Flexible Spending Accounts (FSA/DCAP)

San Bernardino County offers two flexible spending accounts (Health and Dependent Care) that provide tax-savings. FSAs allow employees to take a pre-tax deduction from their income to pay for eligible health and/or dependent care expenses. Employees are eligible to participate in the FSAs if they are covered under a Memorandum of Understanding, Compensation Plan, or Employment Contract.

Enrollment

Employees are eligible to enroll into the FSA and/or DCAP during:

• Open enrollment
• If the employee experiences a mid-year change-in-status event

Plan Year Periods

Contributions & Roll Over

Below is the IRS maximum contribution amount for the FSAs and the County’s eligible roll.

• The maximum employee contribution is $3,200 for the 2024-25 plan year

• The maximum amount eligible to be rolled over to the 2024-25 plan year has increased to $640

How the Plans Work

Eligible employees elect an annual contribution amount to be placed in their FSA and/or DCAP account. The annual contribution is made via bi-weekly payroll deductions in equal installments throughout the year. Participants can access their FSA and/or DCAP contributions through the following ways:

1. Using their FSA benefit card.
2. Submitting a claim for approval (see “How to File a Claim” section)

Eligible Expenses:

Eligible health care expenses include:

• Coinsurance, Copays and Deductions
• Medical and Prescriptions
• Dental and Orthodontia
• Eye Exams, Eyeglasses and Lasik Eye Surgery

Eligible dependent care expenses include:

• Licensed nursery schools, qualified childcare centers, after school programs, summer camps, preschool
• Adult daycare facilities

FSA

Medical Expense Reimbursement Form

Note: If claiming mileage, a print out of an online map source (i.e. google maps) that includes the starting and ending destination points and total miles traveled will need to be provided.

The form has to have the following information for claims:

• Date of services/ products incurred
• Name of the person who the expense was incurred for
• Dollar amount being claimed
• Provider name
• Expense category

DCAP

DCAP Reimbursement Request Form

Note: If claiming mileage, a print out of an online map source (i.e. google maps) that includes the starting and ending destination points and total miles traveled will need to be provided.

The form has to have the following information for claims:

• Name, date of birth, and relation of dependent
• Name, address, and taxpayer ID or social security number of dependent care provider
• Date(s) of services
• Amount claimed for reimbursement of dependent care expenses incurred

• Electronic: Submit claim and upload supporting documentation (e.g. receipts) online via the FSA/DCAP Participant Portal
• Manual: Submit a paper reimbursement claim form and copies of supporting documentation to:
  • Mail: Employee Benefits and Services (EBSD) – 175 W. Fifth Street, First Floor, San Bernardino, CA 92415
  • Fax: 909.387.5566
  • Email: hrfsadcap@hr.sbcounty.gov

• Description of service or product rendered
• Payment received for expense
• Amount paid to other part (i.e insurance) for expense

Note: Claims for eligible expenses incurred within the plan year can be submitted for reimbursement no later than ninety (90) days after the end of the plan year.