Your Tax Saving Benefits Our benefits have been designed with you in mind. An important financial benefit of the Flexible Benefits Plan is that some of the premium payments you contribute can automatically be paid through the premium conversion feature of our plan. This means you will not pay taxes on the income you use to pay for these benefits and your take-home pay will be higher than if you pay for benefits on an after-tax basis. These tax savings can be significant. For example, you can save money on taxes for out-of-pocket health care and dependent care expenses by using the flexible spending accounts. These accounts let you set aside money from your pay before taxes are withheld and use it for qualified expenses.

Flexible Spending Accounts We offer both medical and dependent daycare flexible spending accounts. These accounts allow you to contribute a certain amount of your gross income to a designated account or accounts before taxes are calculated. These accounts are for medical and/or dependent day care expenses not covered by your insurance, from which you can be reimbursed throughout the plan year or claim period as you incur the expenses. These accounts will be administered by myCafeteriaPlan.com effective November 1st. These accounts allow you to set money aside on a pre-tax basis for qualified medical and dependent daycare expenses. This plan covers your dependents even if they are not covered under the Seminole County Public Schools medical insurance.

CAUTION: There is a difference between these two plans!! • •

The medical account is for qualified medical expenses, such as copayments, deductibles, prescription drugs, dental services, orthodontic work, vision services, etc. for you or your eligible dependents. The dependent daycare account is primarily for qualified childcare expenses, such as after school care, daycare, summer camp, etc. for dependent children under the age of 13.

For the medical account, you can set aside between $250 and $2,000 annually. For the dependent daycare account, the election amount is based on your federal tax filing status: $5,000 per married couple filing jointly or single filing head of household. Participation in the dependent daycare account may produce a larger tax savings than the Federal Child Care Tax Credit. Please consult a tax advisor to see which program would be better for your situation. There are at least two significant ways to benefit from a Flexible Spending Accounts. The first is by taking advantage of the tax savings. By reducing your gross income, you pay less in taxes, take home more pay, and have the freedom to choose how your money is used. The second benefit is the “cash flow” increase built into the medical FSA (not the dependent day care FSA). This means that no matter how much money you have actually contributed to the plan at any given point, you can still be reimbursed up to your entire annual election. So a major medical expense at the beginning of the claim period can be reimbursed even though few, if any, deposits have been made into the account at that time. This applies to the medical FSA only.

Medical FSA Claims Reimbursement Through myCafeterianPlan.com, you have a variety of ways to choose from to get reimbursed for your claims: debit card, on-line submission, fax or mail.

Debit Card

You will receive a debit card, which is the most convenient way to receive reimbursement. Simply swipe your debit card at your providers office, pharmacy, hospital, etc. at time of service and your claim will be paid instantly. It is important when you are utilizing the debit card to still ask for and keep an itemized receipt on file. You may still receive a letter from myCafeteriaPlan.com requesting this receipt for IRS documentation purposes. Even if you use the debit card, YOU are ultimately responsible to the IRS for documentation (i.e. a receipt). YOU are required to keep it and submit it so the plan is compliant with government regulations. Please be advised that if you do not respond to myCafeteriaPlan.com’s request for an itemized receipt, your card and your account will be SUSPENDED.

Will I be asked to document all the expenses I use my card for? Not necessarily. Here’s how it works: In order to avoid having to provide documentation for Flex Card swipes, you should always try to purchase your medical items from a vendor that subscribes to the Inventory Information Approval System (IIAS), also called a participating provider. Eligible medical items purchased through a participating provider will be approved automatically. Participating providers will be able to “auto check” the item in question for eligibility and approval. Items marked as eligible will be accepted on the Flex Card, and ineligible items will be denied. Using the Flex Card properly will significantly reduce and possibly eliminate the hassle of submitting claims or documentation for eligible items. It will also eliminate the inconvenience of having to repay the plan for improperly swiped ineligible items. Non-medical vendors such as grocery stores will not be able to accept Flex Cards unless they are a participating provider. For example, an eligible Over the Counter (OTC) item such as band aids purchased at a participating grocery store will be automatically approved by the plan and can be paid for using the Flex Card with no documentation necessary. However, band aids purchased from a non participating store, even though it is an eligible item, will need to be documented. You will receive a receipt request for the necessary information after the purchase. For medical vendors, the IRS allows for benefit co-pay amounts to be automatically approved. Any amounts that are not a copay will require documentation. You should always keep your receipts regardless of eligibility for automatic approval.

