FLEXIBLE SPENDING PLAN SUMMARY. 1. Plan Name: Salem Keizer School District Salary Reduction Plan

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1 FLEXIBLE SPENDING PLAN SUMMARY 1. Plan Name: Salem Keizer School District Salary Reduction Plan 2. Employer Identification Number: Employer Address: 2450 Lancaster Dr NE PO Box Salem, Oregon Plan Administrator: Salem Keizer Public School District 24J is the Plan Administrator 5. Agent for Legal Process (if different from above): Coordinator, Employee Programs and Benefits 2450 Lancaster Dr NE, Salem Oregon Plan Year: October 1 st through September 30th 7. Type of Plan Administration: The Healthcare Flexible Spending Account is a group health plan. The selected plans are a contract administration plan. BestChoice Administrators (BCA) processes flexible spending account claims for the Plan. A health insurance issuer is not responsible for financing or administering (including payment of claims) the plan. Salary reductions are considered employer contributions for the purpose of the Plan. TABLE OF CONTENTS What is a Flexible Spending Account? Enrollment and Termination - How to Enroll - Renewing Your Participation - Termination of Employment - When Does Participation End How the Plan Operates. - General Rules - Use It or Lose It - Uncashed Checks - Amending the Plan - Changing your Election - Affect on Taxes How to File a Reimbursement.. - Supporting Documentation Requirement Appeals. COBRA Rights. Flexible Spending Accounts - What is a Premium Contribution Plan?. - What is a Healthcare Flexible Spending Account? - What is a Dependent Care Flexible Spending Account?.... Eligible & Ineligible Expenses. Over-the-Counter Products.. Page 2 Page 3 Pages 4-5 Page 6 Page 7 Page 8 Page 8 Page 8 Page 9 Attachment A Attachment B 1

2 WHAT IS A FLEXIBLE SPENDING ACCOUNT? A Flexible Spending Account (FSA) is a means for you to have a source of pre-tax funds from which you can be reimbursed for healthcare or dependent care expense. In general, the plan works like this: If you know that you are going to incur medical or dependent care expenses during the plan year, you may arrange to withhold the amount of those expenses from your salary on a pre-tax basis. You will then be reimbursed for IRS eligible medical and dependent care expenses from your account when you submit a completed claim form along with IRS acceptable supporting documentation for the expenses. You can also pay for premiums for qualified benefits offered through your employer s cafeteria plan on a pre-tax basis through the Premium Contribution Plan. Funds deducted from your salary for group insurance premiums are not reimbursable, but sent directly to the insurance carrier by your employer. 2

3 ENROLLMENT AND TERMINATION How to Enroll You can participate in your employer s Flexible Spending Account plan after you meet the eligibility standards set by your employer, including any waiting period. To participate, you must complete and sign the enrollment form prior to your entry date. Your entry date is the date on which you become eligible to participate in the Plan as indicated below: If you are an eligible employee on the date the plan goes into effect, your entry date will be the effective date of the Plan. If you become an eligible employee after the effective date of the plan, your entry date will be the first day of the month following the period the plan requires you to wait after the date of your hire ( waiting period ) to be eligible to participate. You may be required to satisfy waiting periods before becoming eligible to participate. This waiting period is defined in the Plan Summary section. You will be given notice of your eligibility to participate prior to your entry date to allow you time to decide whether or not to participate and to make your elections. If you do not complete the required paperwork prior to your entry date, you will not be eligible to enroll until the plan s next open enrollment period. Renewing Your Participation Upon your employer s renewal of the Plan, you may renew your participation in the Health Care and/or Dependent Care Flexible Spending Accounts and Premium Contribution Plan for the next plan year. You must re-enroll your elections for the new plan year by completing an enrollment form, even if you intend to continue the same salary reduction(s) as during the previous plan year. Failure to enroll will be treated as an election not to participate in the Plan the following plan year. Termination of Employment If your employment terminates during the Plan Year, your participation in the plan will cease and you will not be able to make any more pre-tax contributions to the Plan. See the section titled COBRA Continuation Rights for additional information to determine if you are eligible to continue to contribute to your Health Care Flexible Spending Account with after-tax dollars. Any funds remaining in your Flexible Spending Account(s) will be available for reimbursement for eligible IRS health care or dependent care expenses incurred prior to your termination date. Expenses incurred after your termination date are ineligible for reimbursement. When Does Participation End? Your participation in the Flexible Spending Accounts will terminate on the earliest of the following dates: The date of your death; The date you terminate employment; The date you are no longer a regular, full-time employee as defined by the employer; The date you transfer to an ineligible class of employees; The date you retire; or The end of the plan year, if you fail to renew your participation. WARNING: If the Plan Administrator determines that you have made fraudulent use of the plan, your participation in the plan will terminate and you will forfeit your unused funds. 3

