INFORMATION ABOUT YOUR: FLEXIBLE BENEFIT CAFETERIA PLAN SOUTHERN ADMINISTRATORS AND BENEFIT CONSULTANTS, INC.

PLEASE CHECK WITH YOUR PERSONNEL OFFICE TO DETERMINE YOUR PLAN YEAR

YOUR PLAN MAY OFFER ONE OR MORE OF THE FOLLOWING OPTIONS THE OPTIONS OUTLINED IN THIS PRESENTATION ARE:

DEPENDENT CARE SPENDING ACCOUNT UNREIMBURSED MEDICAL SPENDING ACCOUNT OPTIONS ARE: PREMIUM ONLY PLAN DEPENDENT CARE SPENDING ACCOUNT UNREIMBURSED MEDICAL SPENDING ACCOUNT

PREMIUM ONLY PLAN THIS ACCOUNT ALLOWS YOU TO PAY FOR YOUR ELIGIBLE INSURANCE PRODUCTS SUCH AS: HEALTH, DENTAL, CANCER/ICU AND HOSPITAL INDEMNITY INSURANCE PREMIUMS WITH TAX FREE DOLLARS. BY PARTICIPATING IN THE PREMIUM ONLY PLAN, ALL ELIGIBLE INSURANCE PREMIUMS THAT ARE PAYROLL DEDUCTED WILL BE DEDUCTED BEFORE THE COMPUTATION OF STATE, FEDERAL AND FICA TAXES. LET’S LOOK AT HOW THIS CAN PUT MORE CASH IN YOUR POCKET…

YOUR PAYCHECK WITHOUT A PREMIUM ONLY PLAN $ 2000 GROSS SALARY -$ 600 STATE, FEDERAL AND FICA TAXES $ 1400 -$ 150 INSURANCE PREMIUM $ 1250 TAKE HOME PAY

YOUR PAY CHECK WITH A PREMIUM ONLY PLAN $ 2000 GROSS SALARY -$ 150 INSURANCE PREMIUM $ 1850 IRS REPORTABLE WAGES -$ 555 STATE, FEDERAL & FICA TAXES $ 1295 TAKE HOME PAY

BEFORE AND AFTER A PREMIUM ONLY PLAN LET’S COMPARE BEFORE AND AFTER A PREMIUM ONLY PLAN BEFORE $2000 GROSS SALARY -$ 600 TAXES $1400 -$ 150 INSURANCE $1250 TAKE HOME PAY AFTER $2000 GROSS SALARY -$ 150 INSURANCE $1850 -$ 555 TAXES $1295 TAKE HOME PAY BY PARTICIPATING YOUR TAKE HOME PAY INCREASED BY $45.00

DEPENDENT CARE SPENDING ACCOUNT IF IN ORDER FOR YOU AND YOUR SPOUSE TO WORK, YOU NEED SOMEONE TO CARE FOR YOUR DEPENDENT. THIS OPTION MAY SAVE YOU MORE THAN THE TAX CREDIT YOU CLAIM AT THE END OF THE YEAR. ELIGIBLE DEPENDENT:

A QUALIFYING DEPENDENT IS: A DEPENDENT WHO WAS UNDER AGE 13 WHEN THE CARE WAS PROVIDED AND FOR WHOM YOU CAN CLAIM AN EXEMPTION A SPOUSE WHO IS PHYSICALLY OR MENTALLY NOT ABLE TO CARE FOR HIMSELF OR HERSELF A DEPENDENT WHO WAS PHYSICALLY OR MENTALLY NOT ABLE TO CARE FOR THEMSELVES AND FOR WHOM YOU CAN CLAIM AN EXEMPTION

DEPENDENT CARE HOW DOES IT WORK? FIRST YOU MUST DETERMINE THE AMOUNT YOU WILL BE SPENDING ON DEPENDENT CARE DURING YOUR PLAN YEAR. (YOU MAY PRETAX UP TO $5,000 OR $2,500 IF YOU MARRIED FILING A SEPARATE RETURN) YOUR YEARLY AMOUNT WILL BE DIVIDED BY THE NUMBER OF PAY PERIODS IN YOUR PLAN YEAR. THAT AMOUNT WILL BE DEDUCTED TAX FREE AND PLACED INTO AN ACCOUNT AS THE EXPENSE IS INCURRED, YOU SUBMIT A RECEIPT TO SABC TO BE REIMBURSED CHECK WITH YOUR TAX ADVISOR TO SEE IF THIS OPTION WILL SAVE MORE THAN THE TAX CREDIT

UNREIMBURSED MEDICAL SPENDING ACCOUNT MOST PEOPLE INCUR OUT OF POCKET MEDICAL EXPENSES DURING THE YEAR. OUT OF POCKET EXPENSES ARE THOSE EXPENSES THAT ARE NOT COVERED BY INSURANCE OR ANY OTHER 3RD PARTY. THEY INCLUDE:

PLEASE REVIEW DEDUCTIBLE MEDICAL EXPENSE LIST PROVIDED OUT OF POCKET EXPENSES DEDUCTIBLES CO-PAYS VISION DENTAL MEDICAL OVER THE COUNTER DRUGS PLEASE REVIEW DEDUCTIBLE MEDICAL EXPENSE LIST PROVIDED

UNREIMBURSED MEDICAL TO PARTICIPATE SIMPLY ESTIMATE YOU AND YOUR FAMILY MEMBERS (SPOUSE AND DEPENDENT CHILDREN) OUT OF POCKET MEDICAL EXPENSES THAT WILL BE INCURRED DURING YOUR PLAN YEAR. BE CONSERVATIVE, IF YOU DON’T INCUR THE EXPENSE BY THE END OF YOUR COVERAGE PERIOD,YOUR FUNDS WILL BE FORFEITED TO YOUR EMPLOYER.

