PLEASE NOTE: YOUR FAMILY CANNOT CONTRIBUTE MORE THAN $5,000 TO THIS ACCOUNT FOR THE YEAR.

Use this table to calculate your total dependent care expenses for the upcoming year. Enter your projected expense for each month in the space provided, then enter the number of pay periods for the entire year to find the amount that should be deducted from your pay each pay period. Remember to take into account vacations, holidays, etc. to arrive at the most accurate projection possible. Always use the more conservative figure since you will forfeit any unused funds at the end of the plan year.

Additionally, please note that Dependent Care changes can be made during the plan year if there is a status change. Status changes can include: change in employee's legal marital status, change in number of dependents, change in employment status of employee spouse or dependent that affects benefit eligibility, dependent satisfies or ceases to satisfy dependent eligibility requirements, cost changes (exception if caregiver is a relative, no change permitted), significant coverage change or curtailment, and change in coverage of spouse or dependent under other employer's plan.

You may be reimbursed up to $5,000 of daycare expense per family filing a joint tax return (excluding tuition, educational expenses or overnight camps). Both you and your spouse (if applicable) must be actively employed or seeking employment to be eligible to participate.