4 HOW THE PLAN OPERATES General Rules: You must make all elections before your entry date into the Plan. You may not be reimbursed for any eligible health care or dependent care expenses incurred before the Plan s effective date, before your salary reduction agreement became effective, for any expenses incurred after the end of the plan year, or for expenses incurred after termination in the Plan. The amount that is reduced from your salary or wages cannot exceed the amount of your annual salary or wages. At the end of the plan year, you will have a 90 day run-out period to submit claims for expenses incurred during the previous plan year. Claims submitted after the 90 day run-out period are ineligible for reimbursement. Dollars set aside for the Healthcare Flexible Spending Account cannot be transferred to the Dependent Care Flexible Spending Account and visa versa. Use It or Lose It If you have set aside dollars through salary reduction for the Health Care Flexible Spending Account and/or the Dependent Care Flexible Spending Accounts, you must use those dollars during the plan year to pay for eligible expenses. If there are funds remaining at the end of the plan year, those funds will be forfeited. Dollars cannot be carried over to the next plan year. Uncashed Checks If a check is issued to you and the check is not cashed within a reasonable period of time, funds in the amount of the check may be considered abandoned in accordance with State law. We will make a reasonable effort to contact you before we consider the funds abandoned. Amending the Plan Although the employer expects to maintain the Plan indefinitely, it has the right to amend or terminate all or any part of the Plan at any time. It is possible that future changes in state or federal tax laws may require that the Plan be amended accordingly. The Administrator can modify your election to assure that the plan passes nondiscrimination requirements. Changing Your Election After you have enrolled in the Flexible Spending Account, you cannot change or terminate elections you selected for the plan year. This is called the Irrevocability Rule. However, your election will terminate if you no longer work for the employer. You can change your election during the Open Enrollment period, but the new election will apply to the upcoming plan year. There are some exceptions to the Irrevocable Rule that may allow you to make changes or revoke your election prior to the end of the year. 1. For the Premium Contribution Account and the Dependent Care Flexible Spending Account, you may be eligible to revoke your election and make a new election for the balance of the plan year upon: a. A Change in health insurance premium b. A change in your employment status or your spouse s employment status 4

5 c. A spouse/dependent loses eligibility under the Plan d. A spouse/dependent gains eligibility under the Plan e. A change in family status by the birth, adoption, marriage, divorce, or death of spouse or dependent; or f. A change as allowed under the Family Medical Leave Act (FMLA) g. A significant cost increase/decrease in your dependent care expenses 2. For the Healthcare Flexible Spending Account, the only time you may change your election is prior to the beginning of the Plan year, or if you experience a qualified family status change such as the birth, adoption, marriage, divorce, death of a spouse or dependent, or other events allowed by the IRS. You cannot revoke or cancel your Healthcare Flexible Spending Account if claims have already been paid. You can reduce your Health Care Flexible Spending Account down to the amount that has been reimbursed. However, if you have already been reimbursed your entire annual election, you will be required to continue making your payroll contribution for the remainder of the plan year. The change in election must be consistent with the Qualifying Event. For example, if a second child is born, the election change must be to increase the Dependent Care Flexible Spending Account, not decrease the election amount. To change an election, a Status Change Form must be completed within 30 days from the date the qualified family status change occurred. Affect on Taxes By participating in a Flexible Spending Account, the amount of your taxable compensation will be reduced. Because your salary will be reduced due to the withholding, you will pay less Social Security and income tax. There could also be a decrease in your Social Security benefits and/or other benefits if they are based on taxable compensation. By participating in the Dependent Care Flexible Spending Account, you may not claim any other tax benefit for dependent care expenses. Generally, people in a lower income tax bracket may come out ahead claiming the Dependent Care Credit instead of participating in the Dependent Care Flexible Spending Account. IRS Form 2441, and/or an accountant may assist you in determining if a DCAP will provide a tax advantage. Generally, you will not be taxed on your Health Care or Dependent Care benefits you receive, as long as you are being reimbursed for eligible IRS expenses and you are not being reimbursed from another source, also called double dipping. If you are reimbursed for an ineligible expense, you may be taxed on the benefit received. 5

