Flexible Spending Account Next steps user guide. Getting started Learn how to manage your FSA

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1 cupuncture Ambulance Alcoholism Treatment Braille Books C lasses Chiropractor Crutches Corrective Eyewear Dental Treatm eductibles Dermatologist Dentures & Supplies Diabetes Mana edications Eye Exams First Aid Kits Hearing Aids Home Health earing Treatment Hospital Services Immunization Lamaze Cla icotine Replacement Nursing Home Expenses Optometrist Org ransplant Orthotics Parking Sticker For Handicapped Physical E hysical Therapy Prenatal Care Smoking Cessation Programs Spe chools For The Disabled Substance Abuse Treatment Speech T urgery Transportation Expenses For Receiving Medical Care Weig rograms Wheelchairs X-Ray Fees Acupuncture Ambulance Alc reatment Braille Books Childbirth Classes Chiropractor Crutch orrective Eyewear Dental Treatment Deductibles Dermatologi entures & Supplies Diabetes Management Medications Eye Ex Flexible Spending Account Next steps user guide Getting started Learn how to manage your FSA

2 ograms Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surger penses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupunctu lcoholism Get the Treatment most from Braille your Books FSA Childbirth Classes Chiropractor Crutches Corrective Eyew eatment Eligible Deductibles expensesdermatologist Dentures & Supplies Diabetes Management Medications E What s covered? The list of eligible expenses is too large to print in its entirety here, but the following is a sample of covered expenses. This list may be amended at any time of the year without notice. For comprehensive lists, visit: Health care: Dependent care: compliance/dfsa/dfsa-expenses.pdf Who can incur eligible expenses? A Health Care FSA will reimburse you for the eligible medical expenses you incur for: Yourself Your spouse Your dependents Your adult children A Dependent Care FSA helps you pay for child or elder care expenses incurred so you and your spouse can work. Common eligible expenses: Acupuncture Chiropractic care Contact lenses Co-pays Dental expenses (excluding whitening) Dermatologist fees Diagnostic tests Durable medical expenses (e.g., wheelchair or crutches) Flu shots Guide dog expenses Glucose kits Hearing aids and batteries Immunizations Infertility treatments Lamaze classes Lasik Midwife services Dependent care expenses: Day care In-home care Nursery or preschool After school care Optometrist and ophthalmologist fees Orthodontia Over-the-counter drugs (over-the-counter medicines require additional documentation) Oxygen Physical therapy Pregnancy tests Prenatal care Prescription drugs Prescription eyeglasses, sunglasses and reading glasses Psychiatric fees Smoking cessation programs Substance abuse treatment X-rays Au pair services Day camp Elder care services A note on Dependent Care FSAs: Eligible expenses may include services inside or outside of your home by anyone other than your spouse, a person you list as a dependent or one of your children under 19. Dependent care for a child over 13, overnight camp, babysitting that is not work-related, kindergarten, school tuition and long-term care services are not eligible expenses. 2

3 ograms Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surger penses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupunctu lcoholism Get the Treatment most from Braille your Books FSA Childbirth Classes Chiropractor Crutches Corrective Eyew eatment Understanding Deductibles the Dermatologist rules Dentures & Supplies Diabetes Management Medications E End of Plan Year Balance: $0.00 The use it or lose it rule. What you ve heard is true. The IRS mandates that if you don t use up your FSA account balance by the end of the plan year, you lose the money. So make sure to access your account online to see your balance, claim submission deadline, claim filing deadline and claim information. Changing your contributions. To make an FSA election change, you must experience a significant life event such as: Marriage Divorce Birth Death in your immediate family For a Dependent Care FSA only, you may also make election changes that correspond with the cost of care. Ask your employer what changes you may be able to make in this instance and the procedure for reporting them. What happens if I terminate employment? Participation in the FSA ends if you terminate employment. You may submit a claim for reimbursement of eligible expenses after your participation ends. The expenses must have been incurred prior to the plan termination date and they must be submitted within the run-out period. What is the run-out period? The run-out is a specified period of time after the end of the plan year in which you may continue to submit claims incurred during your period of coverage. This is not a period when you are able to continue to incur new expenses, but rather it allows you time to gather and submit expenses before forfeitures are applied. Health care reform. There are some changes due to health care reform that you should be aware of. To learn how these changes may affect your FSA, go to your self-service website and click on Health Care Reform. 3

