Flexible Spending Account (FSA) / Dependent Care Account (DCA)

Transcription

1 Flexible Spending Account (FSA) / Dependent Care Account (DCA) University Medical Associates PLAN YEAR: 1/1/15 12/31/15 You have 90 days at the end of the Plan to file claims for services provided during the Plan Year. Checks or Direct Deposits are mailed to the participant every Wednesday. Claims have to be received in our office by 12:00 PM EST on Friday in order to be reimbursed for the following week. Benefits card does not require a pin. Process as a credit card transaction. HERE S HOW IT WORKS: First, estimate how much money you will spend in the coming year for eligible healthcare and childcare expenses. Once calculated, the flexible spending account allows you to set aside a portion from your salary each payday. The maximum that you can elect for the Health Care Flexible Spending Account is $2,550 Per Year. The maximum you can elect (per household) for Dependent Care Account is $5,000 Per Year. The amount you allocate to your account is taken out of your pay before taxes are calculated and withheld. That means that part of your pay that goes towards flexible spending account is tax-free. When you pay for eligible expenses during the year, your get reimbursed for them with the money you have set aside in your flexible spending account. Since the money was set aside on a tax-free basis, you ve saved the tax dollars you would have paid on earnings spent for healthcare and child care expenses. ROLLOVER FEATURE: If you have a balance in your 2014 spending account this balance, up to the $500 maximum allowable by the IRS, will roll over to your 2015 balance. You will have access to this $500 after the first quarter of ELIGIBLE HEALTHCARE EXPENSES - Co-Payments - Prescription Drugs - Dental (Orthodontics, Dentures, Crowns, Bridges) - Vision (Exam, Eyeglasses/Contacts, Contact Lenses Solution) INELIGIBLE HEALTHCARE EXPENSES - Vitamins - Cosmetic Surgery - Weight Loss Program (unless it is to treat a specific disease) ONLINE ACCOUNT ACCESS Active participants may track their FSA account status online. Simply log onto and click on Participant Login to create your account. Participants may create an account using their Employer ID (JSLUMA) and Employee ID (social security number no dashes). Note: Your Card Number is not needed, just Employer ID. HOW ARE EXPENSES PAID? There are several options to receive payment: A completed Reimbursement Form and Itemized Receipts or EOB can be mailed to: HealthSmart Benefit Solutions, PO Box 2911, Charleston, WV or faxed to A claim can be ed to fsa.healthsmart.com A completed Reimbursement Form and Itemized Receipts or EOB needs to be attached. HealthSmart Benefit Solutions P. O. 3262, Charleston, WV Phone Fax

2 F L E X I B L E S P E N D I N G A C C O U N T S F O R H E A L T H C A R E A N D D E P E N D E N T C A R E Eligible Expenses Medical Expenses: Acupuncture Alcoholism treatment Ambulance Artificial limbs Autoette / wheelchair Bandages Breast reconstruction Surgery (following mastectomy from cancer) Birth control pills Braille book and magazines Chiropractor Christian Science Practitioner Crutches Diagnostic services Disabled dependent medical care Drug addiction treatment Drugs and medicines Fertility treatment Guide dog Hearing aids Home care Hospital services Laboratory fees Lead based paint removal Maternity care & related services Meals for inpatient Medical information plan Medical services (i.e. physician, surgeon, etc.) Nursing home Nursing services Operations Organ donor s medical expenses Osteopath Over-the-Counter Medications (with a doctor s prescription) Oxygen Prosthesis Psychoanalysis Psychologist Special education Sterilization Stop-smoking programs Surgery Telephone/television for hearing-impaired Therapy Transplants Transportation for medical care Vasectomy Weight-loss program (specific disease diagnosed by doctor) Wheelchair Replacement hair lost due to illness X-ray Dental Expenses Artificial teeth Dental treatment Eye Care Expenses Eyeglasses Contact lenses Prescription sunglasses Eye examinations Eye surgery (for example, LASIK) Optometrist Ineligible Expenses Ineligible healthcare expenses include: Babysitting, childcare, and nursing services for a normal, healthy baby Controlled substances without a prescription Cosmetic surgery Dancing lessons Diaper services Electrolysis or hair removal Funeral expenses Hair transplant Health club dues Health coverage tax credit Household help Illegal operations and treatments Insurance premiums (for example, HMO premiums, Employer sponsored health insurance plan premiums) Maternity clothes Medical savings account (MSA)/ Health Saving Account (HSA) contributions Medicare B and D premiums Nutritional supplements Personal use items Swimming lessons Teeth whitening Veterinary fees Weight-loss program not part of specific disease treatment

