A Guide to Your Flexible Spending Account (FSA)

A Guide to Your Flexible Spending Account (FSA)

Table of Contents Effective January 1, 2006 Aetna will be the new administrator for your Flexible Spending Account (FSA). This booklet contains important information that will help you understand the features and services provided to you as an Aetna Flexible Spending Account participant. If you have any questions regarding the enclosed material, please contact Boeing TotalAccess at 1-866-473-2016 and request the Health and Insurance option from the menu or follow the link to the Health and Insurance Plans through the internal Boeing computing network at http://my.boeing.com. From outside the Boeing computing network, follow the links at https://my-ext.boeing.com. The Boeing Service Center for Health and Insurance Plans website is available 24 hours a day, 7 days a week. Boeing Service Center representatives are available Monday-Friday from 8:00 a.m. through 9:00 p.m. Eastern Time. Aetna Navigator Overview... 2 Direct Deposit Online Enrollment Feature... 3 Streamline... 4 Streamline Online Enrollment Feature... 5 Claim Submission Guidelines and Tips... 6 OTC Medical Expense Reimbursement... 8 OTC Health Care Reimbursement Form... 11 Dependent Care Reimbursement Form... 13 Health Care Reimbursement Form... 15 Contact Information Boeing TotalAccess: 1-866-473-2016 Select the Health and Insurance option from the menu. Representatives are available from 8:00 a.m.-9:00 p.m. Eastern Time Monday through Friday. Internal Boeing computing network: http://my.boeing.com Outside the Boeing computing network: https://my-ext.boeing.com Aetna FSA Claim Submission Fax: 1-888-238-3539 (1-888-AET-FLEX) Aetna FSA Claim Mailing Address: Aetna FSA P.O. Box 4000 Richmond, KY 40476-4000 Aetna Navigator - FSA Self Service Website: Navigator Registration Assistance: 1-800-225-3375 1

Aetna Navigator Overview Aetna s Self-Service FSA Website Aetna Navigator is an online resource for flexible spending account information. Aetna Flexible Spending Account (FSA) participants can take full advantage of our interactive website to complete a variety of self-service options online. You can access the site 24 hours a day, 7 days a week from wherever you have Internet access. Aetna Navigator helps you make the most of your Flexible Spending Account. You can: Check your Flexible Spending Account status. Review your FSA account balance. Obtain details for claim submissions and payments. Look up claim submission deadlines. Receive automatic alerts whenever there is a new Explanation of Payment to view online. Enroll/change FSA direct deposit. Enroll/change Streamline. Request online-only delivery of your Explanation of Payments (EOPs) if you have direct deposit. Eliminate paper EOPs by mail. Print out Aetna standard claim forms. Contact Aetna Member Services. Aetna FSA Participants, Register Today! If you are currently a participant of an Aetna Flexible Spending Account, you may register today! Go to Aetna Navigator via http://my.boeing.com. Click on the Register Now link. Complete the requested information to verify that you are an Aetna member. Select a user name, password and security phrase. Once your registration is complete, your user name and password will give you access to Aetna Navigator. Your claims data will be available ten days after you register. You will receive a confirmation letter via the U.S. Postal Service at the address we have on file. You can find help with questions about registration, security and software by clicking on About Registration at the top of the online registration form. Technical assistance with registering with Aetna Navigator is available toll free, Monday through Friday, from 7:00 a.m.-9:00 p.m. Eastern Time at 1-800-225-3375. 2

Direct Deposit Online Enrollment Feature Make FSA changes online quickly and easily on your secure Aetna member website! Direct deposit allows you to have access to your funds sooner and saves you time! Go to Aetna Navigator via http://my.boeing.com click on Claims and Balances or Requests and Changes; Personal Profile to make changes. Wherever you have Internet access, you can securely and efficiently make your FSA direct deposit changes on the Aetna Navigator website. Submitting this request online, rather than on paper, helps the change to take effect sooner, and it reduces paperwork for you! On Aetna Navigator you can also: View your FSA claims. Review your current FSA account balances and activity. View who is covered on your plan. Request email alerts when there is a new Explanation of Payment (EOP) to view online. Turn off the paper delivery of your EOPs if you have direct deposit. Use the FSA Advisor to project savings. Access the IRS list of approved items for FSA reimbursement. Print Aetna standard claim forms. You ll receive a confirmation when you make changes online. Contact Aetna Member Services. 3