4 ograms Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surger penses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupunctu lcoholism Manage Treatment your Braille account Books Childbirth Classes Chiropractor Crutches Corrective Eyew eatment Using Deductibles your FSA Dermatologist online Dentures & Supplies Diabetes Management Medications E Managing your account is easy. When you access your FSA account online, you can submit claims, check your balance and access forms. You can also: View claim status View claim history Add a dependent Sign up for electronic notifications Account Summary Check your account online today! Forms file claims Electronic Notifications 4 * If your company uses Ceridian s Health & Welfare benefits enrollment solution, you may have a different customer service phone number. Reference your benefits enrollment materials for the correct information.

5 ctive Eyewear Dental Treatment Deductibles Dermatologist Dentures & Supplies Diabetes M cations Eye Exams First Aid Kits Hearing Aids Home Health Care Hearing Treatment Hospital S unization Lamaze Classes Nicotine Replacement Nursing Home Expenses Optometrist Organ T otics Parking Sticker For Handicapped Physical Exams Physical Therapy Prenatal Care Smoking ams Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surgery Tr ses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupuncture A olism Get Treatment reimbursed Braille Books Childbirth Classes Chiropractor Crutches Corrective Eyewea ment How Deductibles it worksdermatologist Dentures & Supplies Diabetes Management Medications Eye ctive Eyewear Dental Treatment Deductibles Dermatologist Dentures & Supplies Diabetes M There are multiple ways to be reimbursed for your eligible expenses: via online self-service, mail, fax or a combination of these methods. You can also choose to receive reimbursements via either direct deposit or a mailed check. Option 1: Submit claim and upload receipt online. For the fastest reimbursement, simply log into your self-service portal to file a claim and upload your receipt or your Explanation of Benefits all online. Option 2: Submit claim online and mail or fax receipt. Log in to self-service, submit your claim online, then print your confirmation page and fax or mail it in with your receipt or Explanation of Benefits. Contact Information Phone: * Fax: Mailing address: Ceridian Benefits Services PO Box St. Petersburg, FL consumerservices@ceridian.com OR Option 3: Submit claim form and receipt via mail or fax. Print a claim form from online self-service or contact your Ceridian representative to have one sent to you. Then, submit the form with your receipt or Explanation of Benefits via fax or mail. OR 5 * If your company uses Ceridian s Health & Welfare benefits enrollment solution, you may have a different customer service phone number. Reference your benefits enrollment materials for the correct information.

