09/01/15 to 08/31/16. Plymouth-Canton Community Schools A Guide to Your Flexible Spending Account. A Balanced Approach To Saving Time and Money

Transcription

1 09/01/15 to 08/31/16 Plymouth-Canton Community Schools A Guide to Your Flexible Spending Account A Balanced Approach To Saving Time and Money

2 Flexible Spending Accounts the of money What if you your A Account can help you to do just that. Just as we have in the past, you an to in two FSA A FSA and a Dependent Care An FSA is a that will help you pay for that by your plan, and for dependent care to you to work. Both of these FSAs will con nue to be offered, however, we will be changing vendors from Meritain to HealthEquity effec ve September 1, And, just as you have had to in the past, your elec on for these programs will require a completed enrollment form. an FSA works: Use to pay for care not by a plan. All IRS code are your and and usual and as well as on drugs, and care. may too. see page 9 for details. care can be set for day care type expenses for or are if for the care of a person under age 13, or an older who is to care for They at least eight hours a day in your home. The Bo om Line: An that your (federal, and your are you money. and pay is increased. are to for the and your tax is to a of You your spendable And a goal we all share. poten al. You will gain the from your FSA if you plan you enroll you in the of you wish to have from your salary and into your FSA over the of a year. To do this, you must in the you want your FSA to cover. If you you will your FSA the end of the year, some of your If you and is le in your FSA at the end of the year, you may have to of this allows you to roll over up to $500. note! it is not to your eligible FSA two to help you: FSA and and Care FSA Determina on. are in this kit, and of and ineligible that can be your and Care FSAs. Addi onally, along with our move to HealthEquity comes addi onal tools and resources. You will now be able to view your FSA informa on through a mobile app or on line member portal. Please see pages 7 and 8 for more informa on! Table of Contents Introduc on... 2 FSA Reminders... 3 Frequently Asked Ques ons Debit Card... 6 Tools & Resources Qualified & Nonqualified Medical Expenses... 9 OTC Guidelines Orthodon a Claims FSA Worksheet Dependent Care Reimbursement Accts Dependent Care Determina on Guidelines to Reimbursement Reimbursement Request

3 FSA Reminders year: 8/31/2016 FSA Reimbursements: are daily. Healthcare FSA maximum: $2,500 Care maximum: per or per if tax returns. forms: A form can be from your or at Please note, if you request any reimbursement via check, you will incur a $2.00 check processing fee. New tools and resources for direct reimbursement through HealthEquity are outlined on pages 7 and 8 and may be viewed at and by clicking on Flexible spending accounts (FSAs). the Plan: The IRS $500 to into the next plan year. All FSA for with of $500 or less as of (end of this plan year) will into the new plan year This the use it or lose it rule on FSA funds as long as the unused do not If the then the unused over $500 are will be he that can be used for an me period. If you not to elect the FSA plan for the new plan year 9/01/15 and you have as of 0 will an FSA account for you in the of the up to You may to seek with or use your card. The the plan only and does not the care FSA plan. The care FSA plan is s ll to the with no of funds. The is not to is with Schools. Deadline: the plan year be filed for 90 days from the end of the plan year, by 11/30/15. the new plan year 90 days from the end of the plan year, by 11/30/16. be filed for Claim Mail and claim Or fax to: to: For addi onal plan inf For plan informa on, refer to your Plan your department, or at: : What else do you need to know about the new FSA vendor, HealthEquity? A list of frequently asked ques ons and answers may be found on the following two pages. Addi onally, there are many new features to the FSA that are outlined on pages 7 3

4 4 Flexible Spending Accounts

5 Flexible Spending Accounts 5

6 Information About Your Benefits Debit Card is a card? Your card is a that you an easy, way to pay for You can the set in your FSA. my card work? It like a with the of your FSA on it. you have a at a that debit you can use your card. The of the qualified will be your and the dollars will be to the for payment. No. Your card is a that can be only for It be for at gas or are no bills and no interest. Will I be receiving new card this year? Your card can be used to pay for and at that or and IRS allow benefits card to use their in and that are able to at If a card tries to use his or her card in a or that does not this the card may be declined. In the Care Act, or into law. The also as will your OTC As of 1, you now a for any OTC or drugs in order to from your You may use your card to OTC that a or drug as long as you your to the at the me of visit for put in by the IRS. You may OTC will at the are steps to with this As a of the the list of and may have changed. Be sure to visit for a list of stores. You save bills or for with your card. You may be to to that your with IRS You show the or name, the or the item the date and the of the purchase. You will be if is a need to a receipt. Addi onal debit cards for the upcoming plan year (09/01/15 08/31/15) may be ordered by calling H at Remember to always save your receipts! This is to that your are eligible. display: or name. purchased. Date and or item of purchase. if I fail to to a charge? If are not as to a with your benefits card, the card may be un l are You may be required to the will you if your card has been we have not a a or the in will allow the card to again. 6

7 Tools & Resources 7

8 8 Tools & Resources

9 Qualified and Nonqualified Medical Expenses 9

10 The Right Balance: Look Over the Counter! for and for (FSAs). The for To or not an is it s you may toll free at or visit As of 1, that a or are no for reimbursement your a This will take on the the are purchased, not your plan In you first a for any or in to obtain your of the plan year that do not or will not a prescrip on. In for the to as a be a or that meets the of a in the in the is that the be by an who is to a in that state. do I will a prescrip on? that will a but are not to the following: Acid controllers pain relief preps and sinus Baby rash ointments/creams Laxa ves products that an bio c sickness An diarrheals ointment treatments An gas Cold sore remedies aids and seda ves and bite cold and flu remedies treatments aids : The above list of items and not be a full lis ng. Can I s ll use my card for purchases? Yes, you may s ll and with your card as long as you your to the at the me of The will to run it as they any other an Rx and all IRS for card use. If you are to use your card at a Here are you pay out of at the of sale and then a claim visit for IRS s pula ons. ps: You can to use your FSA to that do not a or drug (for may to be with or a prescrip on. You may only roll over up to $500 of FSA so to es ma ng the you put in your FSA for the next plan year. etc.). 10

11 Orthodontia Claims 11

12 12 Orthodontia Claims - continued

13 FSA Worksheet and Eligible Expense Guide Expenses. The can help you your that may not be under your plan. all for you, your and your are from your FSA. Medical Expenses Es mated Plan Year Expenses Vision Expenses Es mated Plan Year Expenses Copays $ Contact lens supplies $ Deduc bles $ Copays $ Lab Fees $ Deduc bles $ Physical exams $ Eye examina ons $ Physician fees $ Prescrip on contact lenses $ Prescrip on drug expenses $ Prescrip on eyeglasses or sunglasses $ Dental Expenses Other medical expenses $ Copays $ Other Expenses Deduc bles $ Acupuncture or chiroprac c $ Dentures $ Hearing aids $ Examina ons $ Immuniza on fees $ Orthodon a $ Psychiatrist, psychologist, counseling* $ Restora ve work (crowns, caps, bridges) $ Other eligible expenses $ Teeth cleaning Other dental expenses $ $ TOTAL COLUMN 1 $ TOTAL COLUMN 2 $ TOTAL COL 1 $ + TOTAL COL 2 $ = TOTAL ESTIMATED EXPENSES $ *Allowed for treatment of physical or mental disorder (e.g., depression, alcohol or drug treatment). A diagnosis is necessary for reimbursement. Examples of costs your Healthcare FSA may cover: Copays, deduc bles, and out of pocket costs Acupuncture as a treatment Certain alcoholism and drug addic on treatment costs Ar ficial teeth or dentures Braille books for visually impaired Certain residen al improvements to accommodate the disabled Eye examina ons, contact lenses (including cleaning and maintenance supplies) and eyeglasses Guide dogs for sight or hearing impaired persons Car controls for disabled drivers Hypnosis to treat illness Lead based paint removal Learning disability tui on/therapy Psychological or psychiatric care Nursing home expenses Certain medical transporta on Important note! Reimbursement for certain services listed above is subject to specific requirements. Call the IRS toll free at , or visit to obtain a copy. 13

14 FSA Reimbursement Made Easy! The IRS proof that you can be by your to receive payment: a and FSA form with a achments A of the of All be to your or plan you FSA reimbursement. Claim submission. Mail claim and to: OR for that been can t be accepted. A for copays Your visit show the paid and the date of service. Your drug show the name of the drug, paid, the date of and the name of the pa ent. OR card or cash can t be for copays. items. cash are for OTC that do not a or drug. If the OTC item a or drug, you will need to a cash register as well as a prescrip on. A by a that the name of the purchaser (or the name of the to the the date and amount of the and an Rx number. OR An (for for or services). if you don t have insurance Or fax to: escrip ons f TCs In order to FSA for that a or drug, you first a prescrip on from your doctor. sure the the following: name of the item (the will be valid for one year from this date) Ques ons? Contact customer service toll free at: 14

