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Dependent Care ccounts n Independent Licensee of the Blue Cross and Blue Shield ssociation.

uestions and nswers Dependent Care ccounts Preferred Dependent Care ccount Can Save You Money s part of your benefits program, you may use payroll deductions to create a pre-tax account to help pay for your dependent care expenses. You can set up a Dependent Care ccount during your open enrollment period. Money set aside in your Dependent Care ccount will reduce your taxable income, providing you and your family more value for your dollar. Dependent Care ccount This account reimburses you for expenses associated with the care of your children or other dependents while you (and your spouse) work or attend school full-time. The maximum annual amount allowed for this plan is $5,000 or $2,500 for married taxpayers filing separate returns. Participation in this account is voluntary. Setting up an account can provide tax advantages that your tax advisor can confirm and explain to you. While a Dependent Care ccount can save you money by using pre-tax dollars, it requires careful planning. Keep in mind that money deducted from your pay and deposited in your Dependent Care ccount must be used for the appropriate expenses during the year while you have an active account. Money left in an account does not carry over to the next year, and it is not refundable to you at the end of the year. In other words, if you don t use it, you ll lose it! Eligible expenses that can be paid from the Dependent Care ccount include: Licensed nursery school and day care facilities for children Child care in or outside your home Day care for an elderly or disabled dependent Expenses that are not eligible include: Expenses for educational purposes (for example, kindergarten) Over night camps Child support payments Food, clothing and entertainment Cleaning and cooking services provided by the caregiver Helpful Information From the Internal Revenue Service For a complete list of eligible expenses for Dependent Care ccounts, refer to IRS publication 503 Child and Dependent Care Credit. You may call the IRS at the toll-free number listed in your local telephone directory or visit them on the web at www.irs.gov for a copy of this publication. What bout the Current Child Care Tax Credit? The advantage of the Dependent Care ccount is that it allows you to pay the eligible expenses with pre-tax dollars. There are other tax considerations that you must weigh when making decisions about this account, such as the Child Care Tax Credit. The IRS allows you to take a credit on your federal income taxes for your work-related dependent day care expenses if you file an itemized return. Depending on your income and tax filing status, this Child Care Tax Credit may offer more, or less, tax savings than the Dependent Care ccount. You can use both the tax credit and the Dependent Care ccount (not for the same expenses), but any tax credit you take reduces the amount you can contribute to, and claim from, the account. Only you can decide which method is best for your situation. 1

Dependent Care ccounts How Does the Preferred Dependent Care ccount Work? During open enrollment you decide if you would like to enroll in the Dependent Care ccount and how much to contribute for the upcoming year. Contributions must be made in whole dollars. The amount you elect will be broken down into equal amounts (depending on your pay schedule). These funds are deducted from your pay before taxes are withheld and deposited in your account. This account is administered by Blue Cross and Blue Shield of labama. Once you enroll, you will receive a welcome letter from Blue Cross with information about your account. The money you pay out of pocket for dependent care services is reimbursed to you from your account. You may elect to have your reimbursement deposited directly into your checking or savings account.you will need to file a Request for Reimbursement form in order to be reimbursed. Reimbursements from the Dependent Care ccount cannot exceed the amount deposited in your account at the time your reimbursement is processed. ll reimbursement requests for eligible expenses must be received or postmarked by the end of your plan s timely filing period in order to be processed. Please refer to your benefit booklet for your plan s specific timely filing period. 2

Dependent Care ccounts How Can Preferred Blue ccount Reduce My Taxes? Preferred Blue ccounts reduce your taxes by reducing your taxable income. Using these pre-tax accounts can make a significant difference in your take-home pay. Example Taxable Income Pre-tax Contribution Used for Expenses Taxable Income djusted Without ccount $36,000 0 $36,000 With ccount $36,000-5,000 $31,000 Subtract Federal and Social Security Taxes* fter-tax Dollars Spent on Eligible Expenses Spendable Income Your Tax Savings is: * ssumes combined tax rate of 25.65% -9,234-5,000 $21,766-7,387 0 $23,613 $1,847 The chart illustrates what would happen if your annual pay is $36,000 and you have $5,000 in eligible dependent care expenses. Example: Dependent Care ccount Mary has one child. To enable her to work, she pays $200 per month for day care. Let s look at how a Dependent Care ccount can help Mary. Employee Status: Married, three federal exemptions Weekly Salary: $500 Gross Pay Pre-tax DC deduction Taxable Gross Income Less Taxes: FIC (7.65%) Federal (15.0%) State (4.4%) Net Pay Reimbursement from Dependent Care ccount Spendable Income Without ccount $500.00-0 $500.00 38.25 75.00 22.00 $364.75 $0 $364.75 With ccount $500.00-50.00 $450.00 34.43 67.50 19.80 $328.27 $50.00 $378.27 Mary is paid weekly. She chooses to have $50 each pay period deducted from her gross salary. Because Mary s taxable income is now lower, her taxes are less. fter Mary is reimbursed from her Dependent Care ccount, her total weekly spendable income increases. By the end of the year, Mary increases her spendable income by $703.04. ($378.27 - $364.75 = $13.52 x 52 weeks = $703.04) 3

