Enrollment Toolkit. For Benefits Effective January 1, 2015

Transcription

1 2015 Enrollment Toolkit For Benefits Effective January 1, 2015

2 WELCOME Welcome to the Olathe Public Schools Medical Insurance Program! This enrollment guide outlines your medical benefit program and what options are available to you. It is important that you review this information and understand how to use the various plans to maximize your medical insurance benefits. The plans outlined in this booklet give you a tremendous opportunity to protect you and your family. These plans are designed to take care of you now and in the future. NOTE The purpose of this booklet is to describe the highlights of your benefit program. Your specific rights to benefits under the Plans are governed solely, and in every respect, by the official Plan documents, insurance contracts, and Board Policy and not by this booklet. If there is any discrepancy between the descriptions of the Plans as described in this booklet and the official Plan documents and Board Policy, the language of the Plan documents shall govern. To obtain a copy of the official Plan documents, simply log on to the Blue KC website at You can then either view the appropriate Plan document or print a copy for your records. You may also contact Blue KC at the phone number on your ID card to request a copy be sent to you. 1

3 ELIGIBILITY & ENROLLMENT WHO IS ELIGIBLE? All certified staff working 20 hours or more per week and full-time classified staff working 30 hours or more per week are considered eligible to participate. Please contact the Benefits Department if you have questions about your eligibility or your benefit effective date. Dependents of eligible employees may also be eligible for coverage under many of these benefits plans. Eligible dependents include: Your spouse; Dependent children through the end of the calendar year (December 31) in which they turn 26; Unmarried dependent children over age 26 who are incapable of supporting themselves because of mental or physical handicaps (upon approval). OPEN ENROLLMENT Each year during Open Enrollment, you have the opportunity to re-evaluate your benefit needs and adjust your coverage for the upcoming plan year. Once you make your medical plan election, you may not change your plan until the next open enrollment period unless there is a qualifying status change. All changes made during fall 2014 Open Enrollment are effective January 1 - December 31, Active Employees All enrollment and mid-year qualifying status changes are done through the internet. To enroll or make changes, simply access log in with your user name and password (what you log onto your computer with) and then click on Benefit Enrollment. Retiree & COBRA Participants You will receive a paper enrollment form in the mail that you will need to complete and send back by the deadline listed on the form. IMPORTANT: It is very important that you complete your enrollment by November 25, If you do not complete your enrollment by the deadline, you will have no coverage for the plan year. 2

4 New Hires To enroll, simply access log in with your user name and password (what you log onto your computer with) and then click on Benefit Enrollment. If you don t enroll in your benefits within 30 days of first becoming eligible, you must wait until the next Annual Enrollment. It is your responsibility to enroll during your 30-day eligibility period. QUALIFYING STATUS CHANGES If you experience a qualifying status change during the plan year, you may make changes to some benefits within 30 days of the event. The changes you request must be consistent with the status change event. Qualifying Status Changes Include: Marriage Birth or adoption of your child Death of your spouse or child Divorce, legal separation or annulment Change in your child s dependent status (age requirement, obtaining other coverage, marriage) Change in your or your spouse s employment status (part-time to full-time, commence new job or gain coverage availability) You must notify either Nancy Jirik ( , njirikec@olatheschools.org) Melanie Souder ( , msouderec@olatheschools.org) or Kay Wunder ( , kwunderec@olatheschools.org) in the Benefits Department within 30 days of a qualifying status change to adjust benefits. If the Benefits Department is not notified within this time frame, you must wait until the next Open Enrollment period to adjust your benefits. If you or your dependents become ineligible for Medicaid or CHIP, you may be able to enroll in the District s plan; you must request enrollment within 60 days. Additionally, if you or your dependents become eligible for premium assistance from Medicaid or CHIP, you may be able to enroll yourself and your dependents in the District s plan; you must request enrollment within 60 days. 3