Streamline As an Aetna Flexible Spending Account member, the option may be available to participate in Streamline. Streamline automatically sends your and your covered dependents medical and dental claims directly to your Flexible Spending Account. How does Streamline work? Your current medical and/or dental plan will prepare a claims file containing your and your dependents out-of-pocket medical/dental expenses. The claims file is provided to Aetna and the out of pocket expenses are automatically applied to your Aetna Flexible Spending Account, without you ever having to file a claim. Reimbursement will be sent directly to you. Here's a common example: Visit the doctor and pay your $20.00 copay. The doctor submits the claim to your insurance plan. Your insurance plan will transmit the $20.00 copay amount to Aetna. Aetna will reimburse you automatically for your $20.00 out-of-pocket expense. How do I know if my plan is participating? The following plans have partnered with Aetna to offer Streamline: Medical Plans Traditional Medical Plan (TMP) Aetna PPO+ Account Dental Plans Network Dental (Non Union) Preferred Dental (SPEEA) Scheduled Dental Plan How do I sign up for Streamline? You can sign up for Streamline by accessing the Aetna Navigator link via http://my.boeing.com. You will find the Streamline claims option under Claims & Balances on your Aetna Navigator home page. You must have an Aetna Navigator User ID and Password in order to access the site. Registration for Aetna Navigator is quick and easy. Just click on the First Time User link, follow the steps and register now! You cannot enroll in Streamline if: You have other medical/dental insurance. Your Flexible Spending Account cannot pay an expense that is covered under another health plan. So if you or one of your dependents has other coverage, the claim must be submitted to the other coverage first before your FSA can process the claim. You have orthodontia expenses. If you are paying orthodontia expenses on a contract schedule rather than a per-visit basis, you cannot sign up for Streamline. You have a domestic partner who is not your dependent for tax purposes. Only the expenses of you or your tax qualified dependent can be reimbursed by your FSA plan as defined by Section 125 of The Internal Revenue Code. In the event that you do enroll in Streamline and you fall into any of the aforementioned categories, the reimbursements you receive could be considered taxable income. How do I submit my medical/dental claims to my FSA if I do not participate in the Streamline option? Simply pay the out-of-pocket costs due to the provider, and submit a manual claim with required documentation to be reimbursed from your FSA. Claim forms can be obtained by accessing Aetna Navigator via http://my.boeing.com Please contact Aetna Flexible Spending Account Customer Service if you have any additional questions regarding Streamline. 4

Streamline Online Enrollment Feature Make FSA changes online quickly and easily on your secure Aetna member website! If you have a health care spending account, you can now elect or cancel the Streamline claims option on the Aetna Navigator website. Streamlining automatically passes a medical, dental or pharmacy claim processed by Aetna and other participating medical and dental plans* to the FSA system so you don t have to submit a claim form. Submitting the request online for Streamline enrollment, rather than on paper, helps the change take effect sooner. It is only necessary to enroll in the Streamline feature once per plan year in order for it to apply for the entire year. You can cancel your Streamline election at any time. You cannot elect the Streamline feature if you or your dependent(s) have continuing orthodontic treatments or have coverage under another health plan or if you are covering a domestic partner who is not your dependent for federal income tax purposes. In the event that you do enroll in the Streamline feature and you fall into any of the aforementioned categories, the reimbursements you receive will be considered taxable income and you will not have access to the Streamline option. This online FSA feature will make managing your Streamlining options quick and easy and it will help reduce your paperwork! Go to http://my.boeing.com to access Aetna Navigator and click on Claims & Balances to make Streamline changes. Aetna Navigator offers a wealth of information. You can view who is covered on your plan, track your claims, send a secure email to Aetna Member Services, and much more! You ll receive a confirmation when you make changes online. * Streamline is available for Aetna PPO+ Account participants as well as Traditional Medical Plan (TMP) participants enrolled with Regence Blue Shield, and Dental Plan participants enrolled in Washington Dental Service or the Scheduled Dental Plan. 5

