New Hampshire
Local Government Center
25 Triangle Park Drive Concord, NH 03301
603.224.7447



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Flexible Spending 
Account Administration

At New Hampshire Local Government Center (LGC), we provide Flexible Spending Account (FSA) plans that can offer valuable tax savings for you and your employees while helping support employee recruitment, retention and job satisfaction.Click on one of the links below to learn more about our FSA offerings:

PLAN DOCUMENT PREPARATION
HEALTHCARE FSA
DEPENDENT CARE REIMBURSEMENT
HOW THE FSA PLANS WORK
CUSTOMIZABLE COMPONENTS

FSA ADMINISTRATION RATE SHEET
GETTING STARTED

Link to online FSA information for individual members which includes specifics on how a Healthcare FSA and/or Dependent Care Reimbursement Account works. If you are already partnering with us on offering an FSA plan to your employees, use these handy links to access the following:

LGC'S ADMINISTRATIVE FSA WEB SITE (password protected)
REIMBURSEMENT FORM*
LIST OF ELIGIBLE / INELIGIBLE EXPENSES*
FLEXIBLE BENEFITS PLAN CHANGE-IN-STATUS FORM*
FSA SUPPLY ORDER FORM


*You will need to have Adobe Acrobat Reader® software installed on your computer in order to download these documents as PDFs. If you don't already have it installed, click on our hyperlink to install a free copy.

PLAN DOCUMENT PREPARATION

Section 125 of the Internal Revenue Code (IRC) allows employees to have their medical and/or dental premiums payroll deducted using pre-tax* dollars (*prior to federal income or Social Security tax deductions). This offering is referred to as a premium conversion plan. Premium conversion plans can provide welcome savings for your employees in times of growing healthcare costs and personal budgeting constraints. The IRC requires employers to have formal plan documents in place when implementing premium conversion, healthcare or dependent care reimbursement plans. 

Through our Plan Document Preparation service, LGC will develop and continually update all plan documents as required by federal law changes related to premium conversion plans or healthcare/dependent care reimbursement accounts.   

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HEALTHCARE FSA

Through this FSA offering, your employees may be reimbursed for their health, vision and dental care expenses that are medically necessary but not covered through their benefits programs or any other source. Employees can access their designated healthcare FSA funds by submitting a reimbursement request form (or by using a related debit card should your group choose to offer that feature - see the Customizable Components section below for more related information) after purchasing eligible medical products or incurring medical expenses up to the amount specified through their individual election. 

Examples of medical expenses reimbursable through a Healthcare FSA include the following: 

  • Healthcare plan deductible
  • Percentage of covered expenses that the healthcare plan doesn't pay
  • Dental expenses not reimbursed through a dental plan
  • Hearing expenses, including examinations and hearing aids
  • Vision expenses, including examinations, lenses and frames
  • Contact lenses, including solutions
  • Chiropractic expenses
  • Acupuncture

Certain over-the-counter medications can also be reimbursed if your group chooses this option (see the Customizable Components section below for more related information). 

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DEPENDENT CARE REIMBURSEMENT

This FSA plan reimburses participants for eligible daycare (including eldercare) expenses related to IRS-defined dependents. This includes the cost for providing daycare of dependents so that employees may work as productively and worry-free as possible. Tax savings result by allowing up to $5,000 in pre-tax dollars to be set aside for certain expenses incurred for any child under the age of 13 or for other dependents who are physically or mentally unable to care for themselves.  Examples of expenses reimbursable through a dependent care FSA include the following: 

  • Dependent care provided in a private home (when the costs are reported as income)
  • Dependent care provided in a child or adult daycare center
  • Nursery school
  • After-school program
  • Summer daycare

HOW THE FSA PLANS WORK

Your employees simply need to complete an enrollment form to participate in any of our FSA offerings. If participating in either the Dependent Care Reimbursement or Healthcare FSA, LGC will provide an informational brochure that explains how the program works and features a convenient worksheet for estimating their yearly out-of-pocket reimbursable expenses. Money allocated for either of these FSA offerings is automatically deducted from each paycheck and deposited into an FSA account with LGC. Employees may then draw upon those funds as eligible expenses are incurred. 

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CUSTOMIZABLE COMPONENTS

The following options are available for you to customize LGC's FSA offerings and create tax-saving plans tailored for your employees. 

Debit Card Feature
Participating employees can easily manage their own FSAs with a designated debit card for exclusively purchasing eligible medical products or services up to the amount specified in their FSA plan. This provides employees with convenient access to their FSA funds while eliminating the need to complete and submit reimbursement forms. If you choose to provide your employees with this option, they will receive a Benny™ Prepaid Visa® Card Brochure and Debit Card Frequently Asked Questions handout to help them learn more about the debit card feature.  For plans that allow the purchase of over-the-counter items, the debit card works only at retail establishments that have implemented an Inventory Information Approval System (IIAS). Check these IIAS Participating Merchant List and Pending Merchant List links regularly to view and download the most current listings of certified IIAS merchants and merchants who plan to implement systems to identify eligible healthcare items in the future.

Over-the-Counter Medications
At your group's election, employees who participate in a healthcare FSA can be reimbursed for certain over-the-counter (OTC) medications like allergy medicines, cough syrups and eye drops with their designated pre-tax dollars. LGC can provide you with a List of Eligible / Ineligible Expenses to share with participating employees that identifies both allowable OTC medications and items not considered eligible for reimbursement. 

Extended Reimbursement Deadline
In the past, the Internal Revenue Service's "use-or-lose" rule required employees to use all of their designated FSA funds during a plan year or forfeit remaining balances. Now, however, employers may opt to offer an extended reimbursement deadline allowing participants in either the Dependent Care or Healthcare FSA to carry forward balances for up to two-and-a-half months and receive reimbursement for qualified expenses incurred during those extended months. This feature can take the pressure off your employees to spend FSA monies before a plan year ends. Consider this add-on feature when offering LGC's Dependent Care Reimbursement or Healthcare FSA at your workplace! 

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GETTING STARTED

To start offering LGC's FSA Administration service, contact your LGC Account Representative directly or call 800.852.3358. It's as simple as that!  You can also e-mail us at fsa@nhlgc.org.