Flexible Spending Accounts

PacificSource Administrators
541- 485-7488
800-422-7038 toll free
www.pacificsource.com/PSA
E-mail: psamembership@pacificsource.com

UPDATE - 2019 FSA or DCAP grace period: • Grace period for 2019 contribution use (if you had a remaining 2019 fund balance) has been extended to December 31, 2020. Last date to submit for reimbursement is March 31, 2021. • Use of remaining 2019 funds, must be submitted for reimbursement. Do not use your Benny card as this will draw from 2020 funds.

Note regarding 2019 FSA funds: Eligible expenses/services for 2019 funds must be incurred by March 15, 2020. Documentation for 2019 eligible expenses/services must submitted by June 15, 2020.

PacificSource Administrators Resources

How much should you contribute to your flexible spending account? Use PacificSource's handy expense worksheet to help you estimate.

Want to manage your account online? Create your MyFlex account to submit/view claims, submit documentation, and more.

• Instructions to set up your MyFlex account

You can also submit a claim by fax or mail using the FSA Reimbursement Form

• Fax: (866) 446-6090
• PacificSource Administrators
  PO Box 2797
  Portland, OR 97208-2797

Want to know more about your flexible spending account? Check out these great resources:

• FSA Information Summary Sheet
• Examples of Eligible Expenses
• FSA User’s Guide
• Benny Card Guide
• FSA Grace Period FAQ
• Flexible Spending Account Summary Plan Description
• Summary of Material Modification effective 7/1/2020 - Grace Period
• Summary of Material Modification effective 7/1/2020 - Mid Year

Other Useful Forms:

• Letter of Medical Necessity
• Direct Deposit Authorization (to have reimbursed funds directly deposited into your bank account)
• Dependent Care Recurring Expense Form (to have dependent care funds automatically reimbursed to you)