Flexible Spending Accounts Overview

Save on Health Care Costs with Your FSA Use pretax dollars for important expenses Health care needs For yourself, spouse, dependents You or your dependents do not need to be enrolled in the medical insurance to enroll and utilize the health care FSA.

What Is a Healthcare FSA? Pre-tax benefit account that pays for eligible expenses not covered by insurance Medical expenses Dental expenses Vision expenses Smart, simple way to save money and keep you and your family healthy and protected [Employer Name] sponsors this program, brought to you by WageWorks, to help you save on important health and dependent day care expenses by using pre-tax dollars. A WageWorks® Healthcare Flexible Spending Account (FSA) is a pre-tax benefit account used to pay for eligible medical, dental, and vision care expenses that aren’t covered by your insurance plan. A WageWorks Healthcare FSA is a smart, simple way to save money while keeping you and your family healthy.

Eligible Expenses Use Your Healthcare FSA to pay for: Prescriptions for almost any medical condition Prescribed over-the-counter medicines, e.g. aspirin, cough syrup Co-payments, co-insurance, and deductibles Dental care, both preventive and restorative Orthodontia, child and adult Vision care, eyeglasses, contact lenses, solutions Eye surgery, including laser vision correction Counseling and therapy Psychology and psychiatry Chiropractic care and acupuncture See www.wageworks.com/myfsa for more Here are some of the most popular healthcare expenses that are typically covered by your FSA. Please note that to be eligible, expenses typically need to be for a specific medical condition, not for general wellness. For more information and a full list of expenses, check out the information available at www.wageworks.com.

Why You Need It Save an average of 30% on everyday healthcare expenses Use several easy, no-hassle payment and reimbursement options Access your full election amount starting on day one [Employer Name] sponsors this program, brought to you by WageWorks, to help you save on important health and dependent daycare expenses by using pre-tax dollars. Your FSA can cover a wide range of needs, for many of the big out-of-pocket expenses and everyday purchases that you already pay for. You decide whether to open a healthcare account, a dependent care account, or both. And you choose how much to set aside for expenses during the plan year. You can use money from your FSA for yourself, your spouse, or any of your eligible dependents, even if they are not covered by your health plan. And the program is designed to be as simple, fast, and convenient as possible. Saving has never been this easy. It’s important to remember that the money in your FSA does not roll over from year to year, so make sure to calculate your expenses carefully when planning how much to set aside for the year. The calculator at www.wageworks.com/myfsa is a great place to start.

How It Works Elect how much to contribute from $300 - $2,600 Estimate carefully how much you’ll need for health care expense incurred January 1st through December 31st. Funds are taken from your paycheck before taxes Start saving up to hundreds of dollars in one year Savings result from lower overall taxes Health Care FSA annual maximum election up to $2,600 The program works by setting aside some of your pay before taxes are deducted. The money is still yours to spend on eligible expenses, but you don’t pay taxes on it. Before you enroll, you should estimate your healthcare and/or dependent day care expenses for the upcoming year, so you can decide how much to set aside through your FSA. WageWorks offers easy online calculators that help you project these expenses, plus you’ll find examples and a worksheet in your enrollment materials. Then choose how much to defer in each account when you enroll. Your savings works by reducing the amount of your income that’s subject to federal income tax, FICA (Social Security) tax, and in most states, state income tax. Exactly how much you save depends on how much you spend on healthcare and dependent care expenses each year, and on your tax situation. Most people can save from $30 to $40 in taxes for every $100 set aside through their FSA.

How You Use It Use your WageWorks Card to pay instantly Works like a debit card, just swipe and go Funds come directly from your Healthcare FSA No PIN required This program features on-the-spot access to your account with the WageWorks Healthcare Card. Use it just like a debit card for co-pays, prescriptions, over-the-counter products, and more. The card gives you a fast and easy way to get immediate access to your account, without having to pay and wait for a reimbursement check. Note that although the WageWorks Healthcare Card is technically a debit card, you will need to select “credit” at the register when you pay for services. Also, you should still hang on to your receipts in case WageWorks needs to verify that an expense is eligible.