15 Dependent Care Reimbursement Accounts 15

16 16 Dependent Care Reimbursement Accounts

17 Dependent Care FSA Determination Dependent Care Tax Credit vs. Dependent Care Flexible Spending Account. If you have care you may be able to one or both of two ways to your You may be able to a tax (a in the of taxes you owe) or you may be able to your income. This will help you is for you. If you qualify for the tax credit, you are allowed to deduct from the taxes you owe a percentage of the lesser of (1) your actual qualifying dependent care expense or (2) $3,000 if you have one dependent or $6,000 if you have two or more dependents. The percentage is based on your adjusted gross income for the year. The chart to the right will help you determine your percentage. In lieu of the Dependent Care Tax Credit, each year you may elect to have an amount deducted from your paycheck before taxes and put into your Dependent Care FSA. This amount must be used during the year for qualifying dependent care expenses. In other words, you will not have to pay taxes on the amount you contribute to the Dependent Care FSA that is used to pay your qualifying dependent care expenses. If, however, either you or your spouse has Earned Income (as defined in the plan) of less than $5,000, your income exclusion will be limited to the amount of the Earned Income. Use the following worksheet to determine whether you should use the Dependent Care Tax Credit or the Dependent Care Flexible Spending Account. Remember to compare your actual dependent care expenses to $3,000 (for one dependent) or $6,000 (for two or more dependents). Take the lesser amount from this comparison and mul ply it by your adjusted gross income percentage from the chart. This will be your tax credit. IF YOUR ADJUSTED GROSS INCOME IS: % of Dep. Care You Can Deduct from OVER TO Your Taxes: $0 $15,000 35% $15,000 $17,000 34% $17,000 $19,000 33% $19,000 $21,000 32% $21,000 $23,000 31% $23,000 $25,000 30% $25,000 $27,000 29% $27,000 $29,000 28% $29,000 $31,000 27% $31,000 $33,000 26% $33,000 $35,000 25% $35,000 $37,000 24% $37,000 $39,000 23% $39,000 $41,000 22% $41,000 $43,000 21% $43,000 20% WORKSHEET Using the Tax Credit Using the Dependent Care FSA Adjusted Yearly Gross Income $. $. Subtract: Dependent Care Account (. ) Taxable Yearly Income $. $. Taxes (generally 7.65%) Total Federal* ( %) $. $. State* ( %).. Social Security $. Subtract: Tax Credit (. $. *The actual tax rate will vary depending upon your annual income. Es mate your own tax liability or check with your tax consultant. Eligible Expenses: Fees paid to a childcare center or to a day care camp that, if providing care for more than six children, complies with all state and local regula ons Fees paid to a babysi er inside or outside the home Fees paid to a rela ve who provides dependent care services, other than your spouse, to your child (on the last day of the calendar year) or to a dependent you claim for federal income tax purposes Legally mandated taxes paid on behalf of the provider Ineligible Expenses: Transporta on to and from the place where dependent care services are provided Food, clothing and educa on Expenses for which federal child care tax credits are taken, or are claimed under your Healthcare FSA Overnight camps Tui on See for a complete lis ng. 17

18 Guidelines for Reimbursement NOTE: Incomplete or illegible submission may result in processing delays. Be sure to include all necessary informa on, and sign and date the form. Please make copies for your records, as these documents will not be returned. If you fax your claim, keep the original. Health Flexible Spending Account A ach a copy of the Explana on of Benefits (EOB) for each submission. All claims MUST be submi ed to your insurance company prior to request for reimbursement. Es mates for services that have not yet been incurred cannot be accepted. OR Submit a paid receipt for your co payments. Credit card receipts, canceled checks, or cash register receipts cannot be accepted for copayments. Itemized cash register receipts are acceptable for over the counter (OTC) items/supplies that do not contain a medicine or drug. If the OTC item does contain a medicine or drug, you will need to submit a cash register receipt as well as a doctor s prescrip on. OR If you do not have insurance coverage, submit an itemized statement from the provider showing the provider s name and address, pa ent name, date and descrip on of service and amount charged. Addi onally, prescrip on expenses must include the drug name or number. Balance forward or paid on account statements cannot be accepted. Orthodon c reimbursement: For first request, submit a copy of the Service Agreement or contract itemizing the treatment period, down payment, monthly payment, banding date and amount covered by insurance, if any. For subsequent claims, submit a copy of your monthly payment coupon and/or itemized receipt each me you request reimbursement. Dependent Care Reimbursement Account Expenses submi ed must have been incurred for the care of a qualifying individual for the purpose to be gainfully employed. A qualifying individual is (i) a dependent of yours under age 13, (ii) a dependent of yours (or your spouse) who is incapable of caring for himself/herself. Medical and Dental Expenses Generally Eligible for Reimbursement (Source: IRS Tax Publica on 502) You Should Claim Fees for health services or supplies provided by physicians, surgeons, den sts, ophthalmologists, optometrists, chiropractors, podiatrists, psychiatrists, psychologists, or Chris an Science prac oners. Acupuncture. Fees for hospital, ambulance, laboratory, surgical, obstetrical, diagnos c, dental and X ray services. Costs incurred, including room and board, during treatment for alcohol or drug addic on at a hospital or treatment center. Special equipment, such as wheelchairs, special handicapped automo ve controls, and special phone equipment for the deaf. Special items, such as dentures, contact lenses, eyeglasses, hearing aids, crutches, ar ficial limbs and guide dogs for the vision or hearing impaired. Transporta on for needed medical therapy. Nursing services. Rehabilita on expenses. You Should NOT Claim Any items which will be paid for by insurance or for which you are reimbursed by insurance or any other health plan. Bo led water. Health club dues. Any illegal opera on or treatment. Programs to control weight (unless the program is undertaken at a physician s direc on to treat an exis ng illness, including obesity). Elec ve cosme c surgery. Medical insurance premiums paid outside of your company by you or your spouse at his or her place of employment. Nursing care for a normal, healthy baby. Maternity clothes. Burial expenses. 18

19 Reimbursement Request Form 19

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