2015-2016 Flexible Benefit Plan Enrollment Guide

Plan Administered in Partnership with:

Diocese of Toledo Human Resources Department May 2015

FLEX ENROLLMENT GUIDE You Must Plan Carefully. Flexible Spending Accounts are governed by Federal tax laws. The Internal Revenue Service (IRS) requires that once you set aside money into a Medical or Dependent Care Flexible Spending Account, you can only use those dollars to pay for eligible services that you incur during that same Plan Year. The IRS defines “incurred” as the date(s) on which the Medical or Dependent Care expense is performed, not when you are formally billed, charged for, or pay for the care (orthodontia payment plans are an exception). In no case may the contributions be refunded or moved from one type of account to another. Likewise, changes in your contribution elections are restricted. Changes to your original Medical amount are only permitted if you have a qualified change in status :    

Marriage, divorce, legal separation Death Birth, adoption or placement for adoption of a child Change of employment or unpaid leave of absence for you or your spouse.

The contribution change must be on account of and consistent with the Change in Status Event. Changes to the Dependent Care Account can be made as the need for or availability of day care services change.

You should plan very carefully when putting dollars into a Flexible Spending Account. Be sure to use the worksheet included in this booklet when estimating your annual „out of pocket‟ expenses for the Medical and Dependent Care Flexible Spending Accounts.

Active Employees: Your employer will specify the number of days after the end of the Plan Year to submit claims for expenses incurred during the Plan Year. Claims submitted (postmarked/fax dated) after the deadline will not be paid, and any balance remaining in your accounts will be forfeited per IRS rules. Please refer to your employer’s Plan Highlight Sheet for guidelines related to your deadline. Terminated Employees: Your employer will specify the number of days from your separation date to submit claims for expenses incurred prior to your separation date. No claims will be paid for expenses incurred after your termination of employment. Any balances remaining in your account after the deadline has expired will be forfeited per IRS rules. Please refer to your employer’s Plan Highlight Sheet for guidelines related to your deadline.

FLEX ENROLLMENT GUIDE What are Flexible Spending Accounts? Flexible Spending Accounts (FSAs) allow Participants to use pre-tax money to pay for certain eligible expenses that would otherwise be paid for with aftertax money. FSAs create reimbursement accounts that are used to pay for qualified expenses related to:  

Healthcare (medical, dental, vision) expenses Dependent & daycare expenses

and

FSAs are not “insurance” plans; rather, they are “tax savings” benefits and participation in each is voluntary. If you decide to participate, the dollars you elect to contribute to these accounts will be set aside through payroll deduction prior to taxes being calculated.

As eligible expenses are incurred throughout the year for you and your tax dependents, you are able to submit a claim against your accounts and be reimbursed with your pre-tax contributions for the amount of those expenses. The dollars you set aside in these accounts are exempt from:    

Federal Income Tax State Income Tax FICA Tax City Income Tax

The Medical Flexible Spending Account is fully pre-funded; in other words, your full annual election is available to you on your first day of participation. Reimbursements for eligible Dependent Care expenses are made to the extent of your available payroll contributions at the time of reimbursement.

Vantage Financial Group Partners With TASC: Vantage Financial Group’s FSA, HRA and TRA processing systems and call center services will now be powered by TASC (Total Administrative Services Corporation) an industry leader in reimbursement account technology and support services to bring to our clients and participants cutting edge reimbursement, cash management and call center technology. Total Administrative Services Corporation provides state -of-the-art administrative services and technology platforms for qualified reimbursement accounts such as FSA, HRA and Transportation Reimbursement Accounts. They have over 30 years of experience and are headquartered in Madison, Wisconsin. TASC maintains a network of regional offices throughout the United States.

FLEX ENROLLMENT GUIDE How Do These Plans Save You Money? Illustrated below is an example of how the tax advantages of the Flexible Spending Plan can increase spendable income.