No Card, No Problem Pay My Provider Pay Me Back Pay bills instantly, directly, online Doctor bills, orthodontia and more Pay Me Back Traditional claims Fast reimbursement It’s your money. Your FSA just helps you save it from taxes, and gives you control over how you spend it on your health and your family. The program is built for maximum convenience and control. You choose when and how to spend the money in your account. Use Pay My Provider to make direct payments online to healthcare providers. You can even set up automatic payments for ongoing needs like orthodontia. Or use Pay Me Back to send in traditional claims, and get quick reimbursement. To keep track of your money, you can get information about your account balance, recent activity, claims in progress, and more at any time with the convenient online tools at www.wageworks.com.

How You Manage It Use WageWorks EZ Receipts® File a claim and get reimbursed quickly View transactions and benefit account balances using a single login Snap a photo of receipts and submit them for payment Receive confirmation emails when claims are received, processed, or paid Receive text messages when card verification is required, a transaction is denied, or a claim has been processed Or online at WageWorks.com

How Much You Can Contribute Maximum of $2,600 for 2018 Elect how much to contribute from $300-$2,600 Full amount available on day one You can access your full election amount on the first day of the new plan year You can use the funds for eligible health care expenses incurred from January 1st – December 31st. You have until April 30th 2019 to submit your claims, any money left is forfeited. Everyone has expenses for healthcare that aren’t covered by your health plan or other benefits. [Employer Name] offers the FSA program to help you save money when you pay for these important expenses. You can use your FSA to pay for co-pays, co-insurance, and deductibles when you visit the doctor, for prescriptions, and for other out-of-pocket healthcare expenses you incur. You can also use it for most dental and vision care needs that aren’t covered by your insurance. You can even use your FSA for a wide range of everyday, over-the-counter products to care for your health. Now that a prescription is required for over-the-counter medicines, make sure to get the prescription first before purchasing the item. You still will be able to purchase many items, such as contact lens solution and bandages, without a prescription. See the eligible expense lists available on www.wageworks.com for more details. You can also use your FSA to pay for your eligible dependents’ healthcare expenses—even if they’re not enrolled in your health plan. Eligible dependents include anyone you can legally claim as a dependent on your federal income tax form.

FSA Store Partnership New partnership with FSA Store WageWorks sees the value is simplifying efforts to spend FSA dollars and has teamed up with FSA Store to provide an additional service to our participants This is an affiliate partner program This partnership makes it easier for employees to spend their FSA dollars More than 4,000 products that are all eligible for Healthcare FSA reimbursement When employees use their WageWorks Healthcare Card to buy products and services from FSAstore.com, card transactions are automatically verified—no more submitting receipts

What is a Dependent Care FSA? Pre-tax account that pays for eligible dependent care expenses while you work: Preschool or before/after school programs Summer day camp Elder day care Smart, simple way to save money while taking care of loved ones so you can work [Employer Name] sponsors this program, brought to you by WageWorks, to help you save on important health and dependent daycare expenses by using pre-tax dollars. Your FSA can cover a wide range of needs, for many of the big out-of-pocket expenses and everyday purchases that you already pay for. You decide whether to open a healthcare account, a dependent care account, or both. And you choose how much to set aside for expenses during the plan year. You can use money from your FSA for yourself, your spouse, or any of your eligible dependents, even if they are not covered by your health plan. And the program is designed to be as simple, fast, and convenient as possible. Saving has never been this easy. It’s important to remember that the money in your FSA does not roll over from year to year, so make sure to calculate your expenses carefully when planning how much to set aside for the year. The calculator at www.wageworks.com/dcfsa is a great place to start.

