If a paper form is needed, proceed to the FSA Election and Compensation Reduction Agreement form.
Applications received after the annual open enrollment period has ended must meet IRS guidelines for a qualifying change in status.
Churches and other UCC employers that have not previously participated in the UCC FSA Plan can get started by completing the Health & Welfare Adoption Agreement. Learn how to get started here.
Medical FSA: $3,300
Dependent Care FSA: $5,000
The FSA Plan will be administered by HealthEquity.
The FSA also allows clergy and lay employees to keep more of what they earn. Learn more here.
Your payroll processor should adjust salary records to ensure that the appropriate reductions are made in your 2025 pay, based on your elections. FSA contributions are billed to employers on a monthly basis and payment is due on the 1st of the month following the month FSA dollars are withheld from salary. In accordance with Plan rules, only expenses incurred up to the date the employee stopped contributions to the Plan (due to termination/retirement/qualified change in status) are eligible for reimbursement.