Estimated annual out-of-pocket expenses of $1,400. Without A Medical Flexible Spending Account Jane’s Annual Income

With A Medical Flexible Spending Account

$30,000.00

$30,000.00

$0.00

($1,400.00)

Jane’s Taxable Income

$30,000.00

$28,600.00

Federal Income Tax (15% tax rate)

($4,500.00)

($4,290.00)

FICA Tax (7.65% tax rate)

($2,295.00)

($2187.90)

State Tax (3% tax)

($900.00)

($858.00)

City Tax (2% tax rate)

($600.00)

($572.00)

Net Income

$21,705.00

$20,692.10

Jane’s After-Tax Medical Expenses

($1,400.00)

$0.00

Jane‟s Net Spendable Income

$20,305.00

$20,692.10

Annual Contribution (based on estimated Medical expense)

Set aside $1,400.00 in a Flexible Spending Account for eligible expenses and...

Save $387.10 Based on average 27.65% tax savings by not paying Medicare, Federal, State, and Local Taxes

Flexible Spending Accounts (FSA)

FSA Eligible Expenses Healthcare expenses eligible for reimbursement. Below is a sample list of permissible expenses reimbursable through a full scope Healthcare Flexible Spending Account (FSA) that are incurred by you, your spouse, or qualified dependents.

Medical Expenses • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Acupuncture Artificial limbs Bandages Birthing classes/Lamaze – mother’s portion only (not coach/spouse) for birthing instruction, not child rearing Blood pressure monitor Blood sugar test kits/test strips Chiropractic therapy/exams/adjustments Contact lens and contact lens solutions Co-payments Crutches (purchased or rented) Deductible and co-insurance Diabetic supplies Eye exams Eyeglasses, contacts, or safety glasses, prescription only (warranties are not reimbursable) Flu shots Hearing aids and hearing aid batteries (warranties are not reimbursable) Heating pad Incontinence supplies Insulin Lactation expenses (breast pumps, etc.) Laser eye surgery; LASIK Medical supplies to treat an injury or illness Mileage to and from doctor appointments Nasal strips Optometrist’s or ophthalmologist’s fees Orthopedic inserts Physicals Physical therapy (as medical treatment) Physician’s fee and hospital services Pregnancy test

• • • • • • • • • • •

Section 125 Flexible Spending Accounts

Prescription drugs and medications Psychotherapy, psychiatric and psychological service Reading glasses Sales tax on eligible expenses Services connected with donating an organ Sleep apnea services/products (as prescribed) Smoking cessation programs Treatment for alcoholism or drug dependency Vaccinations Wrist supports, elastic wraps X-ray fees

OTC Medicines and Drugs Over-the-counter (OTC) medicines and drugs, except for insulin, require a prescription from your physician to be reimbursable. The prescription will need to be included with each request for reimbursement. • • • • • • • • • • • • • • • • •

Bengay, Flexall, pain relieving creams or gels Calamine lotion Canker/cold sore relievers Cold medicines Corn removal Diaper rash ointment GasX, baby gas drops Hemorrhoid creams and treatments Hydrogen Peroxide or rubbing alcohol Indigestion or anti-acid relievers Laxatives Nicotine patch Pain relievers (Tylenol, Advil, Aspirin, etc.) Sinus medicines Suppositories Teething gel Wart removal medication

TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com

Dental Expenses • • • • • • •

• Nursery school (preschool) • Registration fees (allocated to dependent care services) • Does not cover medical costs; use Healthcare FSA for medical expenses incurred by you or your dependents.

Braces and orthodontic services Cleanings Crowns Deductibles, co-insurance Dental implants Dentures, adhesives Fillings

Ineligible Medical Expenses

For the Disabled • Automobile equipment and installation costs for a disabled person in excess of the cost of an ordinary automobile; device for lifting a mobility impaired person into an automobile • Braille books/magazines in excess of cost of regular editions • Note-taker for a hearing impaired child in school • Seeing eye dog (buying, training, and maintaining) • Special devices, such as a tape recorder or typewriter for a visually impaired person • Visual alert system in the home or other items such as a special phone required for a hearing impaired person • Wheelchair or autoette (cost of operating/maintaining)

Requiring Additional Documentation The following expenses are eligible only when incurred to treat a diagnosed medical condition. Such expenses require a Letter of Medical Necessity from your physician, containing the medical necessity of the expense, diagnosed condition, onset of condition, and physician’s signature. • • • • • • • • • •