5 MEDICAL BENEFITS BLUE KC When it comes to benefits, we recognize that one size doesn t fit all. We understand that people are different with different lifestyles and needs. Situations change. That s why the Olathe Public Schools plan offers you four levels of coverage insured through Blue Cross Blue Shield of Kansas City (Blue KC) that includes one HMO plan, two PPO plans and the Blue Saver High Deductible Health Plan with H.S.A (Health Savings Account). The difference in each plan is the out-of-pocket cost to you and the premium you pay. On each plan, you have the option to choose between four levels of coverage: Employee Only, Employee & Spouse, Employee & Child (ren), or Employee & Family. WEIGH YOUR OPTIONS When choosing a health benefits plan, the most important question is: Will it provide the right amount of coverage for you and your family? After deciding how much coverage you need, consider the costs and when you pay them. There are two ways you contribute to the cost of a health plan: 1. Up-front costs. This is the part of the health insurance premium you pay. If you re an employee, up-front costs are deducted from your paycheck. If you re retired or on a non-employee plan like COBRA, you write a check or bank draft for the premium. Either way, you pay premium costs regularly, like any bill, no matter how often or how seldom you need health care. 2. Pay-as-you-go costs. These are the out-of-pocket dollars you pay when you see a doctor, go to a hospital or outpatient clinic, or have a prescription filled. Pay-as-yougo costs include copayments, s, and coinsurance. If you need medical care often, you might want to pay more up-front and less as-you-go costs. Budgeting is easier because your premium costs are always the same, and you won t have huge expenses for any major, unexpected medical treatment. If you see a doctor or need prescriptions only two or three times a year, it might make more sense to pay less up-front and more as-you-go. This way, you can save the premiums and avoid paying for more coverage than you might use. 4

6 BLUE KC CHOICES Making the right choices and becoming more knowledgeable about your plan options helps you be a better health care consumer. The plan you choose should simply be the one you re most comfortable with a plan that fits your health needs, budget, and personal preferences. No matter which plan you enroll in, you ll have the assurance of some financial protection against any major, unexpected medical expenses that are covered by your plan. Your choices include all of the plans briefly described below. For more details, refer to the following pages. HMO. With an HMO (Health Maintenance Organization), there s no. Your share of the costs includes copayments for many services. You choose a primary care physician (PCP) who will provide most of your care and recommend specialists as needed. To visit a specialist who participates in the Blue Care Network, simply select the specialist and make an appointment. No referral is required. An HMO generally does not cover any services from non-participating providers, except for emergencies. o The HMO plan utilizes the Blue Care Network. o Preventative care covered at 100%. o Higher premiums/no. PPO. A PPO (Preferred Provider Organization) allows you to see participating and non-participating providers. o The PPO plans utilize the Preferred-Care Blue Network. o In-network preventative care covered at 100%. o The District offers you two PPO plans to choose from the $1,500 PPO and the $1,000 PPO. HDHP PPO. A HDHP (High Deductible Health Plan) PPO allows you to see participating and non-participating providers. This medical plan option consists of two parts the HDHP which provides health insurance coverage through Blue KC and the Health Savings Account (HSA). o The HDHP utilizes the Preferred-Care Blue Network. o In-network preventative care covered at 100%. o Lower premium/higher. 5

7 $1,500 PPO Plan One of the PPO plans you have to choose from is the $1,500 PPO plan. We believe this plan is an attractive option for many District employees due to the lower premium along with the District s contribution to the medical reimbursement account. Highlights of this plan include the following: 1. Once you have met the plan year of $1,500 individual / $3,000 family, all of your in-network, eligible medical and prescription drug expenses will be covered at 100% for the remainder of the year. 2. Employees who have met all of the wellness incentives can enroll in individual coverage on this plan at the low cost of $8 per month! 3. If you enroll in this plan, the District will contribute $69.30 per month ($ per year) to your medical reimbursement account. And, if you contribute $240 of your own money this year to your medical reimbursement account, the District will match that amount with another $240. This means that you would have total funds of $1, to help pay for your out-of-pocket medical expenses! 4. Please see the following pages for a more detailed description of this medical plan as well as the rules associated with the medical reimbursement account. Changes to Existing Plans In addition to the new plan mentioned above, there will be a few changes made to the remaining plans. Highlights of these changes include: 1. $1,000 PPO While the out-of-pocket maximum (OOP) has not changed from 2014, there is a change in the types of expenses that count towards your OOP. In 2014, your medical, coinsurance and all copayments (except prescription drug) accumulated towards the OOP. Beginning on January 1, 2015, in addition to these items, prescription drug copayments will also count towards the OOP. 2. HMO As of January 1, 2015, inpatient and outpatient hospital copayments will continue to be capped at a maximum of five copayments per member per year, but the total OOP as shown on the following pages will also include all other copayments including prescription drug copayments. 6

