BASIC NEO

ABC Test Company

Welcome! Open enrollment for ABC Test Company’s 2020 Flexible Spending Account plan is now through December 10, 2019. If you want to participate in the plan for 2020, you must enroll before that date.

Use the links to the right to learn about the benefits of joining an FSA.

FSA Debit Card: Use the card to pay for eligible healthcare expenses at the point of purchase. However, keep your receipts as some debit card transactions will require that you submit documentation of the card swipe to BASIC .

*** SCROLL DOWN TO ENTER YOUR ELECTION INFORMATION ***

You may make changes to your election any time up to the deadline date noted above. Make the changes you want and resubmit your election. Your prior election will be overwritten.

Questions? Contact BASIC at 1-800-775-3539 or admin@BasicNEO.com.

SSN*
First name*
Middle initial
Last name*
Email
Address*
Street Address City State ZIP Code
Payroll Frequency*
Do you want to enroll in the General or Limited Health FSA?
General Purpose FSA Per Pay Period (Monthly)*
Please enter a number from 0 to 225.00.
General Purpose FSA (Annual Amount)
($2700 Maximum)
Limited Purpose FSA Per Pay Period (Monthly)*
Please enter a number from 0 to 225.00.
Limited Purpose FSA (Annual Amount)
($2,700 Maximum)
Dependent Care FSA Per Pay Period (Monthly)*
Please enter a number from 0 to 416.66.
Elect the Dependent Care benefit only if you pay someone to care for a dependent child under age 13 or an older dependent who needs care while you work. Refer the FSA brochure for additional information.
Dependent Care FSA (Annual Amount)
($5,000 Maximum)
Direct Deposit?
Bank Name
Routing Number

Enter your 9 digit routing number.
Account Type
Account Number
Terms and Conditions

I understand that:
Medical reimbursements will be available only for "qualifying health care expenses" for my qualifying dependents and myself as described in the Summary Plan Description.

Dependent care reimbursements will only be available for "qualifying dependent care expenses" as described in the Summary Plan Description. I agree to provide the claims administrator with the name, address, and taxpayer identification number of the dependent care service provider.

I agree to notify the Employer if I have reason to believe that any expense for which I have obtained reimbursement is not a qualifying expense. I also agree to indemnify and reimburse the Employer for any liability it may incur for failure to withhold federal, state, or social security tax from any reimbursement of a non-qualifying expense, up to the amount of additional tax actually owed by me.

I cannot change or revoke this election any time during the Plan Year unless it is on account of and consistent with a change in status as described in the Summary Plan Description and allowed under current Internal Revenue Code Section 125 regulations.

Any expenses paid through the plan may not be used as a credit or deduction on my federal tax return.

The amount of my compensation redirection shall be credited to a health care reimbursement and/or dependent care reimbursement account and I will be reimbursed for the applicable expenses incurred during the year.

My social security benefits may be slightly reduced as a result of my election.

Amounts that are not claimed for expenses incurred during the Plan Year coverage period will be forfeited and may not be paid to me in cash or carried over for expenses incurred after the Plan Year coverage period.

THIS AGREEMENT IS SUBJECT TO THE TERMS OF THE EMPLOYER'S HEALTH CARE REIMBURSEMENT PLAN AND/OR DEPENDENT CARE PLAN AS AMENDED FROM TIME TO TIME IN EFFECT, SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH APPLICABLE LAWS, SHALL TAKE EFFECT AS A SEALED INSTRUMENT UNDER APPLICABLE LAWS, AND REVOKES ANY PRIOR ELECTION AND COMPENSATION REDIRECTION AGREEMENT RELATING TO SUCH PLAN(S). I UNDERSTAND AND AGREE THAT BY COMPLETION OF THIS ELECTION BY CLICKING THE “SUBMIT” BUTTON, I HAVE AGREED TO THE ELECTIONS MADE UNDER THIS PLAN AND AM BOUND BY THE TERMS AND CONDITIONS OF THE PLAN.

Please read and confirm you agree with terms.
Please read the terms above.*
- I agree with the terms and conditions

Helpful Information and Resources

Save big by paying for health or child care expenses with pretax dollars!

What’s covered under my FSA?

Eligible/Ineligible Expenses List
Special Rules for Orthodontia and OTC Drugs and Medications

Carryover provision for Medical FSA plans

For all plan years beginning in 2020, the amount that employers may allow employees to carryover from one plan year to the next will be indexed in step with the maximum salary reduction amount permitted each year. This means that $550 may be carried over from a plan year starting in 2020 to the following plan year beginning in 2021.

Frequently asked questions about using the FSA plan.

FSA FAQs

Use this cool tool to estimate how much you can save using the FSA plan.

Savings Calculator

General-Purpose Health FSA vs. Limited Health FSA

The General-Purpose health FSA can be used for any medical expense as allowed by IRS Section 213, including medical, dental, vision, prescriptions, etc. The General-Purpose health FSA is not available to you if you or your spouse participate in a Health Savings Account (HSA).
The Limited-Purpose health FSA may be used by employees covered under a Health Savings Account (HSA) Plan. Reimbursement is limited to Dental & Vision expenses ONLY.

How do I access my FSA funds?

Use your BASIC Prepaid Benefits Card to pay for expenses at the point of purchase, or submit claims to get reimbursed directly.

How do I use my BASIC Prepaid Benefits Card?

Your debit card will be loaded with your full annual election at the beginning of your Plan Year. You can use your BASIC Prepaid Benefits Card to pay for expenses after the first date of the plan. You cannot use your card to pay for previous year’s expenses.

Do I get a new debit card every year?

No, your debit card is good until the expiration date listed on the front of the card. Please keep your debit card until that date. New debit cards will automatically be issued to you before the expiration date..

What is the deadline to submit a claim?

Active employees have 90 days after the last day of the Plan Year to submit claims for expenses incurred in the prior year. For example, if your Plan Year ends December 31st, you will have until March 31st of the following year (90 days) to mail, fax or email your claim(s) to our office. Any claims after that date will not be accepted. Claim submission periods for terminated participants may vary.

Payroll Frequency

This describes how often you get paid and the number of times that your FSA deduction will be taken from your check throughout the plan year.

Per Pay Deduction

This is the amount you choose to have withheld from each paycheck.

Looking for ways to use your FSA dollars?

FSAStore.com offers the largest online selection of FSA-eligible products, accepts your BASIC Prepaid Benefits Card, and offers free shipping on all orders of $50 or more. Click here to get $10 off your next purchase!

Welcome to BASIC - CA and Akron, OH Locations