MGM Flex Guide

Transcription

1 MGM Flex Guide

2 Welcome to MGM Benefits Group, your Third Party Flexible Benefits Plan Administrator! With over 30 years experience in employee benefits administration, MGM Benefits Group has partnered with your employer to bring you a state of the arts Flexible Benefits Plan. Enjoy the features of your very own Flex Website, with 24 hour access, where you can: Create your own password File claims online Receive updates to process your claims Get confirmations for your direct deposits Download claim forms and other plan forms We encourage you to review the information in this guide to make informed decisions about your flex account that will benefit you and your family. Benefit Counselors are available to assist you from 8am to 5:30pm (CST), Monday through Thursday and 8am to 2:00pm on Friday. Mail Claims: Contact Phone: Fax Claims: Website: Questions to: MGM Benefits Group 2121 N. Glenville Drive Richardson, Texas (800) (800) flexsupport@mgmbenefits.com

3 How the Plan Works An IRS Section 125 Plan provides participants an opportunity to receive certain benefits on a pre-tax basis. Under your Employers Plan, you may pay the premiums pre-tax for your medical, dental, cancer and vision insurances. Flexible spending accounts are also offered for your health care and dependent care needs for you and your family. Flexible Spending Accounts A Flexible Spending Account (FSA) is a special account for healthcare and dependent care expenses. When you enroll in an FSA, you decide how much to contribute to each account for the entire Plan Year. This annual contribution is then deducted in equal amounts from your paycheck, before Federal & State income taxes and FICA taxes are deducted. These pre-taxed funds are automatically deposited in your account through payroll deduction. Unless you have a qualifying event under Section 125 regulations, your election amount will not change during the Plan year.

4 Managing Your Flexible Spending Accounts There are two kinds of Flexible Spending Accounts: Health FSA Dependent Care FSA You may choose to participate in both plans, depending on the options provided by your employer. Funds in these accounts cannot be co-mingled and the expenses must be incurred during your employer s plan year. Expenses in your flex account that are not incurred by the end of the plan year will be subject to the use it or lose it rules regulated by the Internal Revenue Service. Therefore, a decision as to how much you will contribute to your FSA accounts should be made carefully. Based on your Employer s flexible benefits plan year, you have a specified date or run-off period following the end of the plan year to submit your claims for reimbursement. If you do not exhaust your account balance, all funds still remaining in your account will be forfeited after this claim period ends. Check with the Plan Administrator to verify the last date that you may file claims to be reimbursed for your eligible FSA expenses.

5 Health Flexible Spending Account A Health Care Flexible Spending Account (FSA) is designed to reimburse you for out-of-pocket health care expenses incurred by you or your eligible dependents that are not reimbursable by your medical, dental and vision insurance plans. Eligible Health Expenses These expenses may be incurred by you or your eligible dependents. Expenses include deductibles, coinsurance payments, office co-pays, orthodontics, glasses and contacts. An eligible expense item must not be used for general health or cosmetic purposes. In some instances, you will be required to submit a letter of medical necessity from your health care provider to demonstrate a medical need. Once enrolled in a health FSA, the entire annual election is available to you on the first day of the plan year. You must spend the funds by the end of the plan year or they will be forfeited from your account.

6 Special Health Care Expenses IRS does not allow pre-payment of certain medical treatment programs that may span over multiple plan years. These include orthodontic and prenatal expenses. Reimbursement of the entire expense generally violates the IRS requirement that expenses must be incurred during the coverage period and cannot be paid in advance. Orthodontic Expenses IRS stipulates how orthodontic expenses can be reimbursed in a health care FSA. You should carefully plan when deciding on your annual election if it includes orthodontic expenses. Special planning should be considered if you are planning to take advantage of an up-front discount payment. Please remember, services must be performed and incurred within the current plan year. Reimbursement of a lump sum payment to a dentist may not be eligible for services. Also consider services that will be performed over more than one plan year. You will need to provide a copy of your contract with your dental provider, showing the initial deposit and monthly payments. This expense may be setup as a recurring expense throughout your plan year. Prenatal Expenses For maternity related expenses, payment cannot be advanced, but are reimbursed as they are incurred. Eligible charges may be reimbursed each time you are seen by your physician for prenatal care, but not in advance of the delivery.

7 Eligible Health Care Expenses Partial List of Medically Necessary Services & Items (Some items may require the submission of a Doctor s certification stating the nature of medical condition and required treatment) Dental Services Crowns & Bridges Dentures Exams/Teeth cleaning Extractions Fillings Implants Oral surgery Orthodontia/Braces Insurance Co-pays Deductibles Medications Contraceptives Chiropractic care Hospital services Immunizations & Vaccinations Injections & Vaccinations Nursing Services Physical therapy Operating room fees Optometrist/Ophthalmologist fees Organ transplant Specialty physicians & Surgeons Sterilization Surgery Transportation to medical care Transplants Drugs (prescriptions) Obstetric Services Smoking cessation products Vision Services Insulin treatment ** Over-the-Counter items Laboratory Fees & Tests Blood tests & transfusions Diagnostic tests/health screenings Lab fees X-rays Medical Equipment & Supplies OB/GYN Exams & Treatment OB/GYN Prepaid Maternity fees Laser eye surgery Eye exams Eyeglasses & Sunglasses (corrective) Contact lenses (corrective) & supplies Non-Eligible Items Ambulance service Cosmetic Surgery/Procedures Hearing aids and batteries Exercise or health club memberships Ex Insurance premiums Crutches Guide dog Oxygen equipment Prosthesis Wheelchair Medical Services & Providers Acupuncture Anesthetist Dietary Supplements (vitamins) Electrolysis Personal care items Smoking cessation programs Teeth whitening/bleaching Weight reduction (fees, programs, & food) Physical Therapy for general well being ** OTC Drugs and medicine (with the exception of insulin) are not eligible for reimbursement without a physician's prescription after 12/31/2010. Medical supplies will still be eligible for the Health FSA after 12/31/2010.

8 Over The Counter (OTC) Items The recently enacted Patient Protection and Affordable Care Act of 2010 changes the rules for the purