FLEXIBLE SPENDING ACCOUNTS

•Health Care FSA•Dependent Day Care Assistance Plan

BIG SAVINGS FOR YOU!

SECTION 125 FLEXIBLE BENEFIT PLAN

The dollars you put in Flexible Spending Accounts are TAX FREE, SAVE YOU MONEY and are AVAILABLE IMMEDIATELY

Your pre-tax deductions Are Taken To Fund Your Account, Each Pay PeriodPay Period

You can Participate and Defer HEALTH CARE FSA – Up to $2,500 per Plan Year DEPENDENT DAY CARE ASSISTANCE PLAN – Up to

$5,000 if MARRIED filing jointly or Single Head of Household$2 500 if M i d fili t l• $2,500 if Married filing separately

Your Spending Account pays for eligible expenses for services that take place during the Plan Year: January 1 – December 31, each

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year

FLEXIBLE SPENDING ACCOUNTS???

NOT PARTICIPATING IN PARTICIPATING IN THE THE FLEX PLAN??

Your gross pay is taxedFLEX PLAN?

Your Annual Election d t bl All of Your Take Home

Pay is further reduced by your Out of Pocket

reduces your taxable pay!

Your net take homey yCosts

You have less spending

Your net take home pay is HIGHER

You keep more $$$$$ money in your pocket!

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BENEFIT OVERVIEW

DEPENDENT DAY CAREHEALTH CARE FSA$2,500 Annual Maximum

(Full Amount Available Day 1)

DEPENDENT DAY CARE ASSISTANCE PLAN

$5,000 / $2,500 Annual MaximumPayroll Deduction Amount OnlyPayroll Deduction Amount Only

Health Plan CopaymentsPrescriptions

Dependent Day Care Expenses incurred while you work

Prescribed OTC DrugsDental

Eligible “Tax” DependentsChildren ages 12 and underDi bl d SVision

HearingD d tibl

Disabled SpouseParents incapable of self-care

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Deductibles

YOUR HEALTH CARE FSA

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ELIGIBLE HEALTH CARE EXPENSES

Orthodontia treatment Deductibles Rx co-payments Chiropractic Contraceptive Prescriptions

Contact solutions, cleaners

D t l Contraceptive Prescriptions Psychiatrist/Counseling Durable Medical

Dental expenses Vision expenses Eye glasses,

Equipment Lasik Eye Surgery Co-insurance

Eye glasses, contact lenses

Diabetic supplies Co-insurance PPO, HMO or EPO

co-payments

Prescribed Over-the-Counter Drugs

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Health Care Reform: EligibilityR t i ti O Th C t (OTC) ItRestriction on Over-The-Counter (OTC) Items

Under the Patient Protection and Affordable Care Act and the Health Care and EducationAct and the Health Care and Education Reconciliation Act of 2010, all Over-The-Counter (OTC) drugs, medicines, and biologicals (with the exception of insulin) will be ineligible, unless prescribed by a physician as of January 1, 2011 or thereafter.thereafter.

if i !

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Please contact Medcom if you have questions!

Health Care Reform:S l Li t f O Th C t ItSample List of Over-The-Counter Items

OVER-THE-COUNTER OVER-THE-COUNTER (OTC) ITEMS REQUIRING

A PRESCRIPTION IN ORDER TO BE ELIGIBLE

(OTC) ITEMS ELIGIBLE WITHOUT HAVING A

PRESCRIPTIONO O G SC ONCough, Cold & Flu Medicines

Allergy & Sinus Medications

Insulin & Diabetic Supplies

Bandages and Splints

Pain Relievers

Anti-Diarrheal Products

Birth Control

Reading Glasses

Motion Sickness Pills/Patches

Stomach Remedies

First Aid Supplies

Wheelchairs, Crutches, etc.

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INELIGIBLE HEALTH CARE EXPENSES

Expenses that are not MEDICALLY NECESSARY are pnot eligible and may not be reimbursed from your FSA.

Following is a partial list of INELIGIBLE expenses. Always contact the MEDCOM with questions about

Cosmetic Treatments

eligible expenses.

Cosmetic Prescriptions Teeth Bleaching Herbs and Vitamin Supplements Herbs and Vitamin Supplements Over-the-Counter Drugs and

Medications without a Prescription Insurance Premiums

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Insurance Premiums

YOUR DEPENDENT DAY CARE ASSISTANCE PLANASSISTANCE PLAN

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ELIGIBLE DEPENDENT DAY CARE EXPENSESEXPENSES

Covers CUSTODIAL CARE for your eligible y gdependents as follows Children 12 or younger Day Care or Nanny expenses for Custodial Care “Before” and “After” school care for your childreny Day Camps Custodial Day Care for disabled SpouseCustodial Day Care for disabled Spouse Day Care for dependent parent(s) living with you and

incapable of self-care while you work

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p y

INELIGIBLE DEPENDENT DAY CARE EXPENSESEXPENSES

Day Care for your dependents, if you or your spouse are not working Expenses paid to a caregiver with no Social Security or Tax ID

Number E t fil d t t (Y t fil IRS F 2241) Expenses not filed on your tax return (You must file IRS Form 2241) Tuition Registration Fees Registration Fees Day Care or Babysitters after work hours Expenses incurred if your spouse is unemployed (unless a full time p y p p y (

student or disabled)There are other ineligible Expenses - Contact Medcom if you have

questions

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questions

CALCULATING YOUR PRE TAX DEDUCTIONDEDUCTION

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ANALYZE YOUR COSTS CAREFULLY (YOU WON’T LOSE YOUR MONEY)( )

REIMBURSABLE MEDICAL EXPENSESR E $25 12/ $ 300• Rx Expenses $25 co-pay x 12/year $ 300

• Physician Expenses $20 co-pay x 10/year $ 200

• Specialist Expenses $30 co-pay x 2/year $ 60

• Vision Expenses $ 240(1 set of glasses/exam)

• Dental Expenses $ 200(1 C @ 40% i )(1 Crown @ 40% coinsurance)

Total Reimbursable Medical Expenses $1,000

B. REIMBURSABLE DEPENDENT CARE EXPENSES• Monthly Expense $100 x 10 $1,000

C. TOTAL FSA & DAY CARE EXPENSES $2,000

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GENERAL TAX SAVINGS EXAMPLETAX SAVINGS EXAMPLE

Without FLEX With FLEX

Gross Annual SalaryGross Annual Salary $26,000 $26,000Health FSAHealth FSA 0 - 1,000Dependent Day Care 0 - 1,000Dependent Day Care 0 1,000Taxable Salary $26,000 $24,000Less FICA & Federal Tax -$4,520 -$3,994Take Home Pay $21,480 $20,006Out of Pocket Medical / Day Care -2,000 0Net Take Home $19 480 $20 006Net Take Home $19,480 $20,006SAVINGS $ 526

The above tax savings are understated. Your actual savings will vary depending on your

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The above tax savings are understated. Your actual savings will vary depending on your salary, filing status, state tax savings, etc.

MEDCOM’S FSA/DCAP DEBIT CARDHELPS YOU USE YOUR MONEYHELPS YOU USE YOUR MONEY

•Technically, a “Stored Value” card•For Health Care FSA and DCAP •Typically, a 3-year period of activationTypically, a 3 year period of activation•“24/7” access to transaction and balance info

www.emedcom.netW lthC O li / dwww.myWealthCareOnline.com/medcom

•“24/7” telephone IVR access to balance info800-523-7542

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TRACK TRANSACTIONS AND ACCOUNT BALANCES ONLINE

Presenting the New and Improved Medcom Benefits Portal

BALANCES ONLINE

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MEDCOM’S NEW WEALTHCARE ONLINE PORTALPORTAL

New Features and Conveniences: New Features and Conveniences: Easy-to-navigate user interface