UNREIMBURSED MEDICAL CHECK WITH YOUR EMPLOYER TO DETERMINE YOUR YEARLY MAXIMUM. YOUR ELECTION IS DIVIDED BY THE NUMBER OF PERIODS IN THE PLAN YEAR AND DEDUCTED TAX FREE. YOUR ANNUAL ELECTION IS AVAILABLE TO YOU AT ALL TIMES, MEANING YOU DO NOT HAVE TO WAIT FOR THE FUNDS TO BE DEDUCTED FROM YOU CHECK BEFORE CLAIMING. EXAMPLE: IF YOUR PLAN STARTS JANUARY 1ST AND YOU ELECT $600.00 A YEAR ($50.00 A MONTH), AND YOU INCUR $600.00 IN ELIGIBLE EXPENSES IN JANUARY, YOU COULD CLAIM THE FULL $600.00. YOUR EMPLOYER FRONTS THE MONEY TO YOU AND THE DEDUCTIONS WOULD CONTINUE THROUGHOUT THE YEAR TO PAY THE PLAN BACK.

HOW AM I REIMBURSED? COMPLETE A REQUEST FOR REIMBURSEMENT INCLUDE DEPENDENT CARE AND/OR UNREIMBURSED MEDICAL THIRD PARTY RECEIPT(S). PLEASE COPY RECEIPTS ON A STANDARD SHEET OF PAPER MAIL, FAX OR BRING YOUR CLAIM TO OUR OFFICE FOR REIMBURSEMENT WHILE YOU WAIT. PLEASE COPY RECEIPTS ON AN STANDARD SHEET OF PAPER ALL CLAIMS ARE PROCESSED THE DAY THEY ARE RECEIVED AND MAILED TO YOUR HOME DEPENDENT CARE FUNDS MUST BE AVAILABLE BEFORE REIMBURSEMENT CAN MADE

WHAT RECEIPTS DO I NEED? RECEIPTS MUST BE FROM A THIRD PARTY AND HAVE THE FOLLOWING INFORMATION: DATE OF SERVICE TYPE OF SERVICE SERVICE PROVIDER YOUR COST AFTER INSURANCE AND DISCOUNTS DRUG RECEIPTS MUST HAVE THE NAME OF DRUG ON THE RECEIPT OR STATE CO-PAY OVER THE COUNTER DRUGS MUST HAVE THE NAME OF ITEM PRINTED ON THE RECEIPT EXPLANATION OF BENEFITS(EOB) FROM YOUR INSURANCE CARRIER IS THE BEST RECEIPT

CAN I MAKE A CHANGE TO MY ELECTION DURING THE PLAN YEAR? YOUR ELECTION MUST REMAIN THE SAME UNLESS YOU EXPERIENCE A CHANGE IN STATUS: MARRIAGE BIRTH/ADOPTION DEATH OF SPOUSE OR DEPENDENT CHANGE IN SPOUSE’S EMPLOYMENT STATUS SIGNIFICANT CHANGE IN INSURANCE OR DEPENDENT CARE COST/COVERAGE THE EVENT MUST BE CONSISTENT WITH THE CHANGE REQUESTED

WHAT IF I TERMINATE MY EMPLOYMENT? ALL INSURANCE DEDUCTIONS WILL CEASE DEPENDENT CARE DEDUCTIONS WILL CEASE IMPORTANT: IF YOU PARTICIPATE IN UNREIMBURSED MEDICAL, PAYROLL MAY DEDUCT YOUR REMAINING ELECTION OUT OF YOUR LAST PAYCHECK OR THE PLAN MAY TERMINATE DEPENDING ON YOUR PLAN DESIGN. PLEASE READ YOUR SUMMARY PLAN DESCRIPTION OF ASK YOUR HUMAN RESOURCE REPRESENTATIVE HOW YOU PLAN IS DESIGNED.

DISCLAIMER THIS PRESENTATION WAS FOR INFORMATION PURPOSES ONLY. THIS IN NO WAY DEFINES YOUR PLAN DESIGN. YOUR PLAN DOCUMENT WHICH IS AVAILABLE FROM YOUR EMPLOYER DICTATES THE FEATURES, DESIGN AND OPERATION OF YOUR PLAN.

WE LOOK FORWARD TO SERVING YOU! PLEASE REVIEW ADDITION INFORMATION ON OUR WEB SITE WE LOOK FORWARD TO SERVING YOU! SOUTHERN ADMINISTRATORS AND BENEFIT CONSULTANTS, INC.