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-Flexible Spending Acct/Transp Reimbursement Page 1 of 2 <br /> CITY OF I~I~CE~!E <br /> <br /> I Ho~rr7~~~e~ Benet~ts <br /> <br /> ' ~ F~rr1~s <br /> <br /> E ~ ~ ' <br /> FSA/TRA Enrollment Form <br /> FLEXIBLE SPENDING &t TRANSPORTATION (including Auto Pay form) <br /> REIMBURSEMENT ACCOUNTS Auto Pay Form ~ Auto Pay <br /> Flexible Spending Accounts (FSA) and Transportation Reimbursement Questions/Answers <br /> Accounts (TRA) allow you to use pre-tax dollars to pay for certain dependent M' FSA/TRA Claim Form <br /> care and health care services, and transportation expenses that you would <br /> normally pay for with after-tax dollars. A detailed description of the FSA/TRA j lr,~o t Rex~carces <br /> <br /> j program can be viewed by following the FSA/TRA Booklet link on the right. - ~1~ - - . <br /> Over the Counter Drug List <br /> Eligibility <br /> All regular full and part-time employees are eligible to participate in the Eligible FSA Expenses List <br /> <br /> j FSA/TRA program, including IATSE-represented employees who are eligible <br /> for health insurance benefits. <br /> FSA+TRA B~oklel <br /> Options ~ FSA/TRA Booklet <br /> ¦ FSA Health Care Account: You can defer up to $2,400 a year to pay <br /> for medical/dental/vision expenses which are not covered by the City's <br /> health insurance plans for you and your dependents. <br /> ¦ FSA Dependent Care Account: You can defer up to $5,000 a year for <br /> dependent care expenses which are necessary to allow you to work. <br /> ¦ Transportation Reimbursement Account (TRA): Through a <br /> Transportation Reimbursement Account, you can pay for certain <br /> transportatian expenses with before-tax dollars. Expenses must be <br /> tax-qualified -that is, allowable deductions or credits under current <br /> IRS regulations. Allowable deductions include van pool, mass transit <br /> and parking. The deferrable dollar amounts for each option are <br /> explained in the enrollment form. <br /> For more information an the Flexible Spending and Transportation <br /> Reimbursement Accounts contact HRRS. Far an enrollment form, <br /> follow the link to the right. Print the form, fill it out, and send it to the <br /> HRRS, Benefits Program during the enrollment period. <br /> IMPORTANT: "Use it or lose it" <br /> Any funds remaining in your FSAs at the end of the year are forfeited and <br /> are retained by the City of Eugene. <br /> NOTE: This does not apply to the Transportation Reimbursement <br /> Account program. <br /> Enrollment <br /> You have 30 days from the date you begin working to enroll in this plan, or <br /> you may enroll during the annual open enrollment period held in December. <br /> To continue participation, you must re-enroll each year. <br /> http://www.ci.eugene.or.us/HRRSBenefits/FSATRA.htm 4/27/2004 <br /> <br />