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    Flexible Spending Account (FSA)

    If you have any FSA related questions, please contact Joan Zaw and Debbie Poon. We recommend for all employees to visit the New York City Office of Labor Relations’ webpage for the most up-to-date information and document submission.

    Forms and Resources

    • NYC Flexible Spending Accounts (FSA) Program Summary
    • 2023 Flexible Spending Accounts Program Brochure
    • 2023 FSA Enrollment/Change Form
    • 2023 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
    • 2023 MSC Premium Conversion Enrollment/Change Form

    FSA Claims Forms

    Please direct all inquiries/correspondence and claims as follows:
    1) Inquiries and questions can be sent via email to the Program.
    2) Forms/documents can be submitted electronically to: https://nyc-fsa.leapfile.net

    Please note that, once the FSA office receives and processes the HCFSA/DeCAP enrollment forms, the participants will receive a confirmation letter.

    Important:  If the participant does not experience FSA payroll deductions in January 2023, the participants should notify the FSA office immediately.

    Please note that, for CUNY Baruch employees, the payroll deductions will begin in the second paycheck in January 2023.

    Plan Year 2023

    • 2023 DeCAP Claims Form
    • 2023 HCFSA Claims Form

    Plan Year 2022

    • 2022 DeCAP Claims Form
    • 2022 HCFSA Claims Form

    For additional information please visit the following links:

    • Flexible Spending Accounts (FSA) – Office of Labor Relations (OLR) Homepage
    • Flexible Spending Accounts (FSA) Program Guides, Brochures & Forms – Office of Labor Relations (OLR) Homepage
    Updates

    Plan Year 2023 Annual Open Enrollment Period

    The Annual Open Enrollment Period for Plan Year 2023 will be October 17, 2022 to November 18, 2022. The Flexible Spending Accounts (FSA) Program Enrollment/Change Form will be available in early October. Please check back periodically for program materials and updates.

    FSA Open Enrollment Dates: Oct. 17 – Nov. 18

    Open Enrollment: Flexible Spending Accounts (FSA) Program:

    Enrollment in the HCFSA and DeCAP is not automatic and your previous year’s election will not rollover. New and current participants must enroll/re-enroll each year during the annual open enrollment period.

    Enrollment Dates: October 12, 2021 – November 19, 2021

    • Flexible Spending Accounts Program Brochure
    • FSA Enrollment/Change Form

    How to Submit Enrollment/Change Forms:

    Employees who wish to participate in the HCFSA and/or DeCAP program for Plan Year 2022 can download the applicable form(s) from the FSA website and must submit the completed forms(s) electronically to the following secure site: https://nyc-fsa.leapfile.net

    Please DO NOT mail any forms via UPS or FedEx packages to the FSA Administrative Office. However, employees can submit forms via regular mail to:

    Attn: OLR, Flexible Spending Accounts: 2022
    22 Cortlandt Street, 28th Floor
    New York, NY 10007

    Current Participants in the HCFSA Program and/or DeCAP

    Employees currently enrolled in the HCFSA and/or DeCAP Program will automatically receive a letter sent to their address on file in the beginning of October 2021. They can enroll in Plan Year 2022 for HCFSA and/or DeCAP by completing the bottom portion of the letter and returning it to the above secure site, as long as there are no changes to the participant’s information, except for the indicated goal amount. If there are any changes to the participant’s information, the employee must complete a Plan Year 2022 Enrollment/Change Form.

    Medical Spending Conversion (MSC) Forms

    Please be advised that there are two separate MSC Forms, one for the MSC Health Benefits Buy-Out Waiver Program and one for the MSC Premium Conversion Program. Please make sure that the correct form is used for each program. In addition, each participant’s enrollment in the MSC Program continues from one Plan Year to the next; therefore, the participant does not need to re-enroll each Plan Year, unless there is a change of status. The MSC Health Benefits Buy-Out Waiver annual incentive payment is $500 for waiving individual coverage and $1,000 for waiving family coverage for Plan Year 2022. Current participants will receive this amount automatically in Plan Year 2022.

    HCFSA Program Grace Period & Claims Run-Out Period and DeCAP Claims Run-Out Period

    • For the HCFSA Program only, there will be a Grace Period during which Plan Year 2021 participants may submit claims for eligible medical expenses incurred from January 1, 2022 through December 31, 2022 following the close of Plan Year 2021, using the remaining balance in their Plan Year 2021 account, if any.
    • For DeCAP only, there will be a Grace Period provided from January 1, 2022 through December 31, 2022 during which participants may submit claims for services incurred during Plan Year 2021.
    • The Qualifying Event submission deadline date is 30 days from the date of Qualifying Event.

