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 and documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Please do not submit your form/document more than once.  This will only delay processing.

You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload.  You will not receive a separate email confirmation.

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 above.

 

FSA Program Guides, Brochures & Forms

Brochures and Enrollment/Change Forms

Plan Year 2021

Plan Year 2020

Procedures Guide

Plan Year 2021

  • DeCAP 2021 - available soon
  • HCFSA 2021 - available soon

Plan Year 2020

Plan Year 2019


FSA Claims Forms

Please direct all inquiries/correspondence and claims as follows:
1) Inquiries and questions can be sent via email to the Program.
2) Forms/documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Plan Year 2021

  • 2021 DeCAP Claims Form
  • 2021 HCFSA Claims Form

Plan Year 2020/2019



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.