8 3. BlueSaver High Deductible Plan ($2,600 HDHP) The s and out-ofpocket maximums will be increasing on this plan. All other benefits will remain unchanged. Please see the following page for a reminder about how this plan and the associated Health Savings Account works. Are Your Medical Providers In the Blue KC Network? To obtain a list of providers participating in network, visit Select the blue box on the top right hand side of the page Find Blue KC Doctors, Hospitals, & Pharmacies. When selecting your insurance plan, choose: Blue Care Network if you are enrolled in the HMO plan. Preferred Care Blue for any of the 2 PPO plans as well as the $2,600 HDHP/HSA Plan. *Providers are subject to change at anytime.* 7

9 $2,600 HDHP with Health Savings Account This medical plan consists of two parts: 1. $2,600 HDHP: provides health insurance coverage though Blue KC. 2. Health Savings Account (HSA): a special, tax exempt account used in conjunction with the high health plan. This account provides funding to pay for qualified medical expenses NOT covered by the insurance. The HSA is provided by UMB Bank. o The $2,600 HDHP utilizes the Preferred-Care Blue Network. o In Network Preventative Care is covered at 100% with no or copayment. o Includes a $2,600 individual /$5,200 Family. o Health Savings Account is owned by YOU and is portable in the event you change employers. o Funds contributed to your HSA are not subject to federal income tax at the time of deposit. o HSA has no use it or lose it rule. o Interest or earnings that accumulate in your HSA are not subject to federal income tax. o Funds withdrawn from your HSA to pay for qualified medical expenses-at any time- are not subject to federal income tax. o In the event of disability or at the age of 65, HSA funds can be withdrawn for any purpose without penalty. o HSA funds can be used to help meet and pay for your. o If you enroll in the $2,600 HDHP, the District will contribute $88 per month to your HSA for a total annual contribution of $1,056. o And, if you contribute $240 per year to your HSA, the District will match that with another $240 contribution to your HSA. How Much Can I Contribute? IRS limits the annual maximum contribution. The maximum annual contribution (between the District s contribution and your own contribution) for 2015 is: $3,350 individual / $6,650 family Catch-up contributions of $1,000 are available for employees 55 and over. 8

10 What Are the Eligibility Requirements to enroll in an HSA? Cannot be enrolled in Medicare, Medicaid, Tricare or VA benefits. Cannot be covered by any other Traditional health plan. (If your spouse has an FSA through his employer or you are covered under your spouse s Non-HDHP, you are ineligible for an HSA). Traditional Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs) will make you INELIGIBLE for an HSA. Must be enrolled in a Qualified High Deductible Health Plan (QHDHP). The District s $2,600 HDHP is a qualified plan. What If I. Use my funds for non-qualified expenses, such as a new TV? There is a 20% penalty assessed for non-qualified expenses, plus taxes. Keep your receipts in case of an audit! Turn age 65? You can spend funds on non-qualified expenses with no penalty. Would pay normal income tax. Change to a Traditional plan next year? What happens to the funds in the account? It s your money, so you can continue to spend the funds on qualified medical expenses; you just can t contribute to the HSA. Don t have enough funds in my HSA to cover my service or prescription? You pay out of pocket and can reimburse yourself once your funds are available. 9