Eligible Expenses Use your Dependent Care FSA to pay for: Before/after school care Au pair services Extended day programs Preschool/nursery school Summer day camp Elder day care Ineligible expenses include: Overnight camps Kindergarten or higher-grade tuition Non-work-related day care Long-term elder care services Here are some of the most popular dependent care expenses that are typically covered by your FSA. For more information and a full list of expenses, check out the information available at www.wageworks.com. See www.wageworks.com/mydcfsa for more information on eligible expenses

Why You Need It Save an average of 30% on the dependent care you need Reduce your overall tax burden since funds are withdrawn from your paycheck before taxes are deducted Take advantage of several convenient, no-hassle payment and reimbursement options The program works by setting aside some of your pay before taxes are deducted. The money is still yours to spend on eligible expenses, but you don’t pay taxes on it. Before you enroll, you should estimate your dependent daycare expenses for the upcoming year, so you can decide how much to set aside through your FSA. WageWorks offers easy online calculators that help you project these expenses, plus you’ll find examples and a worksheet in your enrollment materials. Then choose how much to defer in each account when you enroll. Your savings works by reducing the amount of your income that’s subject to federal income tax, FICA (Social Security) tax, and in most states, state income tax. Exactly how much you save depends on how much you spend on healthcare and dependent care expenses each year, and on your tax situation. Most people can save from $30 to $40 in taxes for every $100 set aside through their FSA.

How It Works Elect how much to contribute from $600-$5000 Estimate carefully how much you’ll need for dependent day care expenses incurred January 1st through December 31st. Funds are taken from your paycheck before taxes Start saving up to hundreds of dollars in one year Savings result from lower overall taxes Dependent Care Reimbursement Account annual maximum election up to $5000 The program works by setting aside some of your pay before taxes are deducted. The money is still yours to spend on eligible expenses, but you don’t pay taxes on it. Before you enroll, you should estimate your healthcare and/or dependent daycare expenses for the upcoming year, so you can decide how much to set aside through your FSA. WageWorks offers easy online calculators that help you project these expenses, plus you’ll find examples and a worksheet in your enrollment materials. Then choose how much to defer in each account when you enroll. Your savings works by reducing the amount of your income that’s subject to federal income tax, FICA (Social Security) tax, and in most states, state income tax. Exactly how much you save depends on how much you spend on healthcare and dependent care expenses each year, and on your tax situation. Most people can save from $30 to $40 in taxes for every $100 set aside through their FSA. Be sure to estimate your annual dependent care expenses and make your contributions carefully. Any money left unspent in your Dependent Care FSA at plan year end is forfeited.

How You Use It Pay My Provider Pay Me Back Directly pay your provider instantly, directly, and online Pay Me Back Get reimbursed quickly for payments you make It’s your money. Your FSA just helps you save it from taxes, and gives you control over how you spend it on your health and your family. The program is built for maximum convenience and control. You choose when and how to spend the money in your account. Use Pay My Provider to make direct payments online to health and dependent care providers. You can even set up automatic payments for ongoing needs like child care. Or use Pay Me Back to send in traditional claims, and get quick reimbursement. To keep track of your money, you can get information about your account balance, recent activity, claims in progress, and more at any time with the convenient online tools at www.wageworks.com.

Who Qualifies? Qualifying dependents include: Dependent child* under the age of 13 who lives with you for more than half of the year; or A spouse or other tax dependent who resides in the house a minimum of eight hours a day and requires assistance with day-to-day living. In the case of divorce, IRS guidelines state that a child is a qualified dependent of the "custodial parent." Only the custodial parent may participate in a dependent care FSA. A divorced, non-custodial parent cannot be reimbursed under a dependent care FSA even if the divorced parent claims the child as a tax dependent. *In the case of divorce, IRS guidelines state that a child is a qualified dependent of the "custodial parent."

