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GENERAL
MedFSA REQUIREMENTS AND TERM DEFINITIONS
1.
When can I become a participant in the MedFSA?
You will have the opportunity to enroll prior
to the beginning of the Plan Year. If you begin
employment during the Plan Year, you must meet
the eligibility requirements outlined in “General
Plan Information” of your employer’s
Plan Document. You must enroll within thirty
(30) days after your “entry date”.
2. When is my entry date?
Your entry date will be the first day of the
pay period coinciding with or following the
date you meet the eligibility requirements.
3. What must I do to enroll in my MedFSA?
You must complete, sign and return the Enrollment
Election/Salary Redirection Agreement. This
enrollment form must contain the annual amount
you wish to contribute to your MedFSA.
4. What “Family Status Changes”
must occur before I can change my election”.
Employees may change their election only if
the election change is on account of and consistent
with the change in Family Status, i.e.: birth
of a child would allow you to increase but not
decrease your election amount. The IRS and your
Plan specifically define a Family Status Change
as:
• your marriage, divorce or legal separation
• death of a spouse or dependent
• birth or adoption of a dependent
• termination or commencement of your
spouse’s employment
• you or your spouse changing from part-time
to full-time or full-time to part-time
• your or your spouse taking an unpaid
leave of absence
• ineligibility of dependent
OPERATION
1. How does the MedFSA operate?
You choose whether to contribute to the MedFSA.
If you decide to participate, the minimum and
maximum amounts you can contribute is determined
by your Employer and listed in the Plan Document.
The amount you elect to contribute is deducted
equally from each paycheck before Federal income
taxes, Social Security taxes and most state
taxes are withheld. You can use the amount of
your annual election to pay yourself back for
eligible medical expenses incurred by you and
your family that are not reimbursed by your
health care plan, again, tax-free.
2. What are the “eligible medical
expenses”?
Eligible out-of-pocket medical expenses include:
• Deductibles and co-payments under your
Medical, Dental and Vision Plans.
• Prescriptions and co-payments for prescriptions
• Acupuncture
• Eye exams, glasses and contacts
• Contact lens saline solution
• Dental expenses
• Hearing exams and aids
• Chiropractor expenses
• Vaccinations
• Treatment of substance abuse
• Physical therapy
• Medical expenses associated with quitting
smoking
• A complete list of eligible expenses
are listed in IRS
Pub 502
3. What expenses are not reimbursable?
Examples of expenses that cannot be reimbursed
• Cosmetic surgery
• Health plan premiums for you or your
dependents
4. Are there any special provisions
to this Plan?
In order to provide you with the most convenient
and quickest reimbursement, this Plan requires
that you have either a checking account or a
savings account to receive your reimbursements.
Receipts received by Monday at 4 pm CST will
be reimbursed the following Friday morning after
your posted reimbursable amounts reach $50.
CONTRIBUTIONS
1. How much of my pay can I put into
this Plan?
The annual contribution maximum and minimum
will be set by your employer.
2. What happens to contributions made
to my MedFSA?
At any time during the year that you are an
active participant, you are eligible to be reimbursed
for any eligible expenses incurred by to, your
spouse or other dependent up to the total of
your annual contribution election.
BENEFIT PAYMENTS
1. A completed Reimbursement Request
Voucher (available here
or by fax or mail upon request) including copies
of your eligible medical charges for services
incurred. Request vouchers and receipts
may be mailed or faxed via our toll-free fax
line. Your request voucher /receipts will be
posted to your account immediately. Receipts
received by Monday, 4 pm CST will be automatically
deposited into your designated bank account
on the following Friday morning when your requested
amount totals $50 or more.
2. What happens if I terminate employment?
Termination of employment, whether through normal
termination, death or eligibility is considered
a premature Plan Year ending. You will no longer
be allowed to contribute funds into your MedFSA,
however, you may receive reimbursements for
eligible expenses incurred prior to your termination
date. You have 90 days after the date of termination
to submit claims for reimbursement.
3. What happens if I do not use all
the money in my account?
The MedFSA requires the same exposure as a health
insurance. You have 90 days after the end of
your plan year to submit claims and be reimbursed
for expenses incurred during your Plan Year.
Any money remaining in your account after all
receipts have been submitted will be forfeited.
The law mandates that these forfeited funds
are ineligible for refund, use in any other
flexible spending account or to roll over into
the next year.
PLAN ACCOUNTING
1. How will I be informed about the
activity in my
account?
At the end of the 4th, 8th, 11th & 12th
month of each Plan Year, you will be mailed
an accounting of the activity of your account.
Should you have questions about your account
at other times, call 1-800-925-4087.
HIGHLY COMPENSATED
AND KEY EMPLOYEES
1. Do limitations apply to highly compensated
and key employees?
The Internal Revenue Code places restrictions
on certain “highly compensated”
or “key” employees so that benefits
do not unfairly favor those categories. Your
Employer will notify you if you are in this
group.
ADDITIONAL PLAN
INFORMATION
1. Your rights under ERISA.
Plan participants, eligible employees and all
other employees of the Employer are entitled
to certain rights and protections under Employee
Retirement Income Security Act (ERISA) including:
(a) the right to examine, without charge, all
Plan Documents at the Employer’s office,
and
(b) the right to obtain copies of all Plan Documents
upon request and at a reasonable charge.
ERISA also imposes the duty upon the people
responsible for operation (fiduciaries) of the
benefit to do so prudently and in the best interest
of the participants. If your claim for a benefit
is denied, you will receive a written explanation
of the reason for denial. You have the right
to request a review and reconsideration. Decisions
of the Plan Administrator are conclusive and
binding.
If you feel that your rights have been violated,
you may seek assistance from the U.S. Department
of Labor, or you may file suit in a Federal
Court.
2. Claims Process
Enrollment Applications, Reimbursement Request
Vouchers and receipts should be submitted to
the Plan Administrator via mail or fax. Reimbursement
Request Vouchers must be signed and submitted
with copies of dated medical charges incurred.
Enrollment Applications forms and Reimbursement
Request Vouchers may be downloaded at www.beneflex.com
or ordered by telephone, fax or mail.
3. Will my Social Security benefits
be affected?
If you pay the maximum amount of social security
tax each year, your MedFSA participation will
not reduce the amount of your social security
benefits. However, if your salary is below the
social security wage base, participation in
the Plan may result in a slight reduction in
our social security benefits. Usually, the resulting
reduction will be negligible and far out-weighted
by the current increase in your spendable income.
SUMMARY
We continue to seek the benefits which are truly
helpful to you and your family. Your use of
this Medical Flexible Spending Account will,
if used properly, ALWAYS saves you money. If
you choose not to participate, your lost savings
will automatically be paid into Federal and
State income taxes.
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