FSA (Sec. 125 pre-tax savings)

The Flexible Benefit Plan is a program that allows employees to pay for certain expenses using pre-tax dollars. Money is deducted from your paycheck before Federal, State, Social Security and Medicare taxes are calculated. The Flexible Benefit Plan is administered by Diversified Benefits Services.

Because of the favorable tax treatment, federal regulations allow you to change your coverage only during an open enrollment period or in the event of a qualifying family status change. You must notify the District Human Resource Office within 31 days of the change.

Plan Year: Calendar
Options: Medical Reimbursment
Limited Medical Reimbursement (dental & vision expenses only, HSA participants)
Dependent Care Reimbursement
Group Insurance Premiums

Annual Limits: Medical and Limited Medical Reimbursement, $2,600.00
Dependent Care Reimbursement, $5,000 (or $2,500 if married filing $2,500)

Diversified Benefits Contact Information
DBS, Inc.
PO Box 260
Hartford, WI 53029
Phone number 1-800-234-1229
Fax number 1-262-367-5938
www.dbsbenefits.com

Forms and Documents
Claim Forms can be found on the DBS website.
Employee Guide to Pre-Tax Savings
Summary Plan Description

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