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Personal Risk Services Flexible Spending Accounts __________________________________________ Union College September 6, 2005
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A Closer Look At Flexible Spending Accounts (FSA’s)
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What is an FSA? Flexible Spending Account Allows employees to set aside pre-tax dollars to pay for medical and dependent care expenses. Gives participating employees and employers a tax break
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How does it work? Employee decides how much salary to set aside for either un-reimbursed medical or dependent care expenses. Medical and dependent care are two separate elections. The amount is deducted from the paycheck. When out-of-pocket expenses have been paid, a reimbursement is made.
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Un-reimbursed Medical Expenses: Office visit co-pays Co-insurance/deductibles Prescriptions Employer sets maximum to withhold Advantages of participating In an FSA
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Dependent Care Expenses: Day care and after care for a child under the age of 13 Care for a disabled spouse or dependent incapable of caring for himself. Summer camp (day or overnight) Federal limit of $5,000 Advantages of participating In an FSA
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Estimation Error – An employee may over or underestimate their expenses for the year. “Use it or Lose It Rule” – Under regulations issued two decades ago, employees forfeited any unused balances their FSA accounts at the end of a plan year. However, this rule has been eased effective May 18, 2005. The new regulation allows a 2 ½ month (75 days) grace period at the end of a plan year …extending the time frame for an employee to use money left over at June 30. Irrevocable Election Rule - which prohibits modification to an election during the plan year unless there is a qualifying event in status. Any Disadvantages of participating In an FSA?
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Examples of Ineligible Expenses (Section 105) Un-reimbursed Medical: Weight loss programs Health Club fees…swimming lessons Dancing lessons Insurance premiums Dependent care: Cost of food, clothing and tuition Cost of babysitting fees by local teenage Cost of transportation to place where dependent care is given
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Effective July 1, 2005 The FSA allows OTC’s (over-the-counter medicines & products)
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Examples of acceptable OTC’s Aspirin/Tylenol Contact solution Ace bandages Pepcid AC Cold medications (children/adult)
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Examples of non-acceptable OTC’s Deodorant Shampoo Toothpaste/toothbrush Make-up Soaps & lotions
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How are FSA claims paid? If there is a medical, dental, or vision claim, the ARM claims system will automatically pay to you any co-pay or co-insurance amounts. This is done in a weekly “sweep”. Checks are run bi-weekly. If the claims are co-pays for Rx expense or an OTC, a claim form with receipt must be submitted for reimbursement.
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Claim Forms A claim form is only required if: - the provider is unable to bill ARM directly - the expense is for Rx - the expense is for OTC items Forms can be obtained from our website at www.adventistrisk.org or from your HR dept. www.adventistrisk.org
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Thank you!
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