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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 CompanyHIPAA Confidential/PrivateHelp you save moneyWe are here to help you get the most out of this benefitCompletely voluntary benefit for you and your whole familyYou do not have to enroll in the company insurance to participateYour 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) itemsMail order prescription invoices and online pharmacyAmount Due on medical and dental statements incurred in the plan yearDoctor and emergency room co-paymentsHealth plan deductibles and coinsuranceDental expensesOrthodonticsVision services and eyeglassesLASIK 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 GONEGood Elections

Nondrug Over-the-Counter Items

24/7 Account balance availability Online at www.beneflexhr.comIVR at (913) 789-4600WorksheetTalk with your medical providers to help forecast your upcoming expenses.

Dependent Care FSAThe maximum election is $5,000 per year per householdCovers expenses for the following:DaycareLatchkeySummer/Sports Camp (No overnight)Adult DaycareMedical FSAThe maximum election is determined by your companyCovers expenses for the following:Dr. visit and prescription copaymentsVision ExpensesDental ExpensesNondrug Over-the-Counter ItemsContact your HR department to determine the medical election amount available to you.

FSA Medical ExpensesOver-the-Counter Eligible ExpensesThe 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 ExpensesAs of January 1, 2011FSA 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 ExpensesThe OTC items affected include items in the following categoriesAcid ControllersAllergy & SinusAntibiotic productsAnti-diarrhealsAnti-gasAnti-itch & insect biteAntiparasitic treatmentsBaby rash ointmentscreamsCold sore remediesCough, cold & fluDigestive aidsFeminine anti-fungal/itchHemorrhoidal pres

LaxativesMotion sicknessPain reliefRespiratory treatmentsSleep aids & sedativesStomach remediesOver-the-Counter Eligible ItemsIf 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 doctors 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 doctors prescription.FSA Reimbursement MethodManualDeadline 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 FormsTo download a claim form, go to www.beneflexhr.com, click on Section 125 & HRA, Click Printable Forms

Claim Form Employee InformationComplete all employee informationCheck the box if you have a new address

Complete all requested informationThe claim form can be used as the receipt if the provider signs the form and provides his or her Social Security Number or Tax IDClaim Form Dependent Care

Claim Submission Guidelines Dependent CareDependent Care ReimbursementCanceled 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 renderedDate of original service, not a billing dateAmount of chargeFederal ID number (facility) or social security number (individual)Claim Form Flexible Medical AccountClaim must include a requested amount. Claim must be itemized or group by item. If claiming an OTC medicine, doctors prescription must be attached along with the receipts.If claiming a dual use item, doctors letter must be attached along with receipts.

Claim Submission Guidelines Acceptable ReceiptsGUIDELINES FOR SUBMISSION OF CLAIMS: The Internal Revenue Code provides the following guidelines:Medical ReimbursementThe best receipt is an Explanation of Benefits from your insurance company.If other receipts are submitted, they must show the following information:Who rendered the service (name and address)What type of service was renderedDate service was provided, not a billing or due dateAmount of chargeAny insurance payment, if applicableCanceled checks and credit card slips are not allowable receipts.

Claim Submission Guidelines Over-the-Counter Non DrugsOver-the-Counter (OTC) non drugs Partial listing online at www.beneflexhr.comWhen and who sold the product (date, name & address)Type of OTC was purchased - *Must show product or brand nameAmount 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 DrugsOver-the-Counter (OTC) drugs Doctors prescription requiredWhen and who sold the product (date, name & address)Type of OTC was purchased - *Must show product or brand nameAmount of charge*If the receipt does not show the name of the product you can write the product name on the receipt.Claim Form SignatureAccording 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 BalanceWeb 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.QuestionsPlease call BeneFLEX at (800) 631-3539or(314) 909-6979