The Health Care Authority contracts with Navia Benefit Solutions to manage the Medical Flexible Spending Arrangement (FSA), process claims, and provide customer service for Public Employees Benefits Board (PEBB) Program employees. Who is eligible? The Medical FSA is available to PEBB benefits-eligible employees who work at state agencies, higher- education institutions, and community and technical colleges as described in Washington Administrative Code (WAC) 182-12-114. How can a Medical Flexible Spending Arrangement (FSA) help me? A Medical FSA allows you to set aside money from your paycheck on a pre-tax basis to pay for out-of- pocket health care costs. Here are some of the ways you can benefit from a Medical FSA: • Setting aside a portion of your pay with a Medical FSA reduces your annual taxable income. • You can set aside as little as $120 or as much as $3,050 for the calendar year. The full amount you elect to set aside for your Medical FSA is available on your first day of coverage for expenses. • Your Medical FSA helps you pay for deductibles, copays, coinsurance, dental, vision, over-the- counter medication, sunscreen, menstrual care products, and many other expenses. (See “What health care expenses are eligible?”) • You can use your Medical FSA for you, your spouse or state-registered domestic partner (SRDP), or other qualified dependent's health care expenses, even if they are not enrolled on your PEBB medical or dental plan. Important: You cannot enroll in both a Medical FSA and a consumer-directed health plan (CDHP) with a health savings account (HSA) in the same plan year. How does the Medical FSA work? • You estimate your expenses for the plan year and enroll in a Medical FSA for that amount. The more accurate you are in estimating your expenses, the better this benefit will work for you. • You cannot change your election amount after the plan year starts unless a qualifying event, like a birth or marriage, creates a special open enrollment. • The amount deducted from your pay is your annual election amount divided by the number of paychecks you will receive in the plan year. • Your election will be deducted from your paycheck pre-tax throughout the plan year, so you don’t pay FICA (7.65%) or federal income tax (up to 37%) on your elected dollars. • You cannot cancel participation in the Medical FSA once the plan year starts unless you end employment, lose eligibility for the Medical FSA, or have a life event that would allow you to make a new election. • Unused Medical FSA balances up to $640 can carry over to the next plan year. To receive carryover, you must a) enroll in an FSA the following plan year to carry over any amount up to $640, or b) have at least $120 remaining in your account to carry over any balance between $120 and $640. Any funds above $640, or below $120 if you do not re-enroll, will be forfeited to the plan administrator, the Health Care Authority. See the “Carryover and use it or lose it” section for details. • You must enroll in a Medical FSA again for each year you want to participate. Enrollment does not automatically continue from plan year to plan year. When can I enroll and how do I do it? There are three occasions when you are eligible to enroll in a Medical FSA. You are newly eligible. 1. Enroll no later than 31 days after the date you become eligible for PEBB benefits. To enroll, submit the PEBB Midyear Enrollment Form to your payroll or benefits office. You can find the form online at 3