Document 6427410

Alliance B enefi t G roup ▪ (855) 866-8060 ▪ www .a bgaccess .co m
Flexible Spending Accounts
A Flexible Spending Account (FSA), also known as a Section 125 Flexible Benefit Plan or Cafeteria Plan, is a voluntary, tax-free way for employees to save for qualified medical, dental, vision or dependent care expenses during a
plan year. Employees save between 25 and 50%, depending on their tax bracket.
Three Ways to Save!

Premiums for employer-sponsored medical, dental, vision, etc. are automatically withheld from pay on a pretax basis. (No reimbursement required.)

Reimbursement of out-of-pocket medical, dental and vision expenses not paid by insurance.

Reimbursement of work-related dependent care expenses for children under age 13 and/or older children or
adults who are incapable of self-care.
New for 2013
The recent Health Care Reform law mandates that employees cannot contribute more than $2,500 to a
Health or Limited Purpose FSA for plan years beginning January 1, 2013. Prior to this time the maximum Health or
Limited Purpose FSA election was determined by the employer.
The $2,500 limit applies on an individual level, not a household level, so married couples can each elect up to
$2,500 in their respective Health or Limited Purpose FSAs.
The Dependent Care FSA limit remains the same at $5,000 per household.
How an FSA Works
Prior to the plan year, employees elect how much they would like to have taken out of their paycheck on a pre-tax
basis. ‘Pre-tax’ means before state, federal, Social Security and Medicare taxes are applied. As a result, savings
are somewhere between 25 and 50%, depending on tax bracket.
Contributions to FSAs are deducted from each payroll during the plan year. The amount of contribution to FSAs
should be carefully considered, as unused amounts are forfeited at the end of the plan year.
As eligible expenses are incurred, employees submit claims to Alliance Benefit Group for reimbursement. Alliance
Benefit Group is required to “substantiate” each claim by reviewing receipts, explanation of benefits and claim
forms to ensure all information meets applicable regulations. Alliance Benefit Group reimburses employees directly
by check or direct deposit.
The Health FSA causes an employee and their spouse to be ineligible to contribute to a Health Savings Account, or
HSA. However, the Limited Use FSA, which reimburses only dental and vision expenses, does not impact HSAeligibility.
BeneFIT access Department
201 East Clark Street
PO Box 1226
Albert Lea, MN 56007
Phone: 855.866.8060
Fax: 866.808.7823
Web: www.abgaccess.com
Important Facts About FSAs

If an employee or their spouse is contributing to an HSA they can elect the Limited Purpose FSA for dental and
vision expenses but cannot elect the traditional Health FSA.

If an employee does not spend their election they forfeit it at the end of the plan year.

New elections for Health, Limited Purpose and Dependent Care FSA are required each plan year.

Elections are irrevocable during the plan year unless there is a change in family status.

Spouses and all tax dependents are eligible for reimbursement from the FSA.

IRS Publication 502, available at www.irs.gov, explains eligible health care expenses.

IRS Publication 503, available at www.irs.gov, explains eligible dependent care expenses.
Dependent Care FSA Expenses

What does employment-related mean?
Expenses reimbursed by a Dependent Care Reimbursement Account must be incurred in order to allow the participant and, if applicable, the spouse to be actively and gainfully employed. This means the participant must only
claim expenses incurred while they are actually at work, excluding expenses which might be incurred while the participant is on a leave of absence, on vacation or is out of work ill.
However, temporary absences from work for matters such as illness or vacation can be disregarded if the participant
is required to pay for dependent care expenses on a weekly or longer basis. Dependent care expenses incurred
during a typical leave of absence (paid or unpaid) are non-reimbursable.
The following employment-related expenses are eligible for reimbursement by a Dependent Care Reimbursement
Account:
Before/After-school care
Nanny
Day Camp
Preschool/Nursery school
Daycare Center
Registration fee (to obtain care)
Elder Care
Sick-child facility
Health and Limited Purpose FSA Expenses
The Health and Limited Purpose FSA covers expenses that are necessary to treat or alleviate a physical or mental
defect or illness.

Dual purpose expenses
Some expenses may be considered cosmetic or general-use but also serve a medical purpose. If a doctor recommends a service / item that would not normally be considered “medically necessary” to treat or alleviate a specific,
diagnosable medical condition, it is considered a dual-purpose expense.
A written statement from the physician must accompany these expenses. This statement must explain what the condition is, what service / item is recommended and how it will alleviate this condition.

What to submit with your claim
Supporting documentation is required with all claims. Documentation should be itemized to show the date of service, what service is being claimed and the amount you are responsible for paying.
If the expense was covered by insurance, the Explanation of Benefits from your insurance carrier must be included
with your claim.