Dependent Care ccounts uestions and nswers re there any government forms to complete? Yes, employees must complete the IRS form 2441 or the 1040 when completing income tax returns if they participate in the DC. Can I change the amount I elect to contribute to my DC? Yes, you can change the amount you contribute annually, prior to the beginning of each plan year. During the plan year, you may change your contribution only if you experience a qualified change in family status, as defined in your benefit booklet. What are Dependent Care ccounts? Dependent Care ccounts (DC) are cafeteria plans established under IRS Code section 125, provided by your employer that allow you to pay for dependent care with pre-tax dollars. This helps make these expenses more affordable while providing a tax savings. What are the advantages of a DC? DC offers substantial benefits. Because the money comes out of your pay before taxes, taxable income decreases and you pay less in federal, state, local and Social Security taxes. What happens if I have not used all the money in my account by the end of the year? IRS regulations dictate that any money left in the account at the end of the year is forfeited. This is commonly known as the use it or lose it rule. lthough you will have a period to file for reimbursement for expenses incurred in the previous plan year, it is recommended that you file your expenses as early as possible. Specified timely filing is determined by your plan. Please refer to your benefit booklet for specific information. What are the disadvantages of a DC? It is very important that you estimate your expenses carefully. mounts deposited to your account that are not used in the plan year cannot be returned to you. lso, since you are reducing your Social Security contribution, there could be an effect on your future Social Security benefit. These reductions usually are not significant, but you should be aware of them. 4

uestions and nswers Dependent Care ccounts Do I need receipts in order to receive reimbursement? Yes, dependent care claims require a paid receipt or a personal statement itemizing charges from the provider. In addition, the statement must include the provider s name, tax identification number or Social Security number, date(s) of service, amount charged and the name of the person receiving the care. How do I file for reimbursement? Simply file a Request for Reimbursement form along with a receipt for all dependent care services. Contact Customer Service at 1 800 213-7930 or visit our web site at www.bcbsal.com to request a form. ll requests should be mailed to: Blue Cross and Blue Shield of labama Preferred Blue ccounts P. O. Box 11586 Birmingham, labama 35202-1586 or fax to: 205 220-7991 Toll free : 1 877 889-3610 Can the DC reimburse my dependent care provider directly? No, the DC cannot make a payment directly to your day care provider on your behalf. ll reimbursements must go directly to the member. Do I have to keep track of how much money is in my account during the year? No, Blue Cross will do it for you. You will receive a statement of your account balance with each reimbursement. Statements are also sent quarterly when there is no recent reimbursement to advise you of your account balances. This is an added step to help plan expenses and reduce the amount of unused funds at the end of the year. You can also view your account balance by visiting www.bcbsal.com. If I leave my job, may I still participate in the DC program? If you leave your job, you are not entitled to continue the DC. 5

Dependent Care ccounts uestions and nswers Who is considered an eligible dependent for reimbursement? n eligible dependent must share his or her principal place of residence with the participant and be one of the following: qualified child dependent under age 13 who lives with the participant for more than half the year qualified child dependent, a qualified relative dependent or your spouse who is physically or mentally incapable of caring for himself or herself and who lives with the participant for more than half the year If you have any questions regarding your dependent qualifications, please consult a tax advisor. If I have a question regarding my account, who do I call? Contact Blue Cross and Blue Shield of labama Customer Service at 1 800 213-7930. Who is eligible to use the DC? To be eligible, a participant must be at work during the time the eligible dependent receives care. Participants must meet one of the following requirements: Be a single parent What kind of care is eligible for reimbursement? Expenses may be reimbursed for services provided: Inside or outside the home by anyone other than the member s spouse, a person listed as the member s dependent for income tax purposes or one of the member s children under age 19 In a dependent care center or a child care center, which meets all applicable state and local regulations By a housekeeper whose services include, in part, providing care for a qualifying individual Have a working spouse Have a spouse who is a full-time student at least five months during the year while the employee works Have a spouse who is physically or mentally unable to provide his/her own care Be divorced or legally separated and have custody of the child most of the time even though the former spouse may claim the child as a dependent for income tax purposes 6

uestions and nswers Dependent Care ccounts What if the dependent care provider does not claim the income as earnings? In order to receive reimbursement, the Social Security or tax ID number of the care provider must be provided on the federal income tax return. s a result, the provider will have to pay taxes on that income. Does my dependent care provider have to meet any special requirements for me to participate? The documentation submitted to Blue Cross must include the Social Security number or tax ID number and a signature or formal documentation from the dependent care provider. When completing the IRS form 2441 for filing your income tax return, you must give the ID number of the dependent care provider, which would be the Social Security number for an individual or the tax ID number of the provider providing the care. Can I receive the full amount of my day care expense? Your payroll deduction amount is the maximum amount you can receive from your DC. If your expense is greater than the payroll deduction amount, you will only receive reimbursement for the payroll deduction amount. The expense over the deduction amount will be credited and reimbursed to you after the next payroll deduction. Must I pay a bill first and then be reimbursed later? Yes, under the DC, an expense must be incurred and paid before it is reimbursable. 7

Dependent Care ccounts If you have any questions about your Preferred Dependent Care ccount, call: 1 800 213-7930 File reimbursement requests to: Blue Cross and Blue Shield of labama Preferred Blue ccounts P. O. Box 11586 Birmingham, labama 35202-1586 or fax to: 205 220-7991 Toll free: 1 877 889-3610 8

MKT-84 (Rev. 10-2011) n Independent Licensee of the Blue Cross and Blue Shield ssociation.