Flexible Spending Accounts

A Flexible Spending Account enables you to increase your take-home pay by decreasing your taxable income. You can reduce the cost of insurance premiums, medical expenses not covered by insurance, certain over-the-counter medicines and dependent daycare expenses by paying these costs on a pre-tax basis. Pre-tax denotes that you will not pay state, federal, or FICA withholdings on these earnings. Pacific Source's website is www.PacificSource.com/PSA.  (Please note that over-the-counter drugs and medicines cannot be reimbursed unless prescribed by a medical practitioner to treat a specific medical condition.)

Reimbursements for dependent care and medical expenses which occurred during between April 1, 2016 - March 31, 2017 can still be submitted to Pacific Source through June 30, 2017.  Claims can be submitted with a reimbursement form via fax to (866) 466-6090, mailed to PO Box 2797, Portland OR 97208, or submitted online at https://hrbenefitsdirect.com/PSA

Flexible Spending Account Forms

Flexible Benefits 125 Plan
Pacific Source FSA Summary Plan Description PDF
  Pacific Source FSA Plan Document PDF
  Pacific Source FSA Handout PDF
  FSA Allocation Worksheet PDF
  Eligable Expenses PDF
  Reimbursment Form PDF
  Flexible Spending Account Direct Deposit Enrollment Form PDF
  Dependent Care Contract PDF
  FSA User Guide PDF
  A Guide to Your Benny Card PDF