11 Annual Deductibles (calendar year) Out-of-Pocket Amounts (calendar year) 1 Participating Providers Blue KC Plan Designs Effective January 1, 2015 (amounts shown below are member responsibility) $1,500 PPO $2,600 HDHP Non-Participating Providers Participating Providers Single $1,500 $2,600 Family $3,000 $5,200 Non-Participating Providers Single $1,500 $3,000 $2,600 $5,200 Family $3,000 $6,000 $5,200 $10,400 Lifetime Maximum Benefit Unlimited Unlimited Preventive Care Adult & Child Routine Physicals Covered in full 20% after Covered in full 20% after Physician Services Hospital Services Routine Lab Covered in full 20% after Covered in full 20% after Routine Mammogram Covered in full 20% after Covered in full 20% after Vision Exam $10 co pay 3 20% after $10 co pay 3 20% after Primary Care Physician Office Visit Specialist Office Visit Non-routine diagnostic tests and labs Inpatient Care Outpatient Surgery Outpatient nonsurgical care (i.e. MRI) Urgent Care 20% after 20% after 20% after 2 20% after 2 20% after 2 20% after 20% after Emergency Room Prescription Drugs Participating Pharmacy Participating Pharmacy Calendar Year Deductible No Separate Deductible No Separate Deductible Tier 1 Tier 2 Tier 3 Mail Order (102 Day Supply) 20% after 20% after 20% after 20% after 2 20% after 2 20% after 2 20% after 3 1 PPO out-of-pocket amount includes coinsurance and expenses. 2 Diagnostic services performed at a non-par imaging center within the service area are limited to $200 CY Max. Inpatient services in a non-par hospital within the service area are limited to $200 max per day and are limited to 30 days per CY. Outpatient services at a non-par facility (including ambulatory surgical center) are limited to $200 CY Max. 3 Separate benefit provided through VSP. Note: This is only a summary. Please refer to the booklet/certificate for specific details. If a conflict arises, the booklet/certificate will govern in all cases. Note: This is not an offer of insurance coverage. Information on final rates, coverage s, and limitations must come from the Insurance Company. 10

12 Annual Deductibles (calendar year) Out-of-Pocket Amounts (calendar year) 1 Participating Providers Blue KC Plan Designs Effective January 1, 2015 (amounts shown below are member responsibility) $1,000 PPO HMO Non-Participating Providers Participating Providers Single $1,000 N / A Family $2,000 N / A Single $3,975 $11,925 $2,945 Family $7,950 $23,850 $7,363 Lifetime Maximum Benefit Unlimited Unlimited Preventive Care Adult & Child Routine Physicals Covered in full 40% after Covered in full Physician Services Hospital Services Routine Lab 3 Covered in full 40% after Covered in full Routine Mammogram 3 Covered in full 40% after Covered in full Vision Exam $10 co pay 2 40% after $30 co pay Primary Care Physician Office Visit $40 co pay 4 40% after $30 co pay Specialist Office Visit $80 co pay 4 40% after $60 co pay Non-routine diagnostic tests and labs Inpatient Care 10% after 40% after Covered in full 10% after 40% after 5 $300 co pay per day Copay is charged per day for the first 5 days per calendar year (IP & OP combined) Outpatient Surgery 10% after 40% after 5 $300 co pay/occurrence Outpatient nonsurgical care (i.e. MRI) 10% after 40% after 5 $200 co pay 7 Urgent Care $80 co pay 6 40% after $60 co pay Emergency Room 10% after $150 co pay & $200 co pay Prescription Drugs Participating Pharmacy Participating Pharmacy Calendar Year Deductible $200 Individual / $400 Family $200 Individual / $400 Family Tier 1 $12 co pay ($0 co pay for Value Based) $12 co pay ($0 co pay for Value Based) Tier 2 $60 co pay ($0 co pay for Value Based) $60 co pay ($0 co pay for Value Based) Tier 3 $80 co pay ($40 co pay for Value Based) $80 co pay ($40 co pay for Value Based) Mail Order (102 day supply) 2 times retail co pay 2 times retail co pay 1 PPO and HMO out-of-pocket amounts include coinsurance, and medical co pays as well as pharmacy s and co pays. 2 Separate benefit offered through VSP. 3 Office visit co pay will apply if service is performed in conjunction with an office visit. 4 Office visit co pay applies to specified services; any non-specified services will be subject to and coinsurance. 5 Diagnostic services performed at a non-par imaging center within the service area are limited to $200 CY Max. Inpatient services in a non-par hospital within the service area are limited to $200 max per day and are limited to 30 days per CY. Outpatient services at a non-par facility (including ambulatory surgical center) are limited to $200 CY Max. 6 Urgent care co pay applies to office visit and lab only. Other services performed by Urgent Care provider are subject to and coinsurance. 7 Copay applies only to MRI, MRA, CT and PET scans performed in physician s office, imaging center or other outpatient setting (including hospital). Only one co pay will apply for each provider on a specified date of service even if multiple scans are performed. Note: This is only a summary. Please refer to the booklet/certificate for specific details. If a conflict arises, the booklet/certificate will govern in all cases. Note: This is not an offer of insurance coverage. Information on final rates, coverage s, and limitations must come from the Insurance Company. 11