6 upuncture Ambulance Alcoholism Treatment Braille Books Childbirth Classes Chiropractor C rrective Eyewear Dental Treatment Deductibles Dermatologist Dentures & Supplies Diabete a ograms Special Why are Schools some claims For The denied? Disabled Substance Abuse Treatment Speech Therapy Surger penses For Why Receiving are some Medical claims denied? Many times, a claim is denied because Care of missing Weight-Loss information on a submitted Programs receipt. By The taking following Wheelchairs a X-Ray Fees Acupunctu look Many guidelines times, the will example a claim help you receipts is denied ensure below, because you you submit of can missing valid make documentation information sure you receive on with a fewer submitted your claims. receipt. denials By and taking faster a lcoholism reimbursement. Treatment The following Braille guidelines Books may help: Childbirth Classes Chiropractor Crutches Corrective Eyew Get look reimbursed at the example receipts below, you can make sure you receive fewer claim denials and faster eatment reimbursement. Remember, Deductibles in order The to following process Dermatologist guidelines your reimbursement, may help: Dentures you need to include & an Supplies Explanation of Benefits Remember, Diabetes Management Medications E from your insurance in order to company, process or your copy reimbursement, of your receipt you for need the to expense. include Whichever an explanation documentation of benefits Documentation requirements rrective from Remember, Eyewear your insurance order Dental to company, process or your Treatment a copy reimbursement, of your receipt Deductibles you for need the to expense. include Whichever an explanation Dermatologist documentation of benefits Dentures & Supplies Diabete Your Receipt Must Contain: Date of Service Amount Due Provider Name Type of Service or Service Description you send, it should include four specific pieces of information: you from send, your it insurance should include company, four or specific a copy pieces of your of receipt information: the expense. Whichever documentation you 1. Date send, of service it should include four specific pieces of information: 1. Date of service 2. Amount due (i.e., patient responsibility amount) Amount Date of service due (i.e., patient responsibility amount) In 3. Provider name Provider Amount order due to name process your reimbursement, you need to include an Explanation of Benefits (for health care (i.e., patient responsibility amount) expenses 4. Type of service or service description (e.g., Description Provider Cleaning name only) or type from Crown of are service your insurance company or a copy of your receipt for the expense. Your Explanation valid descriptions; Dental is not.) of (e.g., Cleaning Crown are valid descriptions; Dental is not.) 4. Description Benefits or is type the of preferred service document to submit, as it includes all of the required elements needed for reimbursement. Once (e.g., your Cleaning claim or is Crown approved, Whichever are valid you ll descriptions; be documentation reimbursed. Dental is not.) you send, it should include four specific pieces of information Once approved, you ll be reimbursed. shown in the valid receipt examples below: Once approved, you ll be reimbursed. ABC Dentistry 124 Main Street ABC Dentistry Phone: (123) Main Street Jane Smith Maple Street - Yourtown, WV Phone: (123) Account: 4826 Date Patient Description Tooth Performed By Reference Amount Jane Smith Maple Street John Smith Panoramic film Dr. Johnson John Account: 4826 $ Date John Patient Smith Description Extraction Tooth A Performed Dr. Johnson By Reference John Amount $ John Smith Extraction K Dr. Johnson John $ John Smith Insurance Panoramic Payment film Dr. Johnson John John ( ) ( ) ($56.00) $ John Smith Visa Extraction Payment A Dr. Johnson John John ( ) ( ) ($168.00) $ John Smith Extraction K Dr. Johnson John $ Insurance Payment John ( ) ($56.00) Visa Payment John ( ) ($168.00) Scheduled Appointments New Balance: $0.00 Jane Smith :30PM John Smith :30PM Scheduled Appointments New Balance: $0.00 Jane Smith :30PM John Smith :30PM Valid Receipt receipt Valid Receipt Date Date of Service: service: of service: Amount Date Amount of Service: Due: due: $ due: $ Amount Provider Due: Name: name: $ name: ABC Dentistry ABC Dentistry Provider Service Type of Description: service Name: of service or ABC Dentistry Extraction or description: service Extraction description: Extraction* 4. Service Description: Extraction * Example: Cleaning or Crown are valid descriptions; Dental is not. Main Street Pharmacy (123) Main Street Pharmacy Customer Receipt Customer: (123) JANE SMITH Customer Receipt Customer: LORATADINE JANE SMITH 10MG TABLET Take once daily LORATADINE 10MG TABLET Pay: $15.82 Main Take Street once daily Pharmacy, 123 Main Street, Valid Receipt receipt receipt Valid Receipt Pay: $15.82 Main Street Pharmacy, 123 Main Street, Date Date of Service: of service: service: Amount Date Amount of Service: Due: due: $15.82 due: $ Provider Amount Provider Due: Name: name: $15.82 Main name: Street Main Pharmacy Street Pharmacy Provider Service Type Type of Description: service Name: of service or Main Loratadine Street description: Pharmacy service Loratadine 4. Service description: Description: Loratadine* X X ABC Dentistry 124 Main Street ABC Dentistry Phone: (123) Main Street Jane Smith Maple Street - Yourtown, WV Phone: (123) Account: 4826 Date Patient Description Tooth Performed By Reference Amount Jane Smith Maple Street - Account: Previous Balance $ Date Patient Visa Description Payment Tooth Performed By Reference ($168.00) Amount Previous Balance $ Scheduled Visa Appointments Payment New Balance: ($168.00) $0.00 Jane Smith :30PM John Smith :30PM Scheduled Appointments New Balance: $0.00 Jane Smith :30PM John Smith :30PM Invalid Receipt receipt Invalid Receipt receipt 1. Date of Service: service: Missing 1. Date of service: Missing Date Amount of Service: Due: due: $ Missing Provider Amount Amount Due: Name: name: $ due: ABC Dentistry $ Service Provider Type Provider of Description: service Name: name: or ABC service Dentistry Missing ABC description: Dentistry Missing 4. Service Type Description: of service Missing or service description: Missing It pays to to plan plan ahead. ahead. It pays to plan ahead. 6 Main Street Pharmacy 123 Main Street Main Yourtown, Street WV Pharmacy DATE: Main TIME: Street 10:29AM TERMINAL ID: K J DATE: MERCHANT ID: TIME: 10:29AM VISA TERMINAL ID: K J MERCHANT ID: ************6809 VISA SALE BATCH: ************6809 AUTH: INV: SALE BATCH: AUTH: TOTAL: $ INV: TOTAL: $ X I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT X (MERCHANT AGREEMENT IF CREDIT VOUCHER) I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT (MERCHANT AGREEMENT IF CREDIT VOUCHER) X X Invalid Receipt receipt receipt Invalid Receipt 1. Date of Service: service: of service: Date Amount of Service: Due: due: $15.82 due: $ Amount Provider Due: Name: name: $15.82 name: Main Street Pharmacy Service Provider Type Main of Description: service Name: Street or Main service Pharmacy Missing Street description: Service Missing 4. Type Description: of service Missing or service description: Missing