6 HOW TO FILE A REIMBURSEMENT To be reimbursed for a health care or dependent care claim, adequate claims substantiation must be received. Claims must be substantiated with two items: 1. A written statement from an independent third party providing that the expense has been incurred and the amount of the expense. Please read section below regarding supporting documentation requirements. 2. A written statement from the participant providing that the expense has not been reimbursed or is not reimbursable from another source. This requirement is met with a Claim Form and signature. Supporting Documentation Requirement Supporting documentation satisfies the first requirement of claims substantiation of a written statement from an independent third party providing the expense has been incurred. Supporting documentation must always include the following information: 1. Date of Service 2. Type of Service (such as copay, office call, root canal, extraction, etc.) 3. Provider Name 4. Amount of charges. 5. Dependent care documentation must include the providers Tax ID# or Social Security Number. Examples of appropriate documentation can include an Explanation of Benefits from your insurance company or an itemized statement from the medical/dependent care provider. A receipt from the medical/dependent care provider is also acceptable as long as all of the information above is clearly listed on the receipt. Balance forward statements, statements on payment of account, canceled checks or credit card receipts/statements do not include all of the information above, and are considered unacceptable sources of documentation. To request reimbursement, you must submit a completed claim form and clearly itemize each expense along with appropriate supporting documentation. You can send you completed claim form together with appropriate supporting documentation to: BestChoice Administrators or fax to: or Flexible Spending Accounts P.O. Box Portland, OR Claims are processed within 3-5 days of receipt. BestChoice Administrators, Inc. (BCA) will issue a check or, if elected, directly deposit funds into your bank account for the appropriate amount of your reimbursement. If your reimbursement request is denied for any reason, you will receive written notice within 30 days of the date your claim was received by BCA. The written notice will include the specific reason for the denial, such as an internal rule or guideline, or specific IRS regulation. This time period may be extended for an additional 15 days for matters beyond the control of the Administrator, including in cases where a claim is incomplete. BCA will provide written notice of any extension, including the reasons for the extension and the date by which a decision by BCA is expected to be made, and will allow 45 days for you to complete an incomplete claim. Claim information submitted for reimbursement may be provided to your employer for the purpose of Flexible Spending Account Administration, such as a claims appeal. At the end of the plan year, you will have a 90 day run-out period to submit claims for expenses incurred during the previous plan year. Claims submitted after the 90 day run-out period are ineligible for reimbursement. WARNING: If the Plan Administrator determines that you have made fraudulent use of the plan, your participation in the plan will terminate and you will forfeit your unused funds. 6

7 APPEALS If your claim is denied, notification of the denied claim will set out the specific reasons for the denial and the specific Plan provision on which the denial is based; and will further advise you of what steps, if any, you might take in order to validate your claim. The notification will advise the following: (a) your right to appeal the denied claim by requesting an administrative review; (b) your right to review (on request and at no charge) relevant documents and other information; and (c) your right to file suit under ERISA (where applicable) with respect to any adverse determination after appeal of your claim. If you DO NOT appeal on time, you will lose your right to appeal. You (or your authorized representative) may request a review any time within 180 days of the notice that your claim was denied. Your written appeal should state the reasons that you feel your claim should not have been denied. It should include any additional facts and/or documents that you feel support your claim. You will have the opportunity to submit comments and have them considered. Your appeal will be reviewed and decided by someone who was not previously involved with your claim. The decision regarding the review will be made no later than 60 days after you submit the appeal. If the decision on review affirms the initial denial, you will be furnished with a notice of adverse benefit determination on review setting forth: the specific reason(s) for the decision on review; the specific Plan provision(s) on which the decision is based; a statement of your right to review (on request and at no charge) relevant documents and other information; a description of any specific rule, guideline, protocol, or other similar criterion or a statement that such a rule, guideline, protocol, or other similar criterion was relied on and that a copy of it will be provided free of charge to you upon request; and a statement of your right to bring suit under ERISA 502(a), if ERISA applies to the plan. Send your appeal to: BestChoice Administrators, FSA Appeals, PO Box 67230, Portland, OR