E h d t d t il Enhanced account details Easily update personal and dependent info Submit claims online Upload receipts to substantiate transactions

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RECEIPT SUBSTANTIATION

Debit Card Transactions Where a Receipt Will Not be Requested

Exact Copayment Match with Group Medical PlanRepetitive Medical FSA Transaction

Same Dollar Amount, Same Provider Initial documentation must be filed with Medcom

FSA Purchases at Drugstore comFSA Purchases at Drugstore.com A special “FSA Store” stocked with eligible items

OTC and Rx Purchases atand stores,

and also at many similar independent merchantsRECEIPTS are Requested for ALL OTHER Transactions

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RECEIPTS are Requested for ALL OTHER Transactions

NO “PIN” NO “ATM”

Your Card is NOT eligible for use at Your Card is NOT eligible for use at ATM’s

Must only be used at health or day care related providers such ascare related providers, such as Hospitals Physician offices

D l ffi Dental offices Vision Service providers Pharmacies Daycare Centers

The purchase will be denied at point of sale if unauthorized use is attempted

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p

USING YOUR DEBIT CARD

SWIPE to pay for eligible Health FSA expensesPIN can be used (must be obtained from the web portal)Card transactions immediately post for paymentKEEP ALL RECEIPTS for all transactionsKEEP ALL RECEIPTS for all transactionsEXACT copay, SKU-filtered, or pre-approved recurring transactions

Automatically approve Complete and return a RECURRING EXPENSE FORM to

establish 1st recurring claimRECEIPTS are requested for ALL OTHER transactionsSufficient response submitted – “Transaction Approved!” FAX Receipt Request Letters WITH RECEIPTS to Medcom

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DEBIT CARD – INELIGIBLE EXPENSES

IRS requires taxes to be paid on ineligible expenses

Ineligible expenses are considered a debt owed to the Flex Plan and must be repaid

Funds may be used for other eligible expenses Funds may be used for other eligible expenses

If ineligible expenses not repaid

Card deactivated

Paper claims required

• Paper claim Offset by ineligible expense, or

• Payroll Deducted by Employer

• Employee W2, if ineligible expense not collected

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collected

PAPER CLAIMS

HEALTH FSAi l d E l ti f B fit f i i include Explanation of Benefits from your insurance carrier, co-payment receipts or medical statements with service date(s), out of pocket costs, item or service description.

DAY CARE DAY CARE attach receipts for expenses including the provider’s name and tax

ID number or social security number, dates of service and cost of carecare

RECEIPTS MAY NOT INCLUDE - Cancelled Checks, Credit Card Receipts, Balance-Due Statements

FILING DEADLINE Cl i INCURRED DURING PLAN YEAR FILING DEADLINE – Claims INCURRED DURING PLAN YEAR –Employees have 90 days following the end of the Plan Year to submit claims on expenses already incurred

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ENROLL TODAY!

CALCULATE YOUR HEALTH FSA AND DAY CARE ELECTION

COMPLETE AN ENROLLMENT FORM AUTHORIZING DEDUCTIONS

ORDER A DEPENDENT CARD IF APPLICABLE ORDER A DEPENDENT CARD, IF APPLICABLE

YOUR ELECTION CAN NOT BE REVOKED UNLESS YOU HAVE A QUALIFIED FAMILY STATUS CHANGE

M i l h Marital status change Number of dependents Employment status Dependent loses or gains eligibilityDependent loses or gains eligibility

ENJOY YOUR TAX SAVINGS!!!

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CONTACT US

Mailing AddressMedcom Flex Division

P O Box 10269P O Box 10269Jacksonville, FL 32247-0269

Office 904.596.4500T ll F 800 523 7542Toll-Free 800.523.7542Fax 877.723.0149

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