Flexible Spending Account

1. Flexible Spending Account The more you know about Flexible Spending Accounts The more you save!

2. What is a Flexible Spending Account? An FSA is a free & voluntary benefit that allows you to set aside pre-tax dollars to reimburse out-of-pocket medical, dental, vision, and dependent care expenses.

3. Pre-tax Deductions Elections are withdrawn from your paycheck evenly throughout the year on a pre-tax basis. Benefit: Save 25-30% on pre-tax dollars

4. Eligible Expenses • Guide dog • Hearing aids and batteries • Hospital bills • Insulin and diabetic supplies • Laboratory fees • Laetrile by prescription • Nurse fees • Obstetrical expenses • Operations • Orthodontia • Orthopedic shoes • Osteopath fees • Oxygen • Physician fees • Practical nurse fees • Prescribed drugs–see cosmetic exceptions below • Psychiatric care • Psychologist fees or individual therapy • Radial keratotomy/Laser eye surgery • Routine physicals • Special communication equipment for the deaf • Smoking cessation prescriptions • Special plumbing for the handicapped • Surgical fees • Therapeutic care for drug and alcohol addiction • Therapy treatments, prescribed • Transplants • Transportation expenses/mileage to receive medical care or services • Tuition at special school for physically or mentally impaired • Wheelchairs • X-rays Per IRS regulations, the following, while not intended to be complete, illustrates examples of eligible medical or medical-related expenses. Expenses must be incurred during the Plan Year from which you are requesting reimbursement. Expenses are considered incurred when service is rendered, not when service is billed or payment is made. Expenses cannot be reimbursed in advance of the date service is rendered.

5. Ineligible Expenses Cosmetic procedures are not eligible FSA Expenses Teeth Whitening Not an FSA Eligible Expense Massages Must be Medically Necessary & Require a Doctor’s Letter

6. Who is Eligible to Participate To participate in an FSA , you must be eligible to enroll in your company’s group health insurance. Example: You may still participate in your FSA benefit if you are eligible for your company’s group health insurance, but do not enroll because your coverage is through your spouses employer.

7. Who Can Incur Expenses Expenses can be incurred by: • Participant • Spouse • Dependent Definition of a dependent: Child up to the age of 26, does not have to live at home, does not have to be a full-time student, and may be married.

8. When Are Funds Available Your entire medical FSA election is available to you on the first day of the plan year. Example: If your plan year start date is 1/1/2014, on that same day, you are eligible to use all of the funds in your account, even though your contributions will be deducted from your payroll check throughout the year.

9. How to Submit Claims Employee Portal • Login online at www.beneflexhr.com • Submit claims, view account balance, review claim history, sign up for direct deposit, & update your profile

10. How to Submit Claims BeneFlexHR Mobile App • App is available for all iphones, ipads, and Android devices. • Submit medical FSA claims, check account balances, upload pictures of receipts, and receive text alerts.

11. How to Submit Claims Customer Service • Office Hours 7:00 a.m. to 6:00 p.m. CST • Phone: 314-909-6979 800-631-3539 (toll free) • Email: info@beneflexhr.com

12. Claims Processing Deadline for claims processing is Tuesday at 3:00 p.m. CST. Claims submitted by the Tuesday deadline will be paid on Thursday via check or direct deposit.

13. Claim Form Download at www.beneflexhr.com. Click on “Employee” and then “Printable Forms”.

14. Over-the-Counter Eligible Expenses

15. Requirements for 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.

16. Dependent Care Daycare expenses for a dependent includes; child care expenses for dependent children under the age of 13 years old or care for a dependent that is not mentally or physically able of caring for themselves .

17. Dependent Care Expenses Examples: • Before/After School Programs • Summer Camps (not overnight) • In-Home Daycare • Adult Day Care Programs • Must reside with you at least 6 or more months of the year.

18. Dependent Care Maximum Election: • $5,000 per year/per household Individual or facility must reflect income on tax returns. Claim form must reflect a Social Security Number or Federal Tax ID Number of the provider.

19. Dependent Care Reimbursement Manual claims must be submitted to BeneFLEX for reimbursement via the Employee Portal, fax, or mail. • Dependent Care elections are not loaded on the Benny Card.

20. General Program Rules • Must make an election each year to participate. • Only way to change your election during the plan year is to have a Life Changing or Qualifying Event. Examples of a Qualifying Event: • Marriage, divorce, birth of a child, adoption of a child, or spouse loses his/her job.

21. Questions 10805 Sunset Office Drive, Ste. 401 St. Louis, Mo 63127 Phone: 314.909.6979 Toll Free: 800.631.3539 Email: info@beneflexhr.com Website: www.beneflexhr.com