8 COBRA CONTINUATION Applies to Healthcare Flexible Spending Accounts Only Continuation coverage only applies to Healthcare Flexible Spending Accounts sponsored by employers who have 20 or more employees. Check with your Group Administrator to see if your Employer is required to offer COBRA continuation. If your plan is subject to COBRA and you experience a qualifying event, as defined below, your plan may be required to provide you, your spouse, or dependent(s) continuation of coverage for the remainder of the plan year. Healthcare Flexible Spending Account participants can only elect COBRA if the Healthcare Flexible Spending Account has a positive balance at the time of the qualifying event. A qualifying event is one of the following, but only if it causes loss of eligibility under the plan: termination of your employment (other than by reason of gross misconduct), or reduction of your work hours; your death; divorce or legal separation from your spouse; your becoming entitled to receive Medicare benefits; or your dependent s ceasing to be a dependent. For a qualifying event other than a change in your employment, it is your obligation to inform your employer of the qualifying event within 60 days of its occurrence. The employer will inform you of your COBRA rights, if any. If COBRA is offered and elected in the year in which the qualifying event occurs, COBRA will cease at the end of the plan year and cannot be continued for the next Plan Year. (Length of COBRA coverage for a Healthcare Flexible Spending Account differs from the length of coverage under employer sponsored group health coverage. Please consult your health plan member handbook for COBRA rights regarding medical/dental plans.) PREMIUM CONTRIBUTION PLAN The Premium Contribution Plan is not a reimbursement account, but allows you to have your portion of qualified benefits offered through your employer s cafeteria plan deducted on a pre-tax basis. Qualified benefits include the premium paid for medical, dental and vision insurance (premiums for you, your spouse and/or eligible dependent children), group term life insurance (up to $50,000 benefit) and disability insurance. Your employer will send these pre-tax funds to pay for the premiums directly to the insurance carrier. WHAT IS A HEALTHCARE FLEXIBLE SPENDING ACCOUNT? A Healthcare Flexible Spending Account is a means for you to have a source of pre-tax dollars from which you can be reimbursed for eligible healthcare expenses. Eligible healthcare expenses must be for medical care and primarily for a medical purpose, as defined in Internal Revenue Code 213. Expenses that are merely beneficial to a person s general health or directed at improving a person s appearance do not qualify under the primary purpose rule. Code 213(d)(1) defines medical care as amounts paid for the diagnosis, cure, mitigation, treatment or prevention, or for the purpose of affecting any structure or function of the body. You may not claim reimbursement for a health care expense if you can be reimbursed for the cost by another source, such as a health insurance plan, or will seek reimbursement of the expense. You will not be able to claim the health care expense deduction on an itemized federal income tax return. The maximum you can elect for your health care expenses is defined in the Plan Summary on page 1. The Healthcare Flexible Spending Account can be used to reimburse you for IRS eligible health care expenses incurred by you, your spouse and/or your eligible IRS tax dependents in the current plan year. Healthcare expenses must be incurred while you 8