Ear plugs Massage treatments Nursing services for care of a special medical ailment Orthopedic shoes (excess cost of ordinary shoes) Oxygen equipment and oxygen Support hose Varicose vein treatment Veneers Vitamins and supplements Wigs (for mental health condition of individual who loses hair because of a disease)

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Dependent Care Expenses

•

• Day camp (primary purpose must be custodial care and not educational in nature) • Dependent care expenses that are necessary for you (and your spouse) to work, actively look for work, or attend school full-time • Dependent care for children under the age of 13 or for elderly dependents who reside with you • FICA/FUTA taxes of day care provider • Late pick-up fees • Nanny expenses attributed to dependent care

• • • • • • • • • •

Athletic mouth guards Auto insurance providing medical coverage Chapstick/lip balm Contributions to state disability funds Cosmetic surgery, dentistry, or other cosmetic procedures Cosmetic supplies (makeup, cleansers, moisturizers, etc.) Deodorant Dental floss Diaper service Diet (cost of special foods taken as substitute for regular diet) Dietary and fiber supplements Divorce (when recommended by doctor or psychiatrist) Distilled water purchased to avoid drinking fluoridated city water or for use in medical equipment Domestic help (companion, babysitter, chauffeur who primarily renders services of a non-medical nature) Electrolysis/hair removal Exercise equipment and fees Eye drops for general comfort Eyeglass cases Hand sanitizer Health club or athletic club membership fees Herbal supplements Illegal treatment or medication Insurance premiums, all types Lanyards Lotions or skin moisturizers Marriage counseling Maternity clothes Mattress Medicare premiums Medicated shampoos, conditioners, and soaps Mobile telephone used for personal and physician calls Nursemaids or practical nurses who render general care for healthy infants Pajamas/slippers purchased to wear in hospital Personal use items (toothbrush, pillow, shampoo, mattress, etc.) Physical treatment unrelated to specific health problems (massage for general well-being, stress, depression, or chiropractic wellness) Premiums for coverage through other medical plans (spouse’s employer-sponsored plan or individual plan) Safety glasses (non-prescription) Special foods purchased to replace nutrition or for general health needs (such as diet foods) Sunglasses (non prescription) and sun clips Teeth whitening products Toiletries Toothbrush (includes prescribed electric ones) and toothpaste Vacuum cleaner purchased by an individual with dust allergy Vitamins and supplements for well-being Warranties Weight loss drugs/programs for general well being

TASC • 2302 International Lane • Madison, WI 53704-3140 • 800-422-4661 • Fax: 608-245-3623 • www.tasconline.com FX-4248-090914-A

FLEX ENROLLMENT GUIDE Flexible Spending Expense Worksheet Please use this worksheet to help you determine the amount of your contributions to the Plan. Review your records for last year's expenses, and forecast this year’s expenses for you and your eligible dependents.

Dependent Care Flexible Spending Account

This Year

Next Year

$___________

$___________

2. How much do you pay for Dependent Care for any other eligible dependents you have?

$___________

$___________

Projected „Out of Pocket‟ Dependent Care:

$___________

$___________

1. If you are a single parent or your spouse works, how much do you pay for Dependent Care for children under age 13?

Now divide by the number of payrolls and that will be your per-pay contribution for Dependent Care. The total annual election cannot exceed $5,000 for Dependent Care Flexible Spending.

$___________

Medical Flexible Spending Account Medical Expenses (Not covered by insurance or another plan): 1. Deductibles, co-insurance, co-pays and Over-the-Counter expenses? $___________

$___________

$___________

$___________

3. Chiropractic Care?

$___________

$___________

4. Other medical expenses not covered by insurance?

$___________

2. Vision Care: laser surgery, eye exams, contact lenses, glasses?

$___________

Dental Expenses (Not covered by insurance or another plan): 1.

Exams, cleaning, x-rays, etc.?

$___________

2.

Fillings, crowns, bridge, TMJ treatment?

$___________

3.

Orthodontia?

$___________

4.

Other dental expenses not covered by insurance?

$___________

Projected „Out of Pocket‟ Medical Expenses: Now divide by the number of payrolls and that will be your per-pay contribution for Medical.

