Flexible Spending Accounts

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Home > Benefits > Flexible Spending Accounts

Flexible Spending Accounts

BVSD offers you the benefit of using pre-tax dollars to pay eligible health care expenses that are not reimbursed by the district’s health/dental plans. Read about pre-tax premiums also, which affect take-home dollars. Using pre-tax gross earnings to pay for eligible expenses increases your take-home pay.

Eligible health care expenses: laser eye surgery, contact lens or prescription eyeglasses, contact solution, prescription sunglasses, co-payments, orthodontia, hearing aid batteries, co-insurance, some forms of alternative medicine, some health care not covered or partially covered by insurance, some forms of vitamins, etc. for all family members, even if they are not on your coverage through the district. (Premium payments for other insurance carriers are not an eligible expense.)

Planned Benefit Systems Web Site

Health Care and Dependent Care Plans Information
Transportation Plan Information
Opt Out Form
Flexible Spending Enrollment Form 2009
Eligible Expenses Guidelines
Over the Counter Medications
A Savings Example
Hot Topic - IIAS

Health Care Expense Claim Form

Dependent Care Expense Claim Form

How to File for Reimbursement

For information on submitting claims online, please see Hot Topic - Learn How to File Online Claims.

Complete the form in its entirety (including participant name & signature, employer name, address) & staple Receipt(s) to claim form (when possible). Remit signed and completed claim form by fax or mail to:

PLANNED BENEFIT SYSTEMS, INC.
FAX# 303-221-2785
6377 S. Revere Pkwy-Suite 350
Centennial, CO 80111

Submit your provider receipt or explanation of benefits (EOB) from insurance company with all of the following information:

Name of Service Provider
Address of Service Provider
Date of Service(s)
Cost of Service
Description of Service

Orthodontic and cosmetic work: See information on form. Daycare Claims must also include tax identification number or social security number.

Child Care Claim Form
Health Care Claim Form
Transportation Claim Form

If you are experiencing difficulties downloading the enrollment form, you can get a hard copy sent to you by e-mailing the Human Resources Office or call HRD at (303) 447-5031.

Flexible Benefits Vendor

Boulder Valley School District has a vendor to handle medical flex, dependent care and transportation accounts:

    Planned Benefit Systems, Inc.
    6377 South Revere Parkway
    Suite 350
    Centennial, CO 80111
    Web: www.cci-pbs.com
    303-221-2783

The Planned Benefit Systems staff will answer questions about flexible benefits and/or dependent care accounts. Contact them directly for information.

NOTE: You can create an account USER ID and Password online at the MBI Web Site to check your balance at any time. You can also call a customer service representative at 1-800-800-0133.