Flexible Spending Account (FSA)

If you have any FSA related questions, please contact Joan Albayrak and Marjorie Calixte. 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
• 2024 Flexible Spending Accounts Program Brochure
• 2024 FSA Enrollment/Change Form
• 2024 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
• 2024 MSC Premium Conversion Enrollment/Change Form

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 2024, the participants should notify the FSA office immediately.

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

Plan Year 2024

• 2024 DeCAP Claims Form
• 2024 HCFSA Claims Form

Plan Year 2023

• 2023 DeCAP Claims Form
• 2023 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