13 YOUR MEDICAL PLANS IN ACTION Let s take a look at three very different situations and compare the medical plan options side-by-side based on our assumptions about the health care the member will need during the year. For all three examples, all care will be provided within the appropriate Blue KC network, any prescription drugs are not included, and each employee completed all the wellness requirements needed to receive the maximum premium discount. Consider your own personal situation in a similar manner to help you make informed decisions and choose the most affordable medical plan that best meets your healthcare needs. Remember, these are just illustrations and are not intended to fit every situation. VALERIE Valerie leads a very active lifestyle. She usually goes to her Primary Care Physician (PCP) once a year for her routine physical and recommended screenings. In January, her PCP recommended that she have some moles removed from her back. She had an outpatient service at her PCP s office in February. Following is an estimate of Valerie s out-of-pocket costs: $2,600 HDHP $1,500 PPO $1,000 PPO HMO 1. PCP Office Visit a. Total Cost $100 $100 $100 $100 b. Valerie s Cost* $0 $0 $0 $0 c. BCBS Paid $100 $100 $100 $ Outpatient Surgery a. Total Cost $700 $700 $700 $700 b. Deductible/Copay Paid by Valerie $700 $700 $700 $300 c. Coinsurance Paid by Valerie $0 $0 $0 $0 d. Amount Paid by BCBS $0 $0 $0 $ Total Paid by BCBS (1c+2d) $100 $100 $100 $ Summary of Valerie s Costs a. Medical Expenses (1b+2b+2c) $700 $700 $700 $300 b. Annual Premium $0 $96 $672 $852 c. District HSA/FSA Contribution** $1,056 $ $0 $0 5. Valerie s Total Annual Cost*** $0 $96 $1,372 $1, Remaining HSA/FSA Balance (4c-4a) $356 $ N / A N / A *Routine preventive care is covered at 100% with no copayment. **Only includes District s $88/month HSA contribution or $69.30/month FSA contribution does not include any contribution you might make to either of these accounts. ***Includes annual premium in 4(b) & any medical expenses above the District HSA/FSA contribution in 4(c). 12

14 Ali considers herself to be a relatively healthy individual. This year she got a very bad cold that was diagnosed as pneumonia. She saw her Primary Care Physician (PCP) two times while ill and had blood tests and a chest x-ray upon diagnosis and then additional blood tests and x-rays once she was feeling better. Following is an estimate of Ali s out-of-pocket costs: ALI $2,600 HDHP $1,500 PPO $1,000 PPO HMO 1. PCP Office Visits (2) a. Total Cost $400 $400 $400 $400 b. Ali s Cost $400 $400 $80* $60* c. BCBS Paid $0 $0 $320 $ Lab & X-Ray (2) a. Total Cost $1,200 $1,200 $1,200 $1,200 b. Deductible/Copay Paid by Ali $1,200 $1,100 $1,000 $0 c. Coinsurance Paid by Ali $0 $0 $20 $0 d. Amount Paid by BCBS $0 $100 $180 $1, Total Paid by BCBS (1c+2d) $0 $100 $500 $1, Summary of Ali s Costs a. Medical Expenses (1b+2b+2c) $1,600 $1,500 $1,100 $60 b. Annual Premium $0 $96 $672 $852 c. District HSA/FSA Contribution** $1,056 $ $0 $0 5. Ali s Total Annual Cost*** $544 $ $1,772 $ Remaining HSA/FSA Balance (4c-4a) $0 $0 N / A N / A *Based on two office visits at $40/visit on $1,000 PPO and $30/visit on HMO. **Only includes District s $88/month HSA contribution or $69.30/month FSA contribution does not include any contribution you might make to either of these accounts. ***Includes annual premium in 4(b) & any medical expenses above the District HSA/FSA contribution in 4(c). 13