Claim Submission Guidelines and Tips 6 The guidelines and tips below will ensure that your claim can be paid the first time you submit it. These points highlight the information you need to include, and the steps you need to take so your claim can be processed as soon as we receive it. If you need additional information, please call Boeing TotalAccess at 1-866-473-2016 and request the Health and Insurance option from the menu or follow the link to the Health and Insurance Plans through the internal Boeing computing network at http://my.boeing.com. From outside the Boeing computing network, follow the links at https://my-ext.boeing.com. Your Benefits Resources website is available 24 hours a day, 7 days a week. Boeing Service Center representatives are available Monday through Friday 8:00 a.m.-9:00 p.m. Eastern Time. The Two Must Do's For All Claims: Each Health Care or Dependent Care (child care only) FSA claim submitted, whether faxed or mailed, must have, at the minimum, these two items: A completed and signed claim form (all sections) An Explanation of Benefits (EOB), itemized bill/statement or receipt (independent documentation) from the health care provider that includes the patient's name, type of service, health care provider's name and address, dollar amount charged and date of service. Must Do's For Health Care FSA Claims: Must include Explanation of Benefits (EOB) to indicate the out-of-pocket expenses. If you are covered by more than one health plan (called Coordination of Benefits or COB) please include an EOB from both insurance plans. Must Do's For Pharmacy Claims: Provide the patient name. Provide prescription name and number. Provide dollar amount charged. Identify the actual date the prescription was dispensed. Must Do's For Orthodontics: With the first orthodontic submission, the member must submit a signed Flexible Spending Account Health Care Reimbursement claim form along with: > The orthodontia contract from the orthodontist that indicates the initial fee charged, estimated insurance payment, initial start date, duration of treatment and proof of payment for reimbursement request of any partial or full down payment. You will be reimbursed for the amount you have paid for any service that takes place during the current plan year. Reimbursement for any service that takes place outside of the current plan year is not available. For example, a participant submits an orthodontic treatment plan for 24 months with a total cost of $5,000. The participant has paid the entire $5,000 in February 2006. Aetna will first determine what the monthly rate of reimbursement will be, based on the amount paid and the length of the treatment plan. Payments are broken out on a monthly basis and in this case would be $208.33 per month ($5,000 divided by 24 months). Since it is February, this individual will receive 11 monthly payments of $208.33 in 2006 (for a total of a $2,291 reimbursement for 2006). In January 2007, Aetna will reimburse $208.33 per month, for a total reimbursement of $2,500 ($208.33 X 12 months). The remaining $208.33 would be reimbursed in 2008*. * Provided you re-enroll in the FSA plan in 2007 and 2008. Each time you submit a claim for monthly reimbursement, you must have a completed and signed claim form and an itemized bill/statement or receipt from the orthodontist showing the monthly charge the original orthodontic contract specified. Request for reimbursement for subsequent plan years will be returned to the member for resubmission in the appropriate enrolled plan year(s). Must Do's For Dependent Care Claims: Include caregiver tax ID or Social Security number. > Provide a completed claim form signed by the member and the caregiver. If you are submitting independent third-party documentation it must include: > The name and address of the caregiver. > Social Security number or tax ID > Date(s) of service > Dollar amount Submit claims only for Dependent Care services that have been provided. Reimbursements cannot be made before services are provided.

Common Don't Do's To Ensure Timely and Accurate Claim Processing Below are some common mistakes or problems that occur when submitting claims. Paying close attention to these guidelines will help ensure your claim is handled correctly with the first submission and does not require additional follow-up. Hints on Common Don't Do's: Please do not provide cancelled checks as documentation for services rendered (cancelled checks may be submitted for Dependent Care when services are provided by a relative only). An EOB or itemized bill/statement along with a signed Flexible Spending Account Health Care Reimbursement claim form is required for reimbursement requests. Please do not mail originals without making copies for future reference as required. Please do not highlight or otherwise mark documentation when submitting claims. When preparing claims for submission please do not staple or tape over pertinent information. Please do not submit expenses for different dependent care providers on one claim form. Please use separate forms. Please do not submit balance due, balance forward, previous balance or payment statements from a doctor as documentation for services rendered. Please do not include or submit prepaid expenses or claims with future dates of services. The IRS guidelines require that FSA expenses are reimbursed only on services that have already been provided. Aetna FSA P.O. Box 4000 Richmond, KY 40476-4000 Fax to: 1-888-238-3539 (1-888-AET-FLEX) Please use the guidelines, helpful hints and member Web tools to help ensure one-time claim submission and improved claim processing time and accuracy! 7

