Flexible Spending


What is a flexible spending account, or FSA?

Flexible spending accounts, also called flexible spending arrangements, allow people to use tax-free contributions from their paychecks for specific expenses. There are several types of FSAs, but the most common are health FSAs, which participants can use to pay for medical and dental costs that aren't covered by insurance.

With an FSA, you'll decide how much you want to contribute (up to the cap) at the beginning of the year, and your employer will deduct a portion of it from every paycheck.

FSAs must follow a "use it or lose it" system where unused funds at the end of the year are forfeited. Employees do get up to a 2.5-month grace period (that is, until March 15th of the following year) to spend FSA funds.


All non-temporary St. Louis County employees are eligible to enroll in flexible spending after one full calendar month of employment.

Each year you will choose to participate in St. Louis County's Flexible Spending Plan.   The program could produce real tax savings to you, but it does require that you plan for any anticipated expenses for the entire plan year.  Once the Plan Year begins, you may not make any changes to either the allocation of monies or accounts without a qualifying family status change event.   Your choices and the amounts you allocate to them will depend solely on the needs and expenses of you and your family.  All unclaimed contributions will be forfeited.   A grace period will occur each year between January 1 and March 15th.  Expenses incurred during the grace period will first be reimbursed with any unclaimed flex funds from the prior year and then reimbursed with any current year flex funds.  


Flexible Spending Program Booklet


The only cost for this program is the annual $18 fee for debit/benny cards which is deducted from your flex account.


Maximum Flex Elections:

Health Care Reimbursement Account cap = $3,200 per participating employee
Dependent Care Reimbursement Account cap = $5,000 per tax return ($2,500 for MFS filing status)
Adoption Reimbursement Account cap = $16,810 per child

Health Care Reimbursement Account cap = $3,050 per participating employee
Dependent Care Reimbursement Account cap = $5,000 per tax return ($2,500 for MFS filing status)
Adoption Reimbursement Account cap = $15,950 per child

Health Care Reimbursement Account cap = $2,850 per participating employee
Dependent Care Reimbursement Account cap = $5,000 per tax return ($2,500 for MFS filing status)
Adoption Reimbursement Account cap = $14,890 per child




Choose the correct form below: 


2024 Flexible Spending Enrollment Form


2024 Flexible Spending Amendment Form (Use this form to CHANGE your existing 2024 flex accounts)





Medical Necessity Form
Paper Reimbursement Form






My Flex Account Login

 Default user name: email address 
Default Password: Employee ID


Beth Menor
Sr. HR Advisor - Benefits

Sandra Kohn
Information Specialist II

Angie Rish
Information Specialist III

All contacts

Unspent Flex Funds?  Need Ideas?


What can I spend my FSA money on?

Medical treatment such as doctor and emergency room visits, insurance deductibles and copayments, and prescription medicines are fair game. But there is also a long list of approved products and services that are eligible for FSA coverage.

While some FSA items are automatically eligible for everyone, other products and services require a letter of medical necessity (LMN) from a licensed physician. The following list of FSA-eligible products is not exhaustive, but it covers all of the major categories of medical and dental care that can be paid for with FSA money:

COVID-19: COVID-related products such as face masks, at-home tests and hand sanitizer qualify for FSA reimbursement.

Dental procedures and products: Your dentures, implants, bridges and sealants are all covered by FSA, as are dental reconstruction and wisdom teeth removal. FSA funds usually cover orthodontia, including Invisalign. Veneers require an LMN from a dentist.

Vision: Not only can you use your FSA funds for prescription eyeglasses and prescription sunglasses, you can also use them for non-prescription reading glasses or blue-blocker glasses. Similarly, contact lenses and supplies, including cleaning solution and lens cases, are eligible for FSA coverage, as are cataract and laser eye surgery.

Hearing: Your FSA money can be used for hearing aids, as well as batteries and maintenance for those aids. Telephones for the hearing impaired are also covered, as are products like ear cleaners and wax removers.

Breathing: Respiratory products such as nasal spray, inhalers and vaporizers are eligible for FSA coverage. With an LMN from a doctor, air conditioning, air filters and air purifiers can all be eligible for reimbursement.

Sleep:Along with OTC sleep medications, your FSA money can also be used for CPAP machines for sleep apnea and mouth guards to prevent teeth grinding. Prescription sleep medicine is also included. Items such as pillows with lumbar support or melatonin can be covered with an LMN from a doctor.

