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Flexible Spending Account (FSA) View Below are your Flexible Spending Account elections for the calendar year. Claims may be submitted through March 31 for eligible expenses that were incurred between January 1 and December 31 of the preceding year. Note: Dependent Day Care FSA "Amount Remaining" may include pending claims not yet paid. If you have questions, please contact the Office of Human Resources at 831-2171 or e-mail ben-serv@udel.edu.

Employee ID: 11111	Name: Doe,Jane	Suffix:	Date: 03/28/2004
Plan Year*:

Annual Pledge**   Amount Reimbursed   Amount Remaining Dependent Day Care FSA $5000.00  $2083.31  $3916.69  Health Care FSA $0.00  $0.00  $0.00  *  A plan year is defined as the twelve-month period between January 1 and December 31. **  Even if you have participated in an FSA account in the past , you must re-enroll every year. Flexible Spending accounts do not automatically continue from year to year.

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