15 Robert experienced some stomach pain this year and went to see his Primary Care Physician (PCP). Upon examination, his doctor admitted him to the hospital due to appendicitis. Robert s condition required surgery and additional services from a physician and anesthesiologist. He was in the hospital for two days. Following is an example of Robert s out-of-pocket costs: ROBERT $2,600 HDHP $1,500 PPO $1,000 PPO HMO 1. PCP Office Visit a. Total Cost $150 $150 $150 $150 b. Robert s Cost $150 $150 $40 $30 c. BCBS Paid $0 $0 $110 $ Inpatient Hospitalization a. Inpatient Hospital Charges $10,000 $10,000 $10,000 $10,000 b. Inpatient Physician Charges $2,500 $2,500 $2,500 $2,500 c. Anesthesiology $1,000 $1,000 $1,000 $1,000 d. Deductible/Copay Paid by Robert $2,450 $1,350 $1,000 $600 e. Coinsurance Paid by Robert $0 $0 $1,250 $0 f. Amount Paid by BCBS $11,050 $12,150 $11,250 $12, Total Paid by BCBS (1c+2d) $11,050 $12,150 $11,360 $13, Summary of Robert s Costs a. Medical Expenses (1b+2d+2e) $2,600 $1,500 $2,290 $630 b. Annual Premium $0 $96 $672 $852 c. District HSA/FSA Contribution*** $1,056 $ $0 $0 5. Robert s Total Annual Cost **** $1,544 $ $2,962 $1, Remaining HSA/FSA Balance (4c-4a) $0 $0 N / A N / A *Based on one office visit at $40/visit on $1,000 PPO and $30/visit on HMO. **Based on inpatient hospital copay of $300/day. ***Only includes District s $88/month HSA contribution or $69.30/month FSA contribution does not include any contribution you might make to either of these accounts. ****Includes annual premium in 4(b) & any medical expenses above the District HSA/FSA contribution in 4(c). 14

16 VALUE BASED PRESCRIPTION DRUG PROGRAM Blue KC offers a unique program for members with Diabetes & Coronary Artery Disease. When you seek appropriate treatment, this incentive based program helps reduce financial barriers by combining education and support as well as waived or reduced co pays for selected medications or supplies. For more information regarding this program, contact Blue KC Customer Service by calling the number located on the back of your member ID card. This plan is only available to those members covered under either the $1,000 PPO or HMO plan. It is not available to anyone covered under the $2,600 HDHP or $1,500 PPO plan. MAIL ORDER PRESCRIPTION DRUGS If you are covered under the $1,000 PPO or HMO plan and are taking prescription medications on a regular, on-going basis, you will save money by ordering them through the Express Scripts Home Delivery program. For those of you on the $2,600 HDHP or $1,500 PPO plan, you will not necessarily save money by using this program, but you will be able to benefit from the convenience of having your medication delivered directly to your home. Home Delivery offers the following benefits: Prescriptions are delivered directly to your home with free standard shipping. You get up to a 3-month supply of your medications for two co pays. You can speak with a pharmacist anytime, day or night. Once you begin using Home Delivery, you can order refills by phone or online. 15

17 FLEXIBLE SPENDING ACCOUNTS A great way to plan ahead and save money over the course of a year is to participate in the Flexible Spending Account (FSA) programs. These accounts allow you to redirect a portion of your salary on a pre-tax basis into reimbursement accounts. Money from these accounts is then used to pay medical expenses which are not reimbursed by your insurance plan or to pay for dependent day care expenses. Pre-tax means the dollars you use for eligible expenses are not subject to social security tax, federal income tax, and state and local income tax. Money you would have paid in taxes can be used to pay for qualified expenses. There are three ways to maximize your pre-tax savings: The Medical Reimbursement Account The Limited Medical Expense Reimbursement (MER) Account The Dependent Day Care Account MEDICAL REIMBURSEMENT ACCOUNT You may elect to contribute up to $2,550 of your own money each plan year. Additionally, if you make an annual contribution, the District will match your contribution dollar-for-dollar up to a maximum of $240.00! And, don t forget if you enroll in the $1,500 PPO plan, the District will contribute another $ this year to your medical reimbursement account. Eligible expenses that can be paid from this account are those not covered by your medical, dental, and/or vision plans. Some examples include: Plan s, copayments, and other out-of-pocket costs Vision services, such as contact lenses, eye exams, eyeglasses and laser eye surgery Prescription expenses A complete list of eligible expenses can be found at Don t Forget the *Use it or Lose it Rule!* The IRS does not allow the following expenses to be reimbursed under the Medical Reimbursement Account (the list below includes some of the more common items and is not meant to be all-inclusive): Cosmetic surgery/procedures Electrolysis Hair loss medication Health club dues Herbs & herbal medicines Teeth whitening/bleaching 16

18 Limited MER Account For those who enroll in the $2,600 HDHP with HSA, IRS rules state you are not eligible to participate in the medical reimbursement account. You are, however, eligible to participate in the Limited MER Account, allowing you to pay for any dental and vision care expenses. All rules that apply to the traditional medical reimbursement account also apply to the Limited MER, i.e. once you make your annual election your contributions will remain unchanged; you can file claims for any amount up to your total annual contribution at any time, even if you have not yet had the amount withheld from your pay and any unused amounts at the end of the plan year and grace period are forfeited. DEPENDENT DAY CARE ACCOUNT You may contribute up to $5,000 or up to $2,500 if you are married and file separate tax returns. Eligible dependent day care expenses are for the care of children under age 13 or dependents of any age that are unable to care for themselves because of mental or physical handicap. The services must be necessary to allow you, or you and your spouse if you are married, to work or attend full-time school. REIMBURSEMENTS Some important things to remember about flexible spending accounts: You are responsible for filing claims for reimbursement. You may elect to have reimbursements mailed to your home or deposited directly in your personal account. You may access the website at any time for current account information. You may elect to use the free debit card for healthcare reimbursement, which may allow you to avoid filing claims. It is important that you keep your receipts on file. Your debit card is accepted at only qualified locations, such as pharmacies, doctor s offices, vision care centers, and hospitals. These IRS-imposed limitations help to insure that the card is used only when paying qualified expenses. You can avoid having to verify card purchases by using a retail partner such as CVS, Wal-Mart, Walgreens or Drugstore.com. Only retail partner systems allow qualified purchases to be charged on the debit card. Certain card swipes can be automatically verified. However, if the total amount of a card swipe cannot be matched with your co pays, the IRS requires that all details be verified. Failure to send in requested documentation could result in suspension of your debit card and you may be required to pay-back the plan 17

19 IMPORTANT RULES In exchange for the tax advantages, the IRS has strict rules about how these accounts must work. You may not stop or change your contribution amounts until the next Open Enrollment. Any funds remaining in the accounts at the end of the plan year grace period are forfeited. Use it or lose it. The Medical Reimbursement Account, Limited MER Account and the Dependent Day Care Account function separately; funds may not be transferred from one to the other. The money you contribute to each account for the plan year can only be used for eligible expenses you incur during that same plan year. You may not roll over funds from one year to the next. Expenses for the January 1 December 31, 2015 plan year must be incurred by March 11, 2016 and submitted by March 31,