Custom Benefits Services P.O. Box 3986 Ocala, FL 34478 Phone (800) 809-8161 Fax (352) 369-9461
Flexible Benefits is a program designed to give participating employees benefit savings as well as offer them medical reimbursement and dependent care spending accounts. These benefit savings may result in greater take home pay for employees. Custom Benefit Services is the administrator of the plan.
Flexible Spending Account brochure FSA Debit Card application Claim Form
* Qualified expenses are defined by the IRS. For a listing of qualified expenses, to view account balances, print claim forms or calculate your tax savings by logging on to www.myflexonline.com
You are agreeing that your taxable income will be reduced each pay period during the year or fiscal year by an equal portion of the election you choose and that qualified expenses will be paid on a tax-free basis. You agree that you may change your election in the event of certain changes in your status and that, prior to the first day of each plan year, you will be offered an opportunity to change your benefit election for the upcoming plan year. You agree that the flex benefits debit card is available to pay only qualified expenses and that qualified expenses paid with the card cannot be reimbursed by any other plan and that you will not seek reimbursement for expenses paid with the card from any other source. You agree that when using the flex benefits card you must keep all receipts and that, on occasion, you may be asked for documentation of charges made with the card. You agree that if a payment is made that is not for qualified expenses, you will repay HCC. For any expenses not repaid by you, you are authorizing HCC to deduct the amount from your paycheck (if permitted by state law).
