Limited Purpose FSA and a Medical FSA in the same year.
When your PEBB insurance coverage ends or you go on unpaid leave that is not approved under FMLA or military leave, you are no longer eligible to contribute to your Limited Purpose FSA. Eligibility ends on the last day of the moth of loss of coverage or unapproved leave.
You will be able to claim expenses incurred while employed, only up to your available funds, unless you are eligible to continue your Limited Purpose FSA coverage under PEBB Continuation Coverage (COBRA) or PEBB Continuation Coverage (Unpaid Leave), through Navia Benefit Solutions. Claims may be submitted up to your account balance and must be submitted to Navia Benefit Solutions by March 31 of the following plan year.
A participant, their spouse, or qualified dependent may choose to continue the Limited Purpose FSA if one or more of the following qualifying events occur:
- Death of the participant.
- Termination of the participant’s employment (other than for gross misconduct) or a reduction in hours.
- Divorce of the participant; or dissolution or termination of a state-registered domestic partnership with a domestic partner who qualified as a dependent.
- A dependent child loses eligibility for PEBB insurance coverage.
- A participant becomes enrolls in benefits under Medicare.
When any of these occur, you or a dependent must notify Navia Benefit Solutions. If, on the date of the qualifying event, your remaining benefits for the current year are greater than your remaining contribution payments, Navia Benefit Solutions will give each eligible dependent the right to choose Limited Purpose FSA continuation coverage. If you are eligible for this option, Navia Benefit Solutions will mail a COBRA election notice to you.
If you elect Limited Purpose FSA continuation coverage through Navia Benefit Solutions, you must do so no later than 60 days from the date the notice of continuation rights was mailed to you.
You may continue participating in the Limited Purpose FSA by making post-tax contributions directly to Navia Benefit Solutions for the remainder of the plan year. Participation in the Medical FSA would continue through December 31, or until you stop making the monthly contribution on the predetermined payment date. If you do not make a payment on time, you may submit claims only for expenses incurred through your last active month of paid participation.
You also cannot receive reimbursement from your Limited Purpose FSA if the date of service for the expense is during an unpaid work period when eligibility is lost. For example, if you lose eligibility starting July 1, 2022, you can only receive reimbursements for the rest of the 2022 plan year if:
- You continue making contributions directly to Navia Benefit Solutions during the months of July through December 2022, and
- The dates of service for the expenses occur during the months you continue to contribute.
Finally, if you maintain your Limited Purpose FSA contribution during continuation coverage through December 31, 2022, you have until the March 31, 2023 deadline to submit claims to Navia Benefit Solutions for your 2022 Limited Purpose FSA balance.
If you have not spent all the funds in your Limited Purpose FSA by December 31 — and you are still employed and didn't lose eligibility for the Limited Purpose FSA — you may be able to take advantage of the carryover feature. That means certain unspent funds may carry over into the following year without affecting annual maximums.
To receive carryover, you must enroll in either the Limited Purpose FSA or Medical FSA for the following year or have at least $120 left in your 2022 balance. Unused funds up to $550 will roll over to 2023. Any funds above $550 will be forfeited. Carryover will occur for the first time in January 2023.
You can contribute a minimum annual amount of $240, up to a maximum annual amount of $2,750 for 2022.
To figure out how much you want to contribute, estimate your expenses for the plan year (January 1 through December 31) and enroll in a Limited Purpose FSA for that amount. Divide that amount by the number of paychecks you will receive that year to find out how much will be deducted each pay period.
For more help, use the Navia Benefit Solutions Tax Savings Calculator.
- Online: Navia Benefit Solutions
- Mobile App: download for iPhone or Android
- Email: email@example.com
- Fax: 1-425-451-7002 or toll free 1-866-535-9227
- Mail: Navia Benefit Solutions, PO Box 53250, Bellevue, WA 98015-3250
You can begin submitting reimbursement claims for eligible expenses on or after the first day of your plan year, January 1. The full amount you set aside for your Limited Purpose FSA contribution is available on the first day of the plan year for expenses. You may submit claims for services as often as you like, but not until after the services have been provided.
You must incur all expenses by December 31, 2022 and submit all claims to Navia Benefit Solutions for reimbursement by March 31, 2023. If you are no longer employed or have retired and still have money left in your account, you can still submit claims for reimbursement by March 31, so long as the services took place while you were employed.