9 are an active participant in the Plan. Expenses incurred prior to your effective date, or incurred after your termination in the plan are not eligible for reimbursement. Long-term care expenses are not reimbursable under the Healthcare Flexible Spending Account. You are entitled to be reimbursed up to the full amount of your annual election at all times, regardless if you have contributed the full amount. This is knows as the Uniform Coverage Rule. FMLA Leave of Absence If you go on a qualifying leave under the Family Medical Leave Act (FMLA), you may continue to contribute to your Healthcare Flexible Spending Account in one of the following ways: 1. With after-tax dollars, by sending monthly payments to your Employer by the due date established by your Employer. 2. With pre-tax dollars, by pre-paying all or a portion of the premium or contribution for the expected duration of the leave on a pre-tax salary reduction basis out of pre-leave Compensation. 3. With pre-tax dollars by using a catch-up method, where you pay for your elections upon return all the way back to your leave date. You also have the option of discontinuing your election while on a qualifying leave under FMLA. If you elect not to continue making contributions to your accounts, services incurred during this break in coverage will not be eligible for reimbursement. Likewise, your annual election amount will also be decreased by the amount that was not funded during your leave. WHAT IS A DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT A Dependent Care Flexible Spending Account is a means for you to have a source of pre-tax dollars from which you can be reimbursed for eligible dependent care expenses. To be eligible for reimbursement, the dependent care expense must be Employment-Related, as defined in Code 21. The dependent care expense must be necessary to enable you, or if you are married, you and your spouse, to work or look for employment. If your spouse is not working or looking for work when the expenses are incurred, he or she must be a full-time student or physically or mentally incapable of self-care. The primary purpose for care for a qualifying individual must be to ensure his or her well-being and protection, as defined in Treas. Reg. 1.44A-1(c)(3)(i). Examples of qualifying dependent care expenses include after-school care or extended day programs, day care centers, in-home day care, and Summer day-camps. Expenses for food, clothing and education are not considered to be expenses paid for the care of a qualifying individual. After school activities, such as ballet, karate and soccer are not considered custodial in nature; therefore they are ineligible for reimbursement. Daycare expenses may also be allowed for a spouse or tax dependent that is physically or mentally disabled. Expenses for nursing homes or skilled nursing facilities, which are permanent housing, are not eligible for reimbursement. To be eligible for reimbursement, dependent care expenses must have been incurred in the current plan year and while you are actively contributing to the Plan. Dependent care expenses are reimbursed based on when the service has been incurred, not paid. You cannot be reimbursed for pre-payment of dependent care expenses if the expense has not been incurred. Expenses incurred prior to your effective date, or incurred after your termination in the plan are not eligible for reimbursement. Eligible dependent care expenses can only be reimbursed as funds are available in your account. Dependent care provider cannot be an IRS tax dependent or a dependent under the age of 19. 9

10 Dependent care expenses are those expenses incurred on behalf of any dependent that meets the requirements to be a Qualifying Individual (defined below). A Qualifying Individual is: A person age 12 or younger, for whom you are entitled to claim a dependency exemption on your federal income tax return (if you are a divorced parent, a child is your dependent if you have custody, even if you are not entitled to claim the dependency exemption, refer to Publication 503), or Your spouse or person whom you can claim as a dependent for federal income tax purposes, but only if he or she is physically or mentally incapable of self-care and the individual regularly spends at least eight hours per day in the employee s household. Your election cannot exceed $5,000, if you are married and filed a joint return or single and the head of the household, or $2,500 if you are married filing a separate tax return. To qualify for tax-free treatment, you will be required to file IRS Form 2441 with your annual tax return. You must list on the Form 2441 the names and taxpayer identification numbers of any persons who provide you with dependent care expenses during the calendar year for which you have claimed a taxfree reimbursement. 10

11 Attachment A LIST OF ELIGIBLE AND INELIGIBLE HEALTHCARE AND DEPENDENT CARE EXPENSES This list does not include all IRS expenses that are eligible or ineligible for reimbursement. If you do not see an expense on this list, please call BestChoice Administrators Member Services at or ELIGIBLE HEALTHCARE EXPENSES To be eligible for reimbursement, healthcare expenses must be for medical care and primarily for a medical purpose. Eligible over-the-counter products is on a separate list. Acupuncture Office Visit Alcoholism and drug addiction treatment Ambulance Artificial limbs and teeth Blood pressure monitoring devices Birth control pills and Norplant insertion and removal Chiropractic Co-insurances and copays Contact lenses Contact solution Contraceptives (prescription and over-the-counter) Individual Counseling (for a medical condition) Crutches Deductibles Dental and denture expenses Diabetic Supplies and Insulin Diagnostic services and x-rays Dietary Supplements (if prescribed by a physician to treat a medical condition) Eye glasses and reading glasses Flu Shots Glucose monitoring equipment Hearing Aids Herbal Supplements (if prescribed by a physician to treat a medical condition) Hospital services Immunizations Laboratory fees Laser/Lasik eye surgery and radial keratotomy Massage therapy (if prescribed by a physician to treat a medical condition) Naturopathic Office Visits (excludes homeopathic drugs) Obstetrical expenses Occlusal guards to prevent teeth grinding Operations/Surgeries Orthodontia Osteopath Over-the-Counter Medications (ie: aspirin, pain relievers, cough syrup/drops, allergy medication must treat a medical condition) Oxygen Physical therapy Pregnancy test Prescription drugs Prosthesis Psychiatric and Psychology expenses Screening tests Sterilization procedures Stop-smoking program and over-the-counter products Surgery Transplants Weight-loss programs (if prescribed by a physician to treat a medical condition) INELIGIBLE HEALTHCARE EXPENSES The following expenses are considered cosmetic or primarily used for general health purpose. These expenses are not eligible for reimbursement, even with a physician s recommendation. Annual Fees for medical services (ie: LifeFlight, MedicAlert) Cosmetic Surgery Food supplements for weight loss Fitness Center/Gym Fees (even if prescribed by a physician) Insurance premiums Long-term care expenses Natural/homeopathic medicines Physician retainer fees Vitamins/Herbal Supplements for general health ELIGIBLE DEPENDENT CARE XPENSES To be eligible for reimbursement, the dependent care expense must be custodial in nature and allow you and your spouse, if married, to be gainfully employed. Before and after school care for children under the age of 13 Summer day camps for children under the age of 13 Licensed day-care providers Care provided in your home (provider cannot be an IRS tax dependent or a dependent under the age of 19) Home or daycare for eligible disabled IRS tax dependents that spend at least eight hours per day in your home. Registration Fees INELIGIBLE DEPENDENT CARE EXPENSES The following expenses are not considered custodial in nature and are not eligible for reimbursement. Enrichment programs (dance, sports or music lessons) Educational Fees/Tuition Overnight camps Food, clothing or transportation Housekeeping expenses Care not related to work 11