Special rule for HSA owners
If you and/or your spouse is currently contributing to an HSA you are unable to use the Health FSA. Instead a Limited
Purpose FSA that covers only dental and vision expenses is available.
Limited Purpose = (LP)
Eligible Health FSA Expenses
Acupuncture
Fertility Treatment
Osteopath
Alcoholism Treatment
Flu Shots
Oxygen
Ambulance
Glucose Monitoring Devices
Physical Exams
Artificial Limbs / Teeth LP
Guide Dog LP
Physical Therapy
Bandages
Hearing Aids
Prescription Drugs
Birth Control Pills
Home Care
Prosthesis
Blood Pressure Monitoring Devices
Hormone Replacement Therapy
Psychiatric Care
Body Scan
Hospital Services
Psychoanalysis
Breast Pumps
Immunizations
Psychologist
Chelation (EDTA) Therapy
Inclinator
Reading Glasses LP
Chiropractors
Insulin
Screening Tests
Circumcision
Laboratory Fees
Sleep Deprivation Treatment
Copays / Deductibles
Lactation Assistance Supplies
Sterilization Procedures
Contact Lenses / Related Material LP
Laser Eye Surgery LP
Supplies for Medical Condition
Counseling (excludes marriage)
Learning Disability
Surgery
Crutches
Medical Records Charge
Therapy
Dental Treatment LP
Medical Services
Transplants
Dentures LP
Nursing Services
Vaccines
Diabetic Supplies
Obstetrical Expenses
Vasectomy
Diagnostic Services
Occlusal Guards LP
Vision Correction Procedures LP
Drug Treatment
Operations
Wheelchair
Egg Donor Fees
Optometrist LP
X-Ray Fees
Eye Exams / Glasses LP
Orthodontia LP
Dual-Purpose Health FSA Expenses
Air Purifier
Electric Toothbrush LP
Orthopedic Inserts
Acne Treatment
Exercise Equipment / Programs
Over-the-Counter Drugs (prescribed)
Capital Expenses
Glucosamine
Prescription Weight Loss Drugs
Chondroitin
Health Club Dues
Special Foods
Cryogenic Storage Fees
Language Training (for disability)
Sunscreen
Dietary Supplements
Massage Therapy
Treadmill
Ear Plugs
Mattress
Varicose Veins Treatment
Nutritional Supplements
Weight Loss Programs
Ineligible Health FSA Expenses
Appearance Improvements
Electrolysis
Over-the-Counter Drugs
Baby-Sitting / Child Care
Face Lifts
Personal Use Items
Birthing Classes
Funeral Expenses
Pre-Payment for Services
COBRA Premiums
Genetic Testing
Retin-A
Controlled Substances
Hair Removal
Rogaine
Cosmetics
Household Help
Safety Glasses
Cosmetic Procedures
Illegal Operations
Student Health Fee
Chemical Peels
Insurance Premiums
Sunglass Clips
Dancing Lessons
Long-Term Care
Tanning Salons / Equipment
Diapers
Maternity Clothes
Teeth Whitening
DNA Collection/Storage
Medicare Premiums
Eligible Over-the-Counter Supplies
Bandages
Crutches
Nebulizers
Birth Control Products
Denture Supplies LP
Ostomy Products
Blood Pressure Monitoring Kits
Diabetic Supplies
Oxygen Equipment
Braces / Supports
Diagnostic Products
Pregnancy Test Kits
Canes / Walkers
External Catheters
Reading Glasses LP
Cold / Hot Packs
First Aid Supplies
Syringes
Compression Stockings
Hearing Aid Batteries
Thermometers
Contact Lens Solution LP
Hot / Cold Packs
Wheelchair & Accessories
Corn / Callus Pads
Incontinence Supplies
Ineligible Over-the-Counter Drugs (unless prescribed)
Prescribed OTC drugs will only be reimbursed by ABG if dispensed by the pharmacy. Rx receipt required.
Acid Controllers
Cold, Cough & Flu Medicines
Ointments / Rash Creams
Allergy Medicine
Decongestants
Pain Relievers / Fever Reducer
Anti-Diarrheals
Expectorants
Respiratory Treatments
Anti-Gas Treatments
Digestive Aids
Sleep Aids
Antiseptic Cream / Wash
Laxatives
Stomach Remedies
Benny™ Prepaid Benefits Card
The Benny™ Prepaid Benefits Card draws funds directly from your FSA to pay
for eligible expenses and eliminates the wait for reimbursement. Benny can
only be used at certain places, such as pharmacies, clinics or dental offices,
where you might obtain health care services.
Dependent Care providers accepting Visa® will also accept this card.
Using Benny is easy! Simply present it at qualified merchants and the cost of your transaction will come directly from
your FSA.
Submitting Receipts
IRS rules require all Benny transactions to be substantiated. In some cases, this substantiation will occur electronically and you will not need to submit any documentation for your purchase.
However, you will sometimes be required to submit documentation for a Benny transaction after it occurs in order to
meet the IRS requirements.
No Receipts Required for:

Pharmacy Purchases: Most pharmacy purchases (including discount and grocery store pharmacies) will be
electronically substantiated.

Co-Pay Matching: Purchases in the amount of a co-pay under your employer’s health plan, including multiples
up to five times a co-pay, will be electronically substantiated.

Reoccurring Amounts: Transactions that reoccur in the same amount at the same merchant will only require
documentation the first time in a given plan year.
All other Benny transactions will require receipts.
If you are required to submit receipts for any of your Benny purchases, they will be requested by email or
mail. You will have 60 days to submit any requested receipts. Remember, if ABG asks you to send receipts
for a purchase, the merchant has been paid for your service or expense.
*When submitting requested receipts, do not complete a Reimbursement Request Form.
Other Import Things You Need to Know

Don’t use Benny to pay for expenses that took place in a previous plan year. Benny is only linked to your current
plan year election. Use online or paper claims to submit run-out expenses.

Retain documentation for all Benny purchases, even if ABG does not request it.

Only use Benny to pay for eligible expenses - ineligible transactions will require repayment.

Using Benny is optional - paper or online claims can still be submitted any time.