Preventive screenings: Tests evaluating your health can be paid for with FSA money. Eligible screenings include DNA testing, heart scans, cancer screening, diabetes screening, HPV and HIV screening, breast cancer mammography screening and CT scans, and any blood tests that aren't covered by insurance.

Pregnancy and sexual health: Most pregnancy-related items and services are eligible for FSA funding, including pregnancy tests, prenatal vitamins, infertility treatments, intrauterine insemination and in vitro fertilization. Also covered: costs related to egg donors, surrogates, and egg and embryo storage. Men can use FSA funds on vasectomy reversal and medication for erectile dysfunction.

Menstruation: Pads, tampons, period underwear, pain relievers and other menstrual supplies all qualify as FSA expenses.

Medical equipment: Most products for measuring health are eligible for FSA money. Examples are thermometers, blood pressure monitors, blood sugar test kits and pulse oximeters.

Batteries: Along with the medical equipment itself, if you use batteries to power medical devices, they are FSA eligible.

Mental health: You can use FSA money for mental health treatments and services, including therapy and counseling in person or online. Visits to psychologists or psychiatrists are eligible, as are psychiatric care and prescription medicine. Unfortunately, marriage and couples counseling are not eligible for FSA reimbursement.

Addiction: FSAs can cover smoking cessation treatments and products to help stop smoking, like nicotine gum or patches. They can also cover donations to Alcoholics Anonymous meetings and the cost of transportation to attend, as well as other substance abuse programs and treatment for gambling addiction. An LMN is required to cover the cost of staying at a halfway house.

Weight loss: Weight-loss programs are eligible for FSA coverage, as are gastric bypass or lap-band surgeries. Prescription drugs for weight loss are also eligible.

Physical fitness: Most fitness expenses aren't eligible for FSA coverage unless they are prescribed by a physician with an LMN. These expenses, if doctor recommended, can include personal trainers, gym memberships and yoga classes.

Athletic protection: If you're looking to keep yourself safe and healthy during athletic activity, your FSA funds will cover many items, including athletic tape, braces and bandages, cups, face masks and mouth guards.

Muscle therapy: Most physical therapy is eligible for FSA funding, including massage devices at home. You can also use your FSA money for carpal tunnel supports, back braces or heating and cooling pads.

Babies: FSA funds cover many newborn-related expenses, including breast pumps, lactation consultants, breastfeeding classes, breast milk storage bags, diaper rash ointment, children's sunscreen and baby breathing monitors. Infant formula can qualify, but only with an LMN from a doctor.

Contraception: FSA funds can help prevent unwanted pregnancies as well. Birth control pills, tubal ligation, vasectomies and condoms are all eligible. Levonorgestrel-based "morning-after pills" like Plan B One-Step or Take Action are eligible for FSA funding, as are all legal abortion procedures, including RU-486 pills (mifepristone).

Over-the-counter medicine: OTC medications were not FSA eligible until the passage of the Coronavirus Aid, Relief, and Economic Security Act in 2020. Now, cold, flu and allergy medications, pain relievers like ibuprofen and acetaminophen, motion sickness pills, glucosamine sulfate for joint pain and other OTC medicine all qualify for FSA claims. First-aid kits and supplies like adhesive bandages and antibiotics are also eligible.

Foot care: Even though you can't use FSA funds for athletic shoes (no matter how orthopedic) you can still use FSA money for healthy feet. Foot care products such as supports for high or low arches and corn removers are some of the items eligible for coverage.

Transportation: FSA money can be used to pay for travel expenses related to medical care or advice, including airplane tickets, gas, mileage and maintenance costs, parking, bus or train fares and lodging.

Alternative medicine: A few nontraditional medical products and practices are eligible for FSA funding, including acupuncture, chiropractic services, homeopathy and holistic medicine.

Health-related home improvements: If you need to change your living situation to account for an injury or medical situation, your FSA money should be eligible for most of it, including wheelchair ramps, grab bars, wider doorways, lower kitchen cabinets or counters, and home elevators, 

Mobility: For help getting around, FSA money can cover many products, including scooters, wheelchairs, crutches, canes and artificial limbs. Modifications to vehicles can also be eligible for FSA reimbursement with an LMN from a doctor.