$___________

$___________ $___________ $___________ $___________ $___________ $___________

TASC CARD QUICK START

1. Use your TASC Card for eligible benefits expenses. 2. MyBenefits funds are available immediately at the start of your Plan Year. 3. MyCash is funded by reimbursements only. 4. Access your MyCash funds with the swipe of your TASC Card at a merchant or an ATM, or transfer funds to a personal bank account. 5. Request a PIN if you want to access MyCash funds via an ATM.

Start enjoying the full capabilities of your TASC Card today!

TASC CARD TIPS HOW THE CARD WORKS • The Prepaid Mastercard TASC Card is a prepaid debit card that’s good almost everywhere MasterCard is accepted; it is not a credit card. The TASC Card is good for four years; you’ll be able to use the card each year when you re-enroll in your Plan. • The TASC Card features access to two accounts on one card—MyBenefits and MyCash. • The card’s MyBenefits account holds your employee benefits funds. These funds can be used to pay for eligible healthcare, dependent care, and/or transit and/or parking expenses. Purchases are limited to healthcare merchants eligible under your employer’s benefits Plan and other merchants with a healthcare inventory system in place. • The MyCash account holds your benefits account reimbursement funds. For the occasional out-of-pocket eligible expense, simply submit a request for reimburse-

ment. Your reimbursement is deposited in MyCash. Purchases made with the MyCash funds are not limited regarding merchant or type of expense—and can be spent just like cash at any retailer that accepts MasterCard. • Funds are deposited in MyCash when you are reimbursed for an eligible expense (for which you have submitted a request for reimbursement). You can access your MyCash funds with the swipe of your TASC Card at any merchant or ATM that accepts MasterCard, or transfer to a personal bank account via MyTASC.

• A PIN is required to access MyCash via an ATM using the TASC Card. To obtain the required Personal Identification Number (PIN), log in to MyTASC and click Manage My Card, Request PIN. Only MyCash funds can be withdrawn, and you may withdraw from “savings” only. • Funds in MyCash can be transferred to a personal bank account of your choice. To make a transfer, click Schedule a Transfer from the MyTASC home page. Choose between a one-time or recurring transfer.

USING YOUR CARD • To activate your card, simply swipe it for an eligible expense. It goes live on the first successful swipe. • At checkout, select Credit when making a signature debit purchase (or Debit for PIN transactions). You are authorized to make purchases that do not exceed your available balance. • The TASC Card is able to split purchases automatically when you combine general and healthcare items at checkout. For example, you can purchase a prescription and a greeting card, and pay with one swipe of your card. The prescription is paid from MyBenefits and the greeting card is paid from MyCash. • Funds in MyCash can be used for benefits purchases if you have run out of MyBenefits funds. This dual use helps you avoid embarrassing card declines. It pays to have funds in MyCash! • At gas stations, you must present your card to an attendant inside the gas station. Do not use it at the pump. (Ask the attendant to swipe the card after you have filled up to assure the success of your transaction.) • At restaurants, please be aware that many restaurants automatically add a 20% gratuity charge to your bill. The actual charge will be the price of the meal plus the gratuity that you add. • The TASC Card cannot be used to access MyCash (non-FSA) funds at CVS Pharmacy, Shopko, or Wal-Mart. These merchants have their own inventory approval system and are currently designed to handle FSA (MyBenefits) purchases only.

How is your MyCash account funded? If you paid out-ofpocket for an eligible benefits expense, submit a Request for Reimbursement (via MyTASC Mobile, online Request for Reimbursement form in MyTASC, text, fax, or mail). Your approved reimbursement amount will be deposited in your MyCash account. Access your MyCash funds in three ways: (1) swipe your TASC Card at any merchant that accepts MasterCard, (2) withdraw at an ATM, or (3) transfer to a personal bank account.

CHECK NO. 0000000000 Check Date 9/1/2011

Amount ****$220.00****

PAY: ****Two hundred twenty and 0/100 dollars**** Pay to the order of:

JOHN DOE 2303 INTERNATIONAL LN MADISON WI 53704

Daniel N. Rashke

No more waiting for checks to arrive by mail. Your cash is back in your hands faster than ever!

