HSA card provided for FSA Plan: Claims processing weekly on: Claims Funding Options: (pg. 6) Yes Monday Option 1: Run on Alerus acct and No Tuesday ACH pull total back from Debit card provided for: Wednesday employer Health FSA Thursday Option 2: Run on employer’s Dependent Care FSA Friday acct $500 Carryover Feature: 2 ½ Month Grace Period: Claims run out period: Yes No plan year end or grace (Medical and Limited FSA Only) Yes No If yes: period end) Did Carryover to previous FSA 2 ½ months 30 days plan year: Other 60 days Yes No For: 90 days Medical Dependent Care Other Additional Comments: IV. PARTICIPANT CENSUS DATA The following census data is required for the setup of your participants. This data should be submitted to Alerus in an Excel spreadsheet. Each bulleted item represents a separate column required in the spreadsheet. If a specific column does not apply, (i.e. division) simply leave that column blank. HSA/FSA SPREADSHEET COLUMNS REQUIRED Employee ID # (no dashes or spaces)
HSA card provided for FSA Plan: Yes No Debit card provided for: Health FSA Dependent Care FSA Claims processing weekly on: Monday Tuesday Wednesday Thursday Friday Claims Funding Options: (pg. 6) Option 1: Run on Alerus acct and ACH pull total back from employer Option 2: Run on employer’s acct $500 Carryover Feature: (Medical and Limited FSA Only) Yes No Did Carryover to previous FSA plan year: Yes No 2 ½ Month Grace Period: Yes No If yes: 2 ½ months Other For: Medical Dependent Care Claims run out period: plan year end or grace period end) 30 days 60 days 90 days Other Additional Comments: IV. PARTICIPANT CENSUS DATA The following census data is required for the setup of your participants. This data should be submitted to Alerus in an Excel spreadsheet. Each bulleted item represents a separate column required in the spreadsheet. If a specific column does not apply, (i.e. division) simply leave that column blank. HSA/FSA SPREADSHEET COLUMNS REQUIRED Employee ID # (no dashes or spaces)
Implementation%20Handbook%20for%20HSA%20FSA%20FINAL.docx