What happens if I use my Flex Card for an Ineligible expense? If the transaction is ineligible or lacks sufficient documentation, you will be notified via the monthly receipt request. You have up to 60 days from the initial notification to provide the supporting documentation or to repay the cafeteria plan for the amount of the ineligible transaction. At the end of that period (60 days from the initial notification), if the expense has not been approved or repaid, either a payroll deduction for that amount will be taken by your employer, or your Flex Card will be deactivated. You will be notified of any payroll deductions by your employer.

On-Line You can submit your claims on-line at www.mycafeteriaplan.com. To login to your account, go to www.myCafeteriaPlan.com There you will be prompted to enter a Username (your 9-digit SSN) and Password (the last four digits of your SSN). Once you are logged in, you should change your Username and Password and verify your personal information. You can also check your account balance(s) and see the status of any claims you have submitted. Please note: when updating your personal information it is important to provide your e-mail address for the fastest and most efficient communication. Be sure, when you input the e-mail address, to choose an “Alternate Verification” question (located at the bottom of the page) so that your Username and Password can be sent to you in case they are lost or forgotten. In addition to 24-hour account access, myCafeteriaPlan’s comprehensive website provides downloadable claim forms, answers to frequently asked questions (FAQ pages), and detailed

information about cafeteria plan rules and claim submission. Visit the Employee Home page (www.myCafeteriaPlan.com/employee.htm) for answers to all your cafeteria plan questions.

Fax, Email or Mail You are also able to submit your [email protected] or by mail

claims

via

fax

at

937-865-6502,

by

email

myCafeteriaPlan.com ATTN: Claims Department 432 East Pearl Street Miamisburg, OH 45342 Before submitting a claim or swiping your debit card, you should:

1) Verify that the expense is eligible for reimbursement 2) Assemble all supporting documentation Canceled checks, credit card receipts, and sales slips are not acceptable as documentation for eligible expenses. Cash register and/or pharmacy receipts are acceptable only when they clearly identify a prescription number or over-the-counter (OTC) item. If an OTC item is not clearly identified, the receipt with the marked or highlighted item should be accompanied by the front box cover of that item. FOR ALL OTHER EXPENSES, supporting documentation must include: • Provider name and address • Patient/Dependent name • Date of Service • Description of Service • Amount charged An Explanation of Benefits (EOB) from an insurance company is acceptable and requires no further documentation. If receipts are smaller than 8.5x11 inches, copy or tape onto an 8.5x11 inch sheet of paper – do not staple receipts to the claim form or to each other! If you are requesting multiple prescription reimbursements or a pharmacy receipt has been lost, request a prescription history from the pharmacist; a prescription history is the most efficient way to request prescription reimbursements. 3) Copy the supporting documentation and retain the originals 4) Fill out the appropriate claim form provided by your Human Resources department or obtained from your myCafeteriaPlan online account (www.myCafeteriaPlan.com) 5) Sign the claim form 6) Remember, myCafeteriaPlan cannot process a claim submission without the participant’s signature as authorization.

Medical Eligible Expenses The following is a partial list of expenses that are reimbursable tax-free with a Medical Expense FSA. For a complete list, visit the IRS’s website at www.irs.gov and search for Section 213 expenses. • Acupuncture (if medically necessary) • Ambulance service • Birth control pills

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

Chiropractic care Contact lenses (corrective)* Diagnostic tests Doctor’s fees Drug addiction/alcoholism treatment Drugs (prescription only**) Experimental medical treatment (only if referred by a physician) Eyeglasses*** Hearing aids & exams Injections and Vaccinations Nursing services* Optometrist fees Orthodontic treatment* Prescription drugs to alleviate nicotine withdrawal symptoms Smoking cessation programs/treatments Surgery**** Transportation for local medical care Wheelchairs X rays Some over the counter drugs with a prescription from a physician

*

To be eligible for reimbursement, some treatments, prescription drugs, or services deemed cosmetic in nature require written proof of medical necessity from your health care provider. ** Not all drugs requiring a prescription are approved by the IRS as eligible for reimbursement. *** The effective date for glasses and prosthetic devices is the day the item is available to be picked up, not the date ordered. **** Unused funds designated for Medical Expense FSAs cannot be refunded to you. Please verify with your health care provider (prior to the commencement of the upcoming plan year) that you are a suitable candidate for a surgical procedure before committing the money to your FSA.

