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

Plan Changes due to the new COVID Relief Bill:

• In 2021, employees may elect to change (start, stop or change their annual contribution) their Health Care FSA or Dependent Care FSA contributions mid-year without a qualifying event (i.e., marriage, childbirth, etc). Certain rules apply, please contact HR Benefits for details.
• For the plan year 2020, employees will have until December 31, 2021 to use any remaining 2020 contributions for eligible expenses. You will have through March 30, 2022 to submit reimbursements for any eligible expenses. Any unused funds remaining as of December 31, 2021 will be forfeited. 
• If you were participating in Dependent Care Spending Account (DCAP) prior to January 31, 2020 and had funds remaining in your account you can now use those funds for eligible dependent care expenses. If your child turned age 13 during the 2020 plan year the “age out” date has been extended to age 14. This means employees can access 2020 funds into 2021, until the child turns age 14. Please contact HR Benefits for additional information. 

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
• FSA Summary of Material Modification - 2020 and 2021

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)
• FSA Overpayment Repayment Form (To access this form, right-click the link and select "Save Link As." Open and complete the form from your saved location.)