7 ograms Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surger penses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupunctu lcoholism Get Treatment reimbursed Braille Books Childbirth Classes Chiropractor Crutches Corrective Eyew eatment What Deductibles to do if your Dermatologist claim denied Dentures & Supplies Diabetes Management Medications E In the instance of a denied claim, participants have the opportunity to submit the correct information and resubmit the claim for reimbursement. Be sure all expenses were incurred during the plan year before submitting Be sure the expenses were not previously submitted Make sure that all of the information provided on the claim form (particularly your name, address and the name of your employer) is clearly legible Retain a copy of all claims forms and receipts submitted You may appeal a claim denied in whole or in part by writing to Ceridian within 180 days and providing additional information to establish that the claim is eligible. You may also request a copy of relevant documents, such as the employer s plan document(s). Top reasons claims are denied: Information is difficult to read or missing Expense is ineligible Expense was incurred outside the plan year (when no rollover is allowed) Expense has already been submitted Expenses that are not qualified for the plan that you are participating in Your receipt must contain: Date of service Amount due (i.e., patient responsibility amount) Provider name Type of service or service description (e.g., Cleaning or Crown are valid descriptions; Dental is not.) See contact information on page #5. 7

8 rthotics Parking Sticker For Handicapped Physical Exams Physical Therapy Prenatal Care Smo rograms Special Schools For The Disabled Substance Abuse Treatment Speech Therapy Surge xpenses For Receiving Medical Care Weight-Loss Programs Wheelchairs X-Ray Fees Acupunctu lcoholism Manage Treatment your Braille account Books Childbirth Classes Chiropractor Crutches Corrective Eyew reatment Using Deductibles your FSA Dermatologist online Dentures & Supplies Diabetes Management Medications Visit to: Submit claims Check your balance Access forms and more! How do I login to the Website? First time login only: 1. Go to 2. Select the link First Time Login Click Here! 5. On the next screen enter: Your first name and last name as they appear on correspondence you have received from Ceridian Benefits Services. Your street address. Your city, state abbreviation and the first five numbers of your zip code. If you have a non-u.s. address, check the box indicating that and fill in the requested information. 6. Click the Continue button. You will be prompted to do the following: Enter and confirm your address. Create a new user ID. Your new user ID must include a minimum of 6 characters and contain at least one letter (A-Z). Create and confirm a new password. Your new password must include a minimum of 7 characters and contain at least one number and at least one letter (A-Z). The password is case sensitive. Select your security questions and provide your answers. 3. Start the Registration Process by entering ONE of the following: a Ceridian Benefits Services Account ID (found on most correspondence sent to you from Ceridian Benefits Services). OR your Social Security Number. 4. Click the Continue button at the bottom of the page Click the Register button to complete the process and continue to your Ceridian Benefits Services account(s). For returning users. Since Ceridian is now requiring two security questions and answers to better secure your information, you may see Your Profile page when you login. Re-confirm your address, select a second security question and provide your answer.