How You Manage It Use WageWorks EZ Receipts® File a claim and get reimbursed quickly View transactions and benefit account balances using a single login Skip the receipt and have your provider sign receipts using your mobile device Receive confirmation emails when claims are received, processed, or paid Receive text messages when card verification is required, a transaction is denied, or a claim has been processed Or online at WageWorks.com

How Much You Can Contribute Minimum Election of $600 to a Maximum of $5000 for 2018 IRS sets the contributions guidelines Changes to your election amount can be made only if there is a: Change in legal marital status Change in number of dependents due to birth, adoption, or death Change in employment status Change in cost or coverage charges You can use the funds for eligible dependent care expenses incurred from January 1st – December 31st. You have until April 30th 2019 to submit your claims Dependent care funds are available to you as you contribute. You may need to let your balance accumulate prior to submitting claims If you pay to care for dependents while you’re at work, choose a dependent care account to pay for most kinds of babysitting, day care, preschool programs, and more, plus elder care services for qualifying older adults. Your dependent care FSA typically covers these types of expenses that allow you to work. The eligible expenses specific to your FSA are defined by the IRS and [Employer Name]. For more information and a detailed list, check out the information available at www.wageworks.com.

Administrative Fee – FSA & Commuter A $1.50 administrative fee will be deducted from each paycheck. This is a flat fee for any combination of WageWorks accounts – you will see only one fee whether you have a TSA, PSA and/or a Health Care Flexible Spending Account, Dependent Care Reimbursement Account.

Accessing Your Funds

Health Care FSA Payment Options WageWorks makes it easy for you to use the money in your healthcare benefit accounts to pay for hundreds of eligible healthcare expenses . These payment options are fully automated. Log into your WageWorks account on either the web portal or the mobile app, select your preferred payment option, and follow the prompts.

The Pay Me Back Option If you’ve already paid for an eligible expense out of your own pocket, you can arrange to pay yourself back from your WageWorks account in two ways: Have a check mailed to you; or Have your reimbursements deposited directly into your bank account The quickest, easiest way to get reimbursed for eligible expenses you’ve paid out of pocket is to sign up for direct deposit. Here’s how to submit a Pay Me Back claim. Via the Web Portal Log into your WageWorks account. If this your first time logging into your WageWorks account, be sure to first register for your WageWorks account. Once you have logged into your account, Click Submit Receipt Or Claim and select Pay Me Back. Enter payment information and select Submit Claim. Upload digital copies of your receipts.

Via the Mobile App Log into your WageWorks account on the WageWorks EZ Receipts® mobile app. Click on Submit New Receipt and then Health Care Claim. Follow the prompts to take and send photos of your receipts and other documentation. Via Fax or Mail Download a Healthcare Pay Me Back Claim Form. Fill in all the information requested on the form and sign it. Fax or mail the form, along with copies of your receipts, to: Claims Administrator P.O. Box 14053 Lexington, KY, 40512 Fax: 877-353-9236 Most Pay Me Back claims are processed within one to two business days after they are received and verified. Payments are sent shortly thereafter. Questions about Pay Me Back claims? Check out the FAQs in the Employee Support Center.

The Pay My Provider Option You can arrange to pay your healthcare providers directly from your WageWorks account for your eligible expenses. Here’s how it’s done: Log into your WageWorks account. If this your first time logging into your WageWorks account, be sure to first register for your WageWorks account. Click on Submit Receipt Or Claim. Select the Pay My Provider option. Select the WageWorks account that should pay your provider. Request One-Time or Recurring Monthly payment. Enter the required payment information and select Submit Claim. Upload digital copies of your invoice or receipts. WageWorks sends payment(s) directly from your account to your provider. Questions about Pay My Provider claims? Check out the FAQs in the Employee Support Center.

The Pay by Debit Card Option Depending on your employer’s plan, you may use the convenient WageWorks Healthcare Card associated with your WageWorks account to pay for hundreds of eligible healthcare products and services. Your WageWorks Healthcare Card works like a debit card. Money is deducted directly from your account. If you have more than one WageWorks account, this smart card knows which account to draw money from first. As with every payment option, be sure to save your receipts for all WageWorks Healthcare Card transactions. Questions about your card? Visit the WageWorks Healthcare Card page in the Employee Support Center.

