Employee Benefits >> Reimbursement Accounts >> Dependent FSA






		Dependent Care Reimbursement Account The Dependent Care Reimbursement Account allows benefits eligible faculty and staff to set aside a minimum of $120 and a maximum of $5,000 in pre-tax dollars per calendar year to pay for eligible dependent care expenses. Eligibility and Enrollment For eligibility and enrollment criteria, please refer to the eligibility and enrollment guidelines. If you are eligible and would like to enroll, complete a benefits enrollment form and return it to HRM/Benefits at 250 Columbus Place. Claim Submission and Payment Once enrolled in the Dependent Care Reimbursement Account, claims can be filed. To file a claim, you must complete a Reimbursement Account Claim Form and attach a receipt, containing the name(s) of the covered dependent, period(s) covered, provider name and address and the provider's tax ID. The claim form can also be used as a receipt if the provider section of the claim form is completed by a dependent care provider. Completed claim forms must be returned to EBPA at the address or fax number below and received by the 10th or 25th of the month. Direct deposit is available. To enroll, complete the direct deposit form and return it to the EPBA at the address below. The periods that reimbursement is claimed must occur during the calendar year for which you are enrolled. Claims for the prior year can continue to be submitted until March 31 of the following year. Unused funds are forfeited if claims are not submitted. Claims for the Dependent Care Reimbursement Account are processed semi-monthly and made payable to the employee. If claims are submitted for more than what is in the account, a check will be issued for the current account balance. As the account is funded, EBPA will pay the remaining unpaid balance on the claim. Account statements are mailed quarterly. Fourth-quarter statements will be issued one month before the end of the plan year. Remember: Reimbursed dependent care expenses can not be claimed on federal income tax returns. EBPA P.O. Box 1140 Exeter, NH 03833-1140 Phone: (800) 258-7298 Fax: (603) 773-4415