MANAGING YOUR ACCOUNT • Access account information online in your MyTASC account (www.tasconline.com). Click View Account Overview to see account transactions; click Manage My Card to view TASC Card information, request a dependent card, reissue a card, report a card lost or stolen, and view allowed benefits; click MyCash to view MyCash activity and to schedule a transfer to a personal bank account; Click Profile to update contact information and set email/text notifications. Any questions? Call Customer Care at 800-422-4661.

TASC ∙ 2302 International Lane ∙ Madison, WI 53704-3140 ∙ 800-422-4661 ∙ www.tasconline.com FX-4619-090514

FLEX ENROLLMENT GUIDE How Do I Enroll? Indicate your desired contribution for Medical and Dependent Care. Keep the following in mind when choosing your elections: 1. For Medical/Dependent Care Accounts, your annual election is binding for the entire Plan Year, unless you experience a Qualified Change of Status event and submit a Change of Election form to your Benefit Department within 30 days of the change of status event date. 2. If you choose to contribute to a Dependent Care Flexible Spending Account and file Form 1040, you must complete IRS Form 2441 (Child and Dependent Care Expenses) as well. It is recommended that you consult with a tax advisor to determine if it is more cost effective to claim a dependent care tax credit, if eligible, rather than participate in the Dependent Care Flexible Spending Account.

3. No portion of an FSA balance can be refunded to you except to the extent that you submit eligible claims (subject to COBRA continuation guidelines). 4. No reimbursement will be made for any expense incurred after separation of employment from your employer.

Medical/Dependent Care Flexible Spending Account elections are made on the benefits open enrollment system. Your Plan Highlight Sheet provides eligibility requirements and guidelines.

Who Do I Call if I Need More Information? If you have questions or need additional information, TASC Customer Service at

(800 422-4661.

Total Administrative Services Corporation 2302 International Lane Madison, Wisconsin 53704-3140 (800) 422-4661 www.tasconline.com

Vantage Financial Group 6200 Rockside Road Cleveland, Ohio 44131 (216) 642-7878 www.vanfin.com

Catholic Diocese of Toledo Flex Plan Highlight Sheet This Plan Highlight Sheet provides a quick reference to some of the most common information regarding your Flexible Spending Account(s). This information is also referenced throughout the Enrollment Handout provided to you during open enrollment and within the claim kit materials you will be receiving. If you have any questions or need further assistance, please contact a member of the TASC Customer Care Team at: 1-800-422-4661 th

Plan Year:

July 1st – June 30

Plan Maximums:

Medical Flexible Spending: $2,500.00 Annually Dependent Care Flexible Spending: $5,000.00 Annually

Reimbursement Options:

Debit Card, Check or Direct Deposit

Claim Filing Deadline for Terminated Employees:

Separated employees will be allowed 90 days following their termination date to submit expenses incurred through the end of the month in which they terminated.

Claim Filing Deadline at the End of the Plan Year:

A Grace Period of 2 months (until August 31st) is offered during which additional eligible expenses may be reimbursed from remaining funds in the previous plan year account balance (if available). Claims must be postmarked or received no later than September 30th.

Using your Debit Card During the Grace period

REMINDER– you may use your flex debit card during the grace period to access your previous plan year’s balance.  Grace period transactions will be processed on a “first in / first out” basis.  Once those funds have been exhausted transactions will be applied to the current plan year. The card will automatically split the transaction. It is very important to know that as part of the ―first in — first out‖ process, debit card swipes during the grace period may hit your previous plan year balance before a manual claim. This cannot be reversed.

Website and log on information:

www.tasconline.com Log in using your 12 digit TASC ID and password

Claim Submission:

Please refer to the TASC website for claim filing instructions

Customer Service:

Phone: 1-800-422-4661

NOTE: The debit card may be used for immediate reimbursement of eligible medical or dependent care expenses at benefitrelated providers/merchants. Remember that debit card transaction receipts must still be saved. If you are not using your debit card to pay for an eligible expense and are instead filing a manual claim, a copy of the original receipt must be submitted for reimbursement. The receipt must include the vendor/merchant name, date of purchase/service, a description of the product/service and the amount paid. As of 1/01/2011 Employees with a FSA may no longer use their account funds to purchase OTC medicines, drugs and biological treatments unless they have a Note of Medical Necessity (NMN) or a prescription from their doctor. For further information please contact TASC at: 1-800-422-4661.