Receipts Your WageWorks healthcare benefit accounts are regulated by the IRS. You must have a receipt or an explanation of benefits from your insurance carrier for each claim you submit against your account. Even when you use your WageWorks® Healthcare Card to pay for eligible expenses, you may still need to provide a receipt. Learn more about card use verification in the Employee Help Center. What does this mean for you? Save each and every receipt. Saving and submitting each receipt is the quickest way to process your claims and get reimbursed from your account. Following are a few ways to make it easier to manage your receipts. Questions about receipts? Browse the FAQs in the Employee Support Center.

Receipt Requirements For quick processing, make sure all receipts include these five pieces of information: Patient's Name. The name of the person who received the service or for whom the item was purchased. For retail store purchases, this information may be excluded. Provider's Name. The provider that delivered the service or the merchant where the item was purchased. Date of Service. The date when services were provided or the item was purchased. Type of Service. A detailed description of the service provided or item purchased. A bag tag is sufficient for prescriptions. Cost. The amount paid for the service or product and/or the portion that is not reimbursed through your insurance carrier.

Do’s and Don’ts for Submitting Receipts When submitting receipts as part of a claim against your WageWorks healthcare account, follow these simple do’s and don’ts. DO use your Explanation of Benefits (EOB), especially if your insurance paid a portion of the expense. DO make sure your receipt is legible; check that it isn’t too dark or light and that information is not cut off. DO include stamped provider information on handwritten receipts. DO NOT send cancelled checks, they typically do not include all five key pieces of information. DO NOT use highlighters on your receipts.

Managing Your Receipts WageWorks makes it easy for you to save and keep track of your receipts. With the WageWorks EZ Receipts® mobile app, you can use your smart phone to take a photo of each receipt and store them in your WageWorks account for easy reference. That way, if you’re notified that a receipt is needed to process your claim, a digital copy of your receipt is at your fingertips. Here’s how to take a photo of your receipts using the WageWorks mobile app: Log into your WageWorks account with your username and password. Click on Submit New Receipt. Click on Healthcare Card Receipt. If you have a hard copy of your receipt, click on Actual Receipt. Follow the prompts and instructions on using your smart phone to take a photo of your receipt.

Tips For Claim Submission An eligible dependent is defined as a spouse, qualifying child, or qualifying relative. A qualifying child is defined as a dependent child up to age 26 or any age if permanently disabled. A qualifying relative is someone who resides with you for more than half of the year. Qualifying children and relatives must not provide more than half of his/her own support. For information to claim orthodontia expenses, refer to the guide located at: https://www.wageworks.com/employees/support-center/important-forms.aspx. For a complete list of eligible expenses specific to your plan, log in to your account at www.wageworks.com and select “Eligible Expense” from the left side of the screen. Only submit claims for eligible expenses. A letter of medical necessity is required for any expense listed as “Yes (Letter)” on the eligible expense list to establish medical necessity. Cosmetic surgery or procedures, e.g., teeth whitening, are not eligible expenses unless deemed as medically necessary by a licensed physician. A letter of medical necessity form can be obtained at: https://www.wageworks.com/employees/support-center/important-forms.aspx.

Tips For Documentation Ensure that the documentation is legible. Cancelled or copies of checks and credit card receipts do not contain all 6 required pieces of information needed to approve your expense, and are not acceptable for submission. Explanation of Benefits (EOBs) are recommended, especially if your insurance covered a portion of the expense. The use of a highlighter causes items to not be legible on the documentation; highlighter use is not recommended. Send only photocopies of your claim form and documentation— keep the originals for your records if submitting via US Mail. Your provider may sign the form confirming the date of services, charges and other service or product information in lieu of providing separate documentation or other proof of service.

