.`9\Bs(|+p*l8=+)n'W=rj94 .E~u==&$b4lny^|l *DgN69pvhRk'[y|~^y,x1T`TM~7rn>:4ee&:.sX1&9EX!YT0rV)E^b,q$YcaSJT [0fURCQ"5Z Get access to thousands of forms. Box 661147 Dallas , TX 75266-1147 Effective January 1, 2020, the paragraph Titled Agent for Services of Legal Process in the Read our response. Dallas County is joined with a cooperative insurance group along with other city and county agencies. __g 5j(]c;,mKK{x FG[ojl5kzW|S^}gdhg7_/b3-. endstream endobj 71 0 obj <>/Metadata 3 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 72 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 73 0 obj <> endobj 74 0 obj <> endobj 75 0 obj [/Separation/PANTONE#20137#20C 86 0 R<>] endobj 76 0 obj [/ICCBased 87 0 R] endobj 77 0 obj <>stream If you enroll in the HDP during annual enrollment, your employer will make a one-time cash deposit to your HSA in January. Claims are normally reimbursed within a week of HSA Bank receiving the claim. 2022 Medical, Dental, Vision and Prescription Active Employees. Your Medical Spending FSA may be used to reimburse out-of-pocket medical expenses for you, your spouse, and your dependents. If you retire or otherwise leave City employment, your FSA funds will terminate on the date of your departure. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. 0000029666 00000 n If you are not eligible for HSA contributions for example, if you are enrolled in Medicare the seed money contribution will go to an LP-FSA. Your Spending Account P.O. This guide will help you get started with Your Spending Account (YSA) a website you can use to manage your retiree Health Reimbursement Account (HRA) whenever and wherever it's most convenient for you. Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place this form before your receipts and don't include a cover letter. LOCATION. 0000010668 00000 n Your spending account is your checking account. Austin, Texas 78701-2982. Old Red Museum of Dallas County History and Culture, Community Supervision and Corrections (Adult Probation), Department of Unincorporated Area Services, Office of Homeland Security and Emergency Management, Dallas County Unincorporated Area Strategy, Vehicle Registration - VTR 68-A Inspections, Dallas Area Rapid Transit (DART) Pass Program, Colonial Life Voluntary Supplemental Insurance, Public Employees Benefits Cooperative (PEBC). To comply with HSA rules, your Limited- Purpose FSA may only be used to reimburse out-of-pocket dental and vision expenses for you, your spouse, and your dependents. endstream endobj startxref You can also make pretax contributions to your HSA, up to IRS limits, to help your account grow. . It's free to use. 0000001416 00000 n 0000041523 00000 n your spending account (ysa) login your spending account hewitt ysa reimbursement phone number your spending account phone number at&t hra claim form Create this form in 5 minutes! 4 0 obj %%EOF 0000013089 00000 n All claims must be submitted by March 31, 2023. Accounts - Tarrant County's Credit Union Benefits - Welcome to the City of Dallas, Texas
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