Medical Ineligible Expenses • • • • •

Insurance premiums (these expenses are covered under the Premium Conversion plan feature) Vision warranties and service contracts Health or fitness club membership fees Cosmetic surgery not deemed medically necessary to alleviate, mitigate or prevent a medical condition Over the counter drugs unless they are prescribed

Dependent Day Care Eligible Expenses Generally, child, adult, and elder care costs that make it possible for you and your spouse to work or actively look for work are eligible for reimbursement for IRS defined dependents. If you are married, your spouse must work, be a full-time student, or be mentally or physically incapable of self-care. Payments for dependent care services provided by your dependent, your spouse’s dependent, or your child who is under age 19 are not eligible for reimbursement. Examples of eligible expenses are: • Day care facility fees for qualified dependents • Local day camp fees for qualified dependents (day camp for day care purposes only) • Baby-sitting fees for at-home care of qualified dependents while you and your spouse are working (care cannot be provided by you, your spouse, or other dependent)

Dependent Day Care Ineligible Expenses • • • • • • • • •

Health care costs Child support payments or child care if you are a noncustodial parent Payments for dependent day care services provided by your dependent, your spouse’s dependent, or your child who is under age 19 Overnight care for your dependents (unless it allows you and your spouse to work during that time) Nursing home fees Diaper service Educational tuition Books and supplies Activity fees

Flexible Spending Account (FSA) Rules and Guidelines • • • • • • • •

The IRS does not allow you to pay your medical or other insurance premiums through the Medical Expense FSA. You cannot transfer money between FSAs or pay a dependent day care expense from your Medical Expense FSA or vice versa. st You have a 60 day grace period at the end of the plan year (until December 31 ) for reimbursement of eligible FSA expenses you incurred during your period of coverage within the plan year. You can receive no insurance benefits or other payment for these expenses. You cannot claim reimbursed expenses for income tax purposes. Reimbursement cannot be made before an expense is incurred, that is, before service is received. All expenses should be incurred during your period of coverage within the plan st st year, November 1 through October 31 . Be conservative when estimating your medical and/or dependent day care expenses for the Plan Year. According to IRS regulations, any money that remains in your accounts after the plan year ends cannot be returned to you or carried forward to the next plan year. The annual elected amount for Medical FSA is available on your effective date. The Dependent Day Care amount is available only after deducted from your paycheck.

FSA Contributions for Termination or Leave If you terminate your employment or go on unpaid leave, you can continue contributing to your Medical Expense FSA on an after-tax basis. As long as you make contributions to your Medical Expense FSA, you can receive reimbursements on eligible expenses until you exhaust your account balance or the plan year ends. If you do not continue to contribute to your Medical FSA, the period of coverage ends, and you cannot claim reimbursement for expenses you incur after the date you terminate employment or go on unpaid leave. You cannot continue contributing to your Dependent Day Care FSA, but can continue to request reimbursement for eligible expenses until you exhaust your account balance or the plan year ends. If you terminate your employment, and elect to revoke your benefits, and again become an employee during the remaining period of coverage, you will not be eligible to participate in the Dependent Day Care FSA until the next plan year unless otherwise provided by law.

Medical Expense FSA Setting Aside Funds Before setting aside money in a Medical Expense FSA for any surgical procedure (i.e. corrective laser eye surgery) to treat, cure, or mitigate a specific medical condition, it is recommended that, prior to the commencement of the plan year in which the procedure will be performed, you have completed all testing procedures. It is further recommended that you have secured a written

confirmation from the healthcare provider performing your surgery, that you are a suitable candidate for the procedure, and that it can be scheduled and performed during the plan year.

Availability The maximum amount of reimbursement for eligible uninsured, out-of-pocket medical expenses will be available throughout your period of coverage (reduced for prior reimbursements made during the same period of coverage), provided the request does not exceed your annualized contribution. The minimum is $250 and the maximum annualized contribution for the Medical Expense FSA is $2,000.

Customer Service You can contact myCafeteriaPlan.com’s customer service department at 800-865-6543 between the hours of 8AM-8PM EST Monday through Friday. You will be greeted by a live customer service representative who can address your questions or concerns. You can also e-mail customer service at [email protected].