BeneFLEX HR Resources & Benny Say:

FSAFlexible Spending Account

The more you know about Flexible Spending Accounts

The more you save!

Section 125 Plan

Benefit paid for by the Company HIPAA – Confidential/Private Help you save money We are here to help you get the most out of this benefit

Completely voluntary benefit for you and your whole family

You do not have to enroll in the company insurance to participate

Your election can be used for expenses incurred by you, your spouse, and dependents. They also do not need to be on your insurance plan to participate.

What is a Flexible Spending Account?

An FSA is a benefit program that enables pre-tax dollars to be used to pay for eligible out-of-pocket health care expenses like: Prescription co-payments and nondrug over-the-counter (OTC) items Mail order prescription invoices and online pharmacy “Amount Due” on medical and dental statements incurred in the plan year Doctor and emergency room co-payments Health plan deductibles and coinsurance Dental expenses Orthodontics Vision services and eyeglasses LASIK surgery

An Example:

In this example, the employee participating in the FSA plan saves $100 a month - $1,200 a year pre-tax.

Use It or Lose It – THE FEAR IS GONE

Good Elections

Nondrug Over-the-Counter Items

24/7 Account balance availability Online at www.beneflexhr.com IVR at (913) 789-4600

Worksheet

Talk with your medical providers to help forecast your upcoming expenses.

Dependent Care FSA

The maximum election is $5,000 per year per household

Covers expenses for the following:DaycareLatchkeySummer/Sports Camp (No overnight)Adult Daycare

Medical FSA

The maximum election is determined by your company

Covers expenses for the following:Dr. visit and prescription copaymentsVision ExpensesDental ExpensesNondrug Over-the-Counter Items

Contact your HR department to determine the medical election amount available to you.

FSA Medical Expenses

Over-the-Counter Eligible Expenses

The recently enacted Patient Protection and Affordable Care Act of 2010 has changed the rules for the purchase of over-the-counter (OTC) products using your Flexible Spending Account (FSA) pre-tax funds.

The IRS currently allows OTC drugs and nondrug items to be reimbursed using your FSA dollars.

Over-the-Counter Eligible Expenses

As of January 1, 2011 FSA funds can no longer be used to purchase OTC

medicine and drugs unless a medicine or drug is prescribed. A “prescription” means a written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual who is legally authorized to issue a prescription in that state.

Over-the-Counter Eligible Expenses

The OTC items affected include items in the following categories

Acid Controllers Allergy & Sinus Antibiotic products Anti-diarrheals Anti-gas Anti-itch & insect bite Antiparasitic treatments

Baby rash ointmentscreams

Cold sore remedies Cough, cold & flu Digestive aids Feminine anti-fungal/itch Hemorrhoidal pres

Laxatives Motion sickness Pain relief Respiratory treatments Sleep aids & sedatives Stomach remedies

Over-the-Counter Eligible Items

If you have a prescription for an OTC medicine or drug, you must pay out-of-pocket at point-of-sale and then submit a manual claim requesting reimbursement.

You can continue to use your FSA funds to purchase OTC items that are not considered a medicine or drug (e.g. bandages, splints, contact lens solution, etc.) Please note that insulin remains an eligible expense with or without a prescription.

Remember to consider these new OTC rules when estimating the dollar amount to put in your FSA for the next plan year.

Dual Use

Items under the “dual use” require a doctor’s letter. Once BeneFLEX receives the letter, it is placed on file for the remainder of the year.

In addition to OTC drug or medication requiring a doctor’s prescription.

FSA Reimbursement Method

ManualDeadline Tuesday 3:00 p.m. CSTComplete Claim Form – fax or mail along

with a copy of receipts to BeneFLEXChecks issued on ThursdayDirect Deposit

To download a direct deposit form, go to www.beneflexhr.com, hover over Section 125, HRA & HSA, Click Printable Forms

To download a claim form, go to www.beneflexhr.com, click on Section 125 & HRA, Click Printable Forms

Claim Form – Employee Information

Complete all employee information Check the box if you have a new address

Complete all requested information The claim form can be used as the receipt if the

provider signs the form and provides his or her Social Security Number or Tax ID

Claim Form – Dependent Care

Claim Submission Guidelines Dependent Care

Dependent Care Reimbursement Canceled checks are ok. If you include a copy of the

front & back, the dates of service & either the facility federal ID number or the social security number of the individual providing service.

All receipts must show the following information: Who rendered the services (name and address) What type of service was rendered Date of original service, not a billing date Amount of charge Federal ID number (facility) or social security number

(individual)

Claim Form – Flexible Medical Account

Claim must include a requested amount. Claim must be itemized or group by item. If claiming an OTC medicine, doctor’s prescription must be attached

along with the receipts. If claiming a “dual use” item, doctor’s letter must be attached along with

receipts.

Claim Submission Guidelines Acceptable Receipts

GUIDELINES FOR SUBMISSION OF CLAIMS: The Internal Revenue Code provides the following guidelines:

Medical Reimbursement The best receipt is an Explanation of Benefits from your insurance

company. If other receipts are submitted, they must show the following

information:1. Who rendered the service (name and address)2. What type of service was rendered3. Date service was provided, not a billing or due date4. Amount of charge5. Any insurance payment, if applicable

– Canceled checks and credit card slips are not allowable receipts.

Claim Submission Guidelines Over-the-Counter Non Drugs

Over-the-Counter (OTC) non drugs – Partial listing online at www.beneflexhr.com When and who sold the product (date, name &

address) Type of OTC was purchased - *Must show product

or brand name Amount of charge

*If the receipt does not show the name of the product you can write the product name on the receipt.

Claim Submission Guidelines Over-the-Counter Drugs

Over-the-Counter (OTC) drugs – Doctor’s prescription required When and who sold the product (date, name &

address) Type of OTC was purchased - *Must show product

or brand name Amount of charge

*If the receipt does not show the name of the product you can write the product name on the receipt.

Claim Form – Signature

According to the IRS guidelines, requested reimbursements cannot be claimed through any other plan, the claim form must be signed acknowledging the participant is aware and abiding by this IRS rule.

Know your Account Balance

Web Site – www.beneflexhr.comInteractive Voice Response (IVR)

(913-789-4600)Office Hours (7:00 a.m. to 6:00 p.m.

CST)(314-909-6979) or  (800-631-3539)

3rd Quarter StatementReimbursement Checks

To access your account information, hover over “Section 125, HRA & HSA” on the menu bar.Then click on “FSA & HRA Employee Account Information”.

If you are a new user, click “New User” on the right and follow the steps to setup your account.

Questions

Please call BeneFLEX

at (800) 631-3539

or

(314) 909-6979