Tips for Over-the-Counter Expenses A prescription is required for any over-the-counter expense listed as “Yes (Rx)” on the eligible expense list. As a result of the Health Care Reform Law, in addition to the required detailed receipt, an actual prescription written by a doctor (on a prescription pad or form) dated on or before the date the expense was incurred is required to verify that the over-the-counter medicine is prescribed for a known medical condition. Prescription Tabs, Bag Tags, and Ledgers may also be used for claim substantiation. Prescription or Rx – A prescription is required in order for some over-the-counter items to be eligible under the plan. These items are referred to ‘Yes, Rx’ expenses. A prescription to satisfy this substantiation is a legal document issued and signed by the provider. Necessary information includes: patient name, date issued, product recommendation, and whether or not it may be substituted. The date the Rx was written must be prior to the date that the product was purchased or services were rendered. Prescription Tabs or Bag Tags – These items are attached to the prescription at the point of purchase. Both serve as acceptable forms of substantiation.  Ledgers – Ledgers are running records of services provided. Ledgers may record one or more patients treated from the same family and over a course of time. They may also be used for the substantiation prescriptions if they also contain patient name, date issued, product recommendation, and whether or not it may be substituted. The date the Rx was written must be prior to the date that the product was purchased or services were rendered.

Dependent Care FSA Payment Options WageWorks makes it easy for you to get reimbursed for eligible dependent care expenses using your WageWorks® Dependent Care Flexible Spending Account (FSA). These payment options are fully automated. Log into your WageWorks account on either the web portal or the mobile app, select your preferred payment option, and follow the prompts. Questions about payment options? Browse the FAQs in the Employee Support Center.

The Pay Me Back Option If you’ve already paid for an eligible expense out of your own pocket, you can arrange to pay yourself back from your WageWorks account in two ways: Have a check mailed to you; or Have your reimbursements deposited directly into your bank account The quickest, easiest way to get reimbursed for eligible expenses you’ve paid out of pocket is to sign up for direct deposit. Here’s how to submit a Pay Me Back claim. Via the Web Portal Log into your WageWorks account. If this your first time logging in to your WageWorks account, be sure to first register for your WageWorks account. Once you have logged in to your account, Click Submit Receipt Or Claim and select Pay Me Back. Enter payment information and select Submit Claim. Upload digital copies of your receipts.

Via the Mobile App Log into your WageWorks account on the WageWorks EZ Receipts® mobile app. Click on Submit New Receipt and then Submit Claim. Follow the prompts to take and send photos of your receipts and other documentation. Via Fax or Mail Download a Dependent Care Claim Form Fill in all the information requested on the form and sign it. Fax or mail the form, along with copies of your receipts, to: Claims Administrator P.O. Box 14053 Lexington, KY, 40512 Fax: 877-353-9236 Most Pay Me Back claims are processed within one to two business days after they are received and verified. Payments are sent shortly thereafter. Questions about Pay Me Back claims? Check out the FAQs in the Employee Support Center.

The Pay My Provider Option You can arrange to pay your dependent providers directly from your WageWorks account for your eligible expenses. Here’s how it’s done: Log into your WageWorks account. If this your first time logging in to your WageWorks account, be sure to first register for your WageWorks account. Click on Submit Receipt Or Claim. Select the Pay My Provider option. Select the WageWorks account that should pay your provider. Request One-Time or Recurring Monthly payment. Enter the required payment information and select Submit Claim. Upload digital copies of your invoice or receipts. WageWorks sends payment(s) directly from your account to your provider. Questions about Pay My Provider claims? Check out the FAQs in the Employee Help Center.

Resources City of Los Angeles Benefits Service Center WageWorks Phone (800)778-2133 Email per.empbenefits@lacity.org WageWorks www.wageworks.com Customer Service (877)WageWorks (1-877-924-3967) TTY (866)353-8058 Visit keepingLAwell.com

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