3 Announcement: Important Information Regarding Your Benefit Accounts HealthSmart Benefit Solutions will transition to a new administrative platform for the management of your Flexible Spending Account (FSA) and Healthcare Reimbursement Account (HRA) accounts. Features of the new system: A new and improved participant portal providing you access to manage accounts, view account history, and submit claims. A powerful mobile application that will be available January 1, Benefit debit cards will still be offered allowing convenient, real-time access to your account funds. The new card platform allows more flexibility in design features increasing auto substantiation and eliminating paperwork and reimbursement delays. Increased functionality providing you efficiency and flexibility in managing your flexible spending account. Greater levels of automation providing you with multiple methods of claims submission and claims substantiation. Improved participant engagement providing you the basic features you are accustomed to, plus enhanced online, mobile and phone based engagement channels. Additional Benefit Enhancements: Electronic fund transfers You will have the ability to receive reimbursement through electronic fund transfers (EFT). Electronic claim submission and substantiation You will have the ability to submit and substantiate claims using either the online participant portal or the mobile application. Participant notifications You have the ability to receive electronic notifications regarding the status of your claim.

4 Questions? Q. Will I receive a new card? A. If your plan has a debit card, you will continue to use the same card. Q. How will my account be impacted by this transition? A. There will be no impact to your account. Q. Will I be required to create a new username and password? A. Yes. Beginning December 6 th, go to to establish a username and password. Once you have registered your account, you can use this to sign on for both the employee portal and the mobile application. NOTE: Mobile application will not be available until January 1, Q. Is there a new customer service number, and fax number? A. No. You can continue to use the same customer service number, fax number and address that you are currently. Q. If I want to submit a paper claim, what address do I use? A. Please use the following address to file any paper claims: HealthSmart Benefit Solutions, PO Box 2911, Charleston, WV

5 Flexible Benefits Plan Election Form and Salary Reduction Agreement Plan Year to Month Day Year Month Day Year Employer: SS# Name: Address: City, State, Zip: Effective Date Debit Card *? Yes No *Debit card options are specific to each Employer s Plan. They do not use a pin number. Process the transaction as a credit card. I decline to participate in this Plan. I understand that my declination will be valid for the Plan Year referenced above, and that I may not make changes without a qualifying event. I elect to receive the following benefits under the Plan. My Employer and I hereby agree that my salary will be reduced by the amounts set forth below for each pay period during the Flexible Benefits Plan Year listed above. Benefit Option Annual Election Amount # of Pay Periods Health Care FSA $ $ Dependent Care Assistance Plan (DCAP) $ $ Other (please specify): $ $ Totals $ $ Reduction Amount Per Pay Period I understand that: I cannot change or revoke this benefit election or compensation reduction agreement as of any date prior to the 12 month period known as the Plan Year, unless the change is due to a change in family status (i.e. marriage, divorce, death of a spouse or child, termination or commencement of employment of spouse), or other such events as the Plan Administrator determines will permit a change or revocation of an election under the Internal Revenue Code, as amended. If my required contributions for the elected benefits are increased or decreased while this agreement remains in effect, my pay reduction will automatically be adjusted to reflect that increase or decrease. Prior to the first day of each Plan Year, I will be offered the opportunity to change my elections for the following Plan Year. A new election must be made for each plan year. This election revokes any prior election I have made. The Plan Administrator may reduce or cancel my salary reduction or otherwise modify this Agreement should it believe advisable in order to satisfy certain provisions of the Internal Revenue Code. The reduction in my salary under this agreement shall be in addition to any other reduction agreements or benefit plans. This Salary Reduction Agreement reduces my compensation for Social Security tax purposes. Social Security benefits could be decreased due to the decreased amount of compensation that is considered for Social Security Purposes. This agreement is subject to the terms of the Employer s Flexible Benefit Plan as may be amended from time to time in effect, shall be governed by and construed in accordance with applicable laws, shall take effect as a sealed instrument under the applicable laws, and revokes any prior election and salary reduction agreement (if any) relating to such a plan. Employee Signature: Plan Administrator Signature: Date: Date: Please return form to: HealthSmart Benefit Solutions P.O. Box 2911, Charleston, WV Fax: fsa@healthsmart.com Phone: