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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.
The Limited Purpose FSA allows you to set aside money from your paycheck on a pretax basis to pay for out-of-pocket dental and vision costs like glasses, contact lenses and solution, dentures, dental copays, orthodontia, and more (See eligible expenses). You can use your Limited Purpose FSA to pay dental and vision expenses for you, your spouse, or your qualified tax dependents, even if they are not enrolled in your PEBB medical or dental plan.
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 set up a Limited Purpose FSA account:
- No later than 31 days after the date you become eligible for PEBB benefits. Submit the Midyear Enrollment Form to your payroll or benefits office.
- During annual open enrollment. Visit the online portal on the Navia Benefits Solutions website.
- No later than 60 days after you or an eligible family member has a qualifying event that creates a special open enrollment. Submit the Midyear Enrollment Form to your payroll or benefits office.
University of Washington and Washington State University employees must enroll through Workday.
You must enroll in a Limited Purpose FSA for each plan year you want to participate. Your enrollment does not automatically continue year to year. If you want to enroll, make sure to choose this benefit again during each open enrollment.
You can contribute a minimum annual amount of $120, up to a maximum annual amount of $2,750 for 2022.
To figure out how much you want to contribute, estimate your dental and vision 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: firstname.lastname@example.org
- 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.
When your PEBB insurance coverage ends or you go on unpaid leave that is not approved under the Family and Medical Leave Act (FMLA) or military leave, you are no longer eligible to contribute to your Limited Purpose FSA. Eligibility ends on the last day of the month 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.
You can continue your Limited Purpose FSA election if the time between employment is 30 days or less and within the current plan year. Submit the PEBB Agency Transfer form to your new employer’s payroll or benefits office no later than 31 days after your first day of work. If you end employment or retire during the year, submit the PEBB Medical FSA and Limited Purpose FSA Termination to your payroll or benefits office.