Flexible
Spending Accounts
A Flexible Spending Account allows employees to use before-tax dollars
to pay for eligible out-of-pocket expenses. Mount Holyoke College
has established two types of flexible spending accounts.
- Health Care Spending Account - employees
can contribute a minimum of $120 to a maximum of $6,000 to pay
for eligible health care
expenses (including dental expenses).
- Dependent Care Spending Account - employees can contribute
a minimum of $120 to a maximum of $5,000 to pay for eligible dependent
care expenses.
- Access your Flexible
Spending dollars using the mySourceCard MasterCard Debit Card.
No waiting for reimbursement, simply use your card to pay for
qualified
medical,
dental and dependent care expenses.
Pertinent Forms:
 Flexible
Spending Account Direct Deposit [Word.doc]
Flexible
Spending Account Enrollment [PDF]
Flexible
Dependent Care Worksheet [PDF]
Flexible
Health Care Worksheet [PDF]
Flexible
Spending Reimbursement (Word)
Flexible
Spending Accounts Booklet 2010 [PDF]
Qualified
Status Change Event (Word.doc)
Notice
of Continuation of Benefits (Word.doc)
Contact
Information
American Benefits Group
P.O. Box 1209
Northampton,
MA 01061-1209
Telephone: 413-584-9923 or 800-499-3539
24/7 IVR: 866-891-1020
FAX: 866-EZE-FLEX (866-393-3539)
You can
access information
about your Flexible
Spending Accounts
through American Benefits Group.
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