Overthe-Counter Medical Expense Reimbursement The IRS has determined that certain over-thecounter (OTC) items could qualify as medical care and be reimbursed through a Flexible Spending Account (FSA). This includes expenses such as aspirin, allergy and sinus medication, antacids, cold medicines and pain relievers. The guidelines further clarify that expenses merely beneficial to health such as vitamins and other nutritional aids are not eligible for reimbursement through FSAs. Claim substantiation rules have not changed. Members must provide documentation that validates the expense, including type of drug, date of service and amount of purchase. Over-the-Counter Medical Expense Reimbursement through Health Care FSAs IRS Rev. Rul. 2003 102, September 3, 2003 The list below is not intended to be all-inclusive, but is rather to answer frequently asked questions. If you need additional information, please call Boeing TotalAccess at 1-866-473-2016 and request the Health and Insurance option from the menu or follow the link to the Health and Insurance Plans through the internal Boeing computing network at http://my.boeing.com. From outside the Boeing computing network, follow the links at https://my-ext.boeing.com. The Boeing Service Center for Health and Insurance Plans website is available 24 hours a day, 7 days a week. Boeing Service Center representatives are available Monday through Friday 8:00 a.m.-9:00 p.m. Eastern Time. Reimbursable Expenses Relating to Medical Care Cold medicines, such as tablets, syrups, drops and lozenges Analgesics, such as fever and pain reducers like aspirin, Tylenol, ibuprofen Antacids and heartburn relief, such as Alka-Seltzer, Mylanta and Phillips Milk of Magnesia Stomach and digestive relief, such as Pepto-Bismol, Imodium, Colace, Lactaid Laxatives Eye care, such as contacts, saline solution and lubricant eye drops Motion sickness remedies, such as pills, patches, bracelets First aid, such as heat wraps, compresses, bandages, tape, gauze dressing, adhesive pads and pain relieving creams Joint support bandages and hosiery, such as knee supports, elbow supports Arthritis pain-relieving creams Antibiotic ointments Anti-itch and hydrocortisone creams Allergy relief, such as oral medications, nasal sprays, patches Athlete s foot treatment, such as nail and foot antifungal creams Wart removal medication Vaporizers and humidifiers Diabetes glucose monitor and related equipment Blood pressure monitor and related equipment Cholesterol test equipment Urinary pain relief Smoking cessation relief, such as patches, gum Feminine care relating to treatment of vaginal infections Tooth and mouth pain relief, such as Orajel, Anbesol Shampoo treatments relating to treatment of psoriasis, lice Eye patches Incontinence products, such as Depend and Serenity pads Family planning, such as pregnancy tests, condoms 8

Not Reimbursable Expenses Relating Primarily to Good Health Personal hygiene, such as deodorant, soap, body powder, shaving cream and razors, feminine care and sanitary products Cosmetics, such as makeup, lipstick, cotton swabs, cotton balls, baby oil Skin care, such as sunblock, skin and body moisturizing lotion, lip balm Hair care, such as hair color, shampoo, conditioner, brushes, and hair loss products like Rogaine Routine dental care, such as toothpaste, toothbrushes, dental floss, mouthwashes (including antibacterial mouthwash and fluoride rinses), breath strips, teeth whitening products Denture care, such as denture cleansers and denture adhesive creams Nail care and personal grooming, such as scissors, nail files Vitamins EXCEPTION*: Vitamins prescribed at the direction of a doctor. A physician statement is required. Nutritional and dietary supplements, such as bars, milkshakes, power drinks, Pedialyte EXCEPTION*: Supplements prescribed at the direction of a doctor. A physician statement is required. Weight-reduction aids, such as Slim-Fast, appetite suppressants EXCEPTION*: Weight-reduction products prescribed at the direction of a doctor. A physician statement is required. Sleep aids, such as oral medications, snoring strips EXCEPTION*: Sleep aids prescribed at the direction of a doctor. A physician statement is required. *Exceptions (These are considered eligible for reimbursement as they relate primarily to medical care.) 9

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Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna company that offers, underwrites or administers benefits coverage is Aetna Life Insurance Company. This material is for informational purposes only and contains only a partial, general description of plan benefits or programs and does not constitute a contract. While this material is believed to be accurate as of the print date, it is subject to change. CCG 06-0458 (01/06)