Health FSA Plan

$345.00

Plan documents prepared for your church

MEDICAL REIMBURSEMENTPRE-TAXFOR CHURCHES

Let employees set aside pre-tax dollars for medical costs like co-pays, prescriptions and vision care. Usually 100% employee funded.

Lower payroll taxes for the church and employees
Covers co-pays, deductibles, prescriptions, dental and vision
A popular, low-cost benefit to offer
Plan document, SPD, forms and administrative handbook

2026$

2026 IRS limitEmployees can set aside up to $3,400 for the year. The IRS adjusts this limit each year.

Need help choosing the right solution?For more than 45 years, we’ve helped clergy and religious organizations with tax, payroll, bookkeeping and HR. Connect with an advisor for guidance tailored to your needs.

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Options

Type of Plan *

Your Name (First/Last) : *

Your Address – City/State/Zip : *

Your Phone Number : *

Your E-mail Address : *

Employer/Church Name : *

Employer/Church Address – City/State/Zip : *

Employer/Church Phone Number : *

Employer Federal ID# : *

State of Incorporation : *

Number of Employees : *

Plan Administrator (First/Last Name) : *

Annual Plan Limits (The IRS limits Health FSA plans to $3,300 in employee contributions (effective 01/01/2025) – Enter the standard $3,300, or enter a lower employee contribution limit below. : *

$600.00 Carryover Provision (Employees can carryover up to $600 of unused Health FSA benefits to the next plan year) : *

2.5 month Grace Period (Employee has 2.5 months after plan year to spend-down unused Health FSA benefits) :

90 day “Run-Out” Period (you would have until March 31 of the following year to submit claims for reimbursement.) :

Effective Date *

Effective Date :

Eligibile Employee Work More than _____ hours per week. : *

Waiting Period *

Number of Days : *

Other :

Description

Description

How it works

Three steps to a finished plan.

Complete the enrollment formFill out the form above.

Advisor reviewA benefit plan advisor reviews your questionnaire for completeness.

Finalize your planSchedule an appointment to finalize. Then we prepare your plan document, SPD, forms, helpful guides and signing instructions.

What can be reimbursed

Qualifying medical expenses, including but not limited to:

Vision, glasses and contactsHealth plan deductiblesPrescription drugsHealth plan co-paymentsOrthodonticsChiropracticDental chargesBlood work and X-raysOther qualifying medical expenses

What the plan includes

Prepared for your church and kept on file for compliance.

Resolution to adopt

Meeting minutes recording the church’s decision to establish the plan as an employee benefit.

Customized plan document

The rules, benefits and terms of your plan, prepared for your church and kept on file for IRS review.

Summary Plan Description

An easy-to-read guide for employees with all federally required disclosures (plan year, Federal ID, agent for legal service, COBRA, FMLA and DOL information).

Election and claim forms

Personalized forms for employees to join the plan and submit expenses for reimbursement.

Administrative handbook

Administration, non-discrimination testing, and reporting and disclosure.

Common questions

About the plan and your order.

Who pays into a Health FSA?

FSAs are set up by the employer and are usually funded entirely by employees through pre-tax payroll deductions.

How much can employees set aside?

For 2026 the IRS limit is $3,400 per employee. It’s adjusted each year.

Where can I read more?

The IRS explains how FSAs work in Publication 969 (PDF).

Can I return it?

See the Refund & Return Policy tab above.

I’d rather have someone help me.

Our team works with churches and clergy every day. Email clientservices@clergyfinancial.com or call (888) 421-0101.

Serving Those Who Serve