12 Attachment B OVER-THE-COUNTER PRODUCT LIST Over-the-Counter (OTC) products are eligible for reimbursement from your Healthcare Flexible Spending Account, if the OTC product is for medical care and primarily for a medical purpose. Expenses or procedures that are directed at improving a person s appearance, or the primary purpose of the product is to improve the general health of an individual, are not considered expenses for medical care and not eligible for reimbursement. 1. APPROVED OTC PRODUCTS the primary purpose of these products is for medical care and for a medical purpose. The following products are eligible for reimbursement. Allergy medication/spray Antacid and acid reducer Anti-diarraheal medication Anti-fungal spray/ointment/cream Anti-itch lotions and cream Bandages/band-aids Blood Pressure Monitor Cold remedies Cold Sore/Fever Blister Contact Lens Solution Contraceptives Cough Drops/Syrup Crutches Eye Drops for Allergy/Cold Relief Gastro-intestinal medicine Gauze pads Glucose Monitor Hemorrhoid suppositories/cream Hot/Cold packs Incontinence products Laxative Menstrual Cycle Medication Muscle & joint cream/gel Nasal spray (decongestant/allergy) Orthopedic inserts Pain relievers Pregnancy Test/Ovulation Test Reading glasses Rubbing alcohol Smoking cessation aids and products Sunburn ointment/cream Syringes Test Strips Toothache and teething pain reliever Throat lozenges/spray Vaporizer 2. DUAL PURPOSE OTC PRODUCTS these products have both a medical purpose and a personal/cosmetic or general health purpose. To be considered for reimbursement, a letter from a physician prescribing the OTC medication stating the medical condition that is being treated is REQUIRED. Acne treatment/medication Dental fluoride treatments Dietary supplements (ie: vitamins) Fiber supplements Herbal supplements Nose strips for proper breathing Sleeping Aids Snoring cessation aids and medication 3. INELIGIBLE OTC PRODUCTS - these products are considered cosmetic or used primarily for general health purposes. The following products are not eligible for reimbursement, even with a letter from a physician. Cosmetics Deodorants Face creams & cleansers Feminine hygiene products Hair removal treatments and waxes Lip products (ie: Chapstick, Carmex) Lotions & Moisturizers Mouthwash, antiseptics and oral anesthetics Multi-Vitamins Sundry Items (ie: cotton balls/q-tips) Sunscreen Teeth whitening kits and products Toiletries (ie: soap, shampoo, toothpaste, toothbrush) Wrinkle reducers 4. SUPPORTING DOCUMENTATION REQUIREMENT The Plan will require an itemized grocery/drug store or pharmacy receipt that includes the name of the specific OTC product that was purchased. The receipt must also have the location and the date purchased. The IRS does not allow a generic receipt with a copy of the packaging as acceptable documentation. If the receipt does not list the specific OTC product, the expense cannot be reimbursed. 12

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