    Plan Year 2021 Program Deadline Dates:

    HCFSA Plan Year: January 1, 2021 – December 31, 2021
    Grace Period*: January 1, 2022 – December 31, 2022

     

    DeCAP Plan Year: January 1, 2021 – December 31, 2021
    Grace Period*: January 1, 2022 – December 31, 2022

    Additional information can be found on the NYC Office of Labor Relations FSA website.

    Open Enrollment

    The Annual Open Enrollment Period for Plan Year 2022 will be October 12, 2021 to November 19, 2021. The Flexible Spending Accounts (FSA) Program Enrollment/Change Form will be available in early October. Please check back periodically for program materials and updates.

    Enrollment in the HCFSA and DeCAP is not automatic and your previous year’s election will not rollover. New and current participants must enroll/re-enroll each year during the annual open enrollment period.

    Enrollment Dates: October 12, 2021 – November 19, 2021

     

    For Plan Year 2021 Participants:
    As indicated on the FSA website, pursuant to IRS Notice 2020-29 released in response to COVID-19, 2021 Plan Year participants may use any remaining 2021 Plan Year contributions to pay or reimburse expenses incurred through December 31, 2022.

    For Prospective Plan Year 2022 Participants:
    • Re-enroll for Plan Year 2022 between October 12, 2021 through November 19, 2021, for an effective date of January 1, 2022.

    • 2022 Plan Year Contribution Limits as of 10/14/2021. Please note that the IRS has not released any guidance for Plan Year 2022 contribution modifications. Please check the FSA website periodically for updates:

    Minimum Maximum
    HCFSA $260 $2,750
    DeCAP $500 $5,000

    • “Use It or Lose It:” Federal regulations require that you use the entire amount you allocate to HCFSA and/or DeCAP by the end of the Plan Year, or forfeit the unused balance.

    HCFSA Plan Year 2021

    • Plan Year 2021 HCFSA participants are allowed to cancel their deductions or increase or decrease their goal amounts one time only during Plan Year 2021, without a Qualifying Event, on a prospective basis for Plan Year 2021. This request must be submitted to the FSA program no later than September 30, 2021 in order for it to be processed. Such requests will take effect approximately 2 pay periods after the request is processed.
    • For the HCFSA Program, the Grace Period for Plan Year 2021 is extended through December 31, 2022. Plan Year 2021 participants may submit claims for eligible medical expenses incurred through December 31, 2022, using the balance in their Plan Year 2021 account, if any.
    • An employee who ceases City service during Plan Year 2021 may continue to receive reimbursements from unused contributions through December 31, 2021 (including the Grace Period), as long as they are not submitting the same claims to another employer.

    DeCAP Plan Year 2021 Changes

    • As a result of nondiscrimination testing for highly compensated employees, the Plan Year 2021 goal amount is $5,000. However, federal law allows a maximum benefit of $10,500 in 2021. Employees should consult with a tax advisor regarding additional tax deductions on their federal tax return.
    • Plan Year 2021 DeCAP participants are allowed to cancel their deductions or increase or decrease their goal amounts one time only during Plan Year 2021, without a Qualifying Event, on a prospective basis for Plan Year 2021. This request must be submitted to the FSA program no later than September 30, 2021 in order for it to be processed. Such requests will take effect approximately 2 pay periods after the request is processed.
    • For the DeCAP Program, there is a Grace Period for Plan Year 2021.  A Grace Period is offered following the end of a Plan Year.  During this Grace Period for Plan Year 2021 participants may submit eligible claims through December 31, 2022, using the remaining balance in their Plan Year 2021 account, if any.
    • Plan Year 2021 participants can submit claims for a dependent until their dependent turns age 13 in the calendar year 2021.
    • An employee who ceased City service during Plan Year 2021 may continue to receive reimbursements from unused contributions through the end of the Plan Year (including the Grace Period), as long as they are not submitting the same claims to another employer.

    DeCAP Deductions

    Dependent Child Care Assistance Program (DeCAP) participants can suspend their DeCAP deductions or lower their annual goal amount by submitting an online request to the FSA program, submit a letter via secure email, or fax a letter to (877) 290-6587.

    Upon return to work, DeCAP participants can resume their deductions by notifying the FSA Program that they would like to resume. Additionally, they can submit a claim for any deductions taken already this year with eligible claim dates.

    Important FSA Forms:
    2021 FSA Enrollment/Change Form


    Office of Human Resources One Bernard Baruch Way, Box D-0202 (New York, NY 10010) 646-660-6590
    Human.Resources@baruch.cuny.edu
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