2015 Dental and Vision Plan Flexible Spending Account

2 Dental Benefits BENEFIT DESCRIPTION BENEFIT (Subject to Usual and Customary Charges) CLASS A, B AND C EXPENSES COMBINED CALENDAR YEAR MAXIMUM BENEFIT $1,100 per Covered Person Class A-Preventive Services Example: (routine oral exam) 80% Class B-Basic Services Example: (x-rays, simple extractions) 80% Class C-Major Services Example:(dentures and bridges) 50% CLASS D ORTHODONTIC LIFETIME MAXIMUM BENEFIT (Coverage is provided only for Covered Persons under age 19) $1,500 per Covered Person Class D-Orthodontic Services (Coverage is provided only for Covered Persons under age 19) 50%

 $ per Calendar Year per Covered Person  Benefit can be used for:  Eye exam,  Lenses (including contact lenses) and  Frames Vision Benefits

Dental & Vision  Coverage for unmarried dependent child(ren) ages will be available through calendar year of attaining age 25. ( Example: Turn 25 in July, coverage until December 31)  Dependent child(ren) over 19 must be a full time student.  Orthodontia coverage will be available to covered person under age 19. Dependent Eligibility

 A tax-effective, money-savings option that will help you pay for qualified health care expenses that aren’t covered by your medical plan, and for dependent care services.  Funds are deducted pre-tax from your employer pay check.  These are pre-tax dollars so they help save money (approximately 25% in tax savings when deducted from your paycheck pre-tax) 5 What is a Flexible Spending Account (FSA)?

What is an FSA?  Kellogg Community College offers you an opportunity to participate in two Flexible Spending Account Programs:  Healthcare FSA or Limited Healthcare FSA (if you have an Health Savings Account)  Dependent Care FSA What is a Flexible Spending Account (FSA)?

Health Care Spending Account (HCSA)  For healthcare expenses if you do not have a Health Savings Account (HSA)  Maximum amount you can contribute is $2,500 per year  Can be used for most medical expenses not covered by your health plan including: Deductible, coinsurance, copays, prescription drugs, dental, vision, hearing and orthodontic care. Certain over-the- counter medications qualify too. FSA for Healthcare

 If you have a Health Savings Account (HSA), the Flexible Spending Account is limited or restricted to:  Dental expenses  Vision expenses  Medical and prescriptions only AFTER the high deductible HAS BEEN MET. 8 Limited Flexible Spending Account

 Maximum amount you can contribute is $5,000 per year  Expenses are eligible for child care under age 13 or elder care for IRS dependents.  Tax ID or Social Security Number and receipt are required  Reimbursable only after services have been incurred and money has already been deducted from payroll. 9 IRS allows $5,000 FSA for Dependent Care

 Plan carefully! The amount of money you want to contribute to your FSA accounts are elected in advance.  If you underestimate, you may deplete your FSA before the end of the year, losing so of your tax-savings.  If you overestimate, you risk forfeiture of any unused FSA funds. KCC allows you to roll up to $500 from the previous plan year. Mid-year election changes are not allowed without a qualifying event! (work hours reduced, birth, death, divorce) Maximize Your Savings Potential

 Submit a complete and signed FSA reimbursement form with these attachments: - A copy of the Explanation of Benefits (EOB) OR -A receipt for co-pays and an itemized cash register receipts for OTC items that do not contain a medicine or drug OR - Effective 1/1/2011, for OTC items containing a medicine or drug, an itemized cash register receipt as well as a doctor’s prescription OR - An itemized statement from your healthcare provider if you don’t have insurance coverage (for example, dental or vision services). Submit early! How to receive reimbursement

 Signing up for direct deposit is a fast and easy way to be reimbursed on expenses.  When you submit a claim for reimbursement, the funds will be directly deposited into your checking account.  Use the direct deposit form to sign up.  Return the form via the fax number or mailing address on the form. 12 Fast and easy! Direct Deposit

 The Patient Protection and Affordable Care Act of 2010 changed the rules for the purchase of Over The Counter (OTC) products.  As of January 1, 2011, FSA, HRA and HSA funds can no longer be used to purchase OTC medicine and drugs unless such medicine or drug is prescribed by a doctor.  Some eligible OTC items include: Bandages without antibiotic ointments, thermometers, hot/cold packs, rubbing alcohol, splints, etc.  This is only a partial list. Refer to your FSA materials, contact Meritain Health or visit FSA Reminders

14 IMPORTANT DEADLINES PlanIncur ExpenseSubmit Claim Health Care Account 12/31/20152/28/2016 Dependent Care Account 12/31/2015 2/28/2016

Questions about your account. Web: Check status of a claim, FSA Balances, EOB’s Call: Meritain customer service Questions?