2011 expenses can be submitted to Allegiance for reimbursement until March 2012, but the service must have been incurred in 2011 for reimbursement from the 2011 account.

Just a reminder that effective January 1, 2011 many Over-the Counter expenses are no longer covered under this plan, please review the Allegiance website for details.

The City of Salem offers a Section 125 plan for IRS qualified expenses with pre-tax money. 

During the Plan year, you will have access to the pre-tax money for reimbursement of out of pocket qualified healthcare and/or dependent care expenses that you would normally pay for with after-tax dollars. 

Annual Election

This is a Calendar year contract and enrollment is required annually.   The full amount you choose to set aside for your Plan year must be used within the Plan year for qualified healthcare/dependent care expenses or you will lose it.  The IRS mandates that this is a use it or lose it type of account.  To reduce this risk, participants should carefully review their estimated out of pocket expenses before making the decision to participate. 

Annual Maximums

• Health care – up to $3,000
• Dependent care – up to $5,000 

Eligibility / changes

The annual election amount can only be changed within 30 days of a life event that would result in a status change, for example: marriage, birth, adoption or change in your or your spouse's eligibility status.                *You are responsible to review plan documents for complete details.* 

Reimbursement

Complete form and attach an explanation of benefits, pharmacy or sales receipt, and any other proof of service documentation.  Claim can be mailed or faxed to the FSA carrier.  Reimbursement average turn-around time is 48-72 hours.  Reimbursement can be mailed to your home or direct deposited.

Online Services allow you access to: 

• Account balance and claim information
• Claim forms and worksheets
• Contact information
• Eligible expense list
• Frequently asked questions
• Tax Consequences

Because you are not paying any social security tax on the portion of your income that has been set aside, your social security benefits may be slightly reduced.                                                                                         We encourage you to contact a tax advisor for advise specific to your situation.

Effective 2010   

Allegiance                                                                                                                                                                                                        

  Customer Service (877) 424-3570 www.allegianceflexadvantage.com    

    Mail reimbursement forms to: Allegiance PO BOX 4346 Missoula MT 59806-4386   Fax# 1-877-424-3539