Flexible Spending Accounts (FSA)

What is an FSA? How do they work? 

Watch the video below, provided by our FSA Administrator, P&G Group. It provides a detailed overview of both FSAs that we offer: Healthcare FSA and Child Care Dependent FSA.  

The video also reviews what events qualify members to make changes to their existing FSA elections outside of Open Enrollment (e.g. when a daycare center re-opens) and describes what qualifying expenses are. This video was recorded on 10-20-20.


With a Flexible Spending Account (FSA), City and County of San Francisco and Superior Court of San Francisco employees can save up to 40% paying pre-tax for qualified out-of-pocket health care and dependent care expenses. FSA administrator P&A Group provides tools that allow you to submit reimbursements online or with a smartphone. So it is easier than ever to make the most of your FSA account. Read the FSA brochure for details.

You can sign up for an FSA during open enrollment or as a new hire. The amount you request is deducted from each paycheck before taxes, and placed in your P&A Group FSA account. You then submit receipts to P&A Group for qualifying expenses, to receive your reimbursement.

You can choose to make contributions to a Healthcare FSA, a Child Care Dependent Care FSA, or both.

A Healthcare FSA allows you to pay pre-tax for qualifying health care expenses for yourself and eligible family members, including:

  • medical, dental and vision co-pays,
  • massage,
  • chiropractic, and
  • acupuncture

The CARES Act and Healthcare FSAs

The CARES Act passed in March of 2020 and expanded the list of eligible expenses you can spend your Healthcare FSA dollars on.

Eligible expenses now include over-the-counter medications that previously required a prescription as well as menstrual products. If you have funds that expire at the end of December 31, 2020, you can use your FSA funds on over-the-counter medications.

These items can be purchased using you FSA debit card at most major retailers. For an expanded list of eligible products please visit FSA Store

Child Care Dependent Flexible Spending Accounts 

A Child Care Dependent Care FSA allows you to pay for certified day care, pre-school and elder care needed by eligible children under age 13 or aging parents. Note: if you have a stay-at-home parent in your household, you are not eligible for a Child Care Dependent Care FSA.


Due to COVID-19, the IRS recognizes that the need for childcare changes during this time, account usage for members who are enrolled in Child Care Dependent Care Flexible Spending Accounts can change. If there is a significant increase or decrease in the cost for dependent care, this may present an opportunity for members to adjust their elections for the Child Care Dependent
Care FSA only. 

The IRS allows members to enroll, change or cancel their Dependent Care election mid-year for the following reasons:

  • Birth/Adoption
  • Need for the service changes.
    • This means if you previously didn’t need dependent care services, because you or your spouse were at home, but now are returning to work, then this would qualify for a mid-year change to enroll or increase your dependent care election.
    • If you were using dependent care services, and now you or your spouse will be working from home, then you can decrease or cancel your election. If you are canceling or decreasing your election, you can only reduce your election to an amount already reimbursed to you or to the amount you have already contributed. No contributions to dependent care can be refunded as a result of canceling or reducing your election.
  • Cost of the service changes. If the provider you are using increases or decreases their costs, you can change your Child Care Dependent Care election accordingly. 

If you are enrolled in a Child Care Dependent Care FSA and your needs for childcare have changed, you can change your bi-weekly contributions that are deducted from your paycheck by submitting your request in writing and mail to SFHSS or fax at (628) 652-4701

How Much Should I Set Aside?

Before enrolling in an FSA make sure to work out a detailed estimate of the eligible expenses you are likely to incur for the plan year ahead. Budget conservatively. 

Based on federal law, you may roll forward up to $500 in unused funds year-over-year for Healthcare FSAs only (roll-overs do not apply to Child Care Dependent Care FSAs). Any unreimbursed funds in excess of $500 are forfeited at the end of the plan year and cannot be returned to you.

What Kind of Deductions are Eligible for FSA Reimbursement?
P&A Group has a list of deductions that qualify for FSA reimbursement here

After You Enroll
After you are enrolled, there are four ways to submit an FSA claim to P&A Group:

  • Benefits debit card. This allows you to swipe a card at the point-of-service. The qualifying expense will be deducted from your Flexible Spending Account balance. Use this form to request an FSA debit card.
  • Submit a claim from your smartphone. Take a picture of the receipt or other supporting documentation. Go to the P&A website on your smartphone. Log into your P&A Account and select upload.
  • Submit a claim from your desktop computer. Scanning a receipt or other documentation. Log into your P&A Group account and select upload.
  • Submit a paper claim. Download and complete the Claim Form below. Send to P&A Group, along with required documentation for your eligible expense.
  • Toll-free fax: (877) 855-7105
  • Mailing address: P&A Group, 17 Court Street, Suite 500 Buffalo, NY 14202

Consult with your tax advisor or the IRS about your specific situation and your potential tax savings with an FSA. View IRS Publication 502 for information about the Healthcare FSA, and IRS Publication 503 for details about the Child Care Dependent Care FSA.

In some cases, due to certain qualifying events, a member may be allowed to initiate or modify FSA contributions during the plan year. A maximum of two benefit election changes due to qualifying events may be made per year. Contact SFHSS Member Services at (628) 652-4700 if you have questions about an FSA and a qualifying event.

FSA Administrator: P&A Group

Questions? P&A Group administers FSA's on behalf of SFHSS, including processing reimbursement forms. P&A Group's mailing address is: P&A Group, 17 Court Street, Suite 500 Buffalo, NY 14202 and their toll-free fax number is (877) 855-7105. Contact P&A Group by visiting padmin.com or calling (800) 688-2611.