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Flexible Spending Accounts
Important Notice
The Flexible Spending Accounts Program client service center is closed. Due to the closure of the office, if you mailed or faxed forms or correspondance March 11, 2020 or after, we cannot access or process that form.
Please resubmit your forms and documents as follows:
1) Inquiries and questions can be sent via email to the Program.
2) Forms/documents can be sent via secure email to: https://asonet.com/emailFSA.aspx
3) Forms can also be faxed to: (877) 290-6587
Also, please do not send forms or documents via express mail. The office is closed and the package cannot be accepted.
Please check back periodically for updates and how to send forms and claims electronically to the Program.
IMPORTANT - If you are currently receiving your reimbursement via check, please complete a Direct Deposit Form in order to receive reimbursement in a timely fashion. Do not mail your completed form to the address on the form. Please submit your completed form following the directions in #2 or #3 above.
FSA Program Guides, Brochures & Forms
Brochures and Enrollment/Change Forms
Plan Year 2020
- Plan Year 2020 Flexible Spending Accounts Program Brochure
- Plan Year 2020 FSA Enrollment/Change Form
- Plan Year 2020 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
- Plan Year 2020 MSC Premium Conversion Enrollment/Change Form
- Plan Year 2020 HCFSA/DeCAP SPD
- Plan Year 2020 MSC SPD
Plan Year 2019
- Plan Year 2019 Flexible Spending Accounts Program Brochure
- Plan Year 2019 FSA Enrollment/Change Form
- Plan Year 2019 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
- Plan Year 2019 MSC Premium Conversion Enrollment/Change Form
- Plan Year 2019 HCFSA/DeCAP SPD
- Plan Year 2019 MSC SPD
Procedures Guide
Plan Year 2020
Plan Year 2019
FSA Claims Forms
Please direct all written inquiries/correspondence and claims to the following mailing address:
New York City Flexible Spending Accounts Program
Bowling Green Station
P.O. Box 707
New York, NY 10274
Plan Year 2020
Plan Year 2019
Lost Check Claim
To submit a claim for a lost check from the Management Benefits Fund, the Dependent Care Assistance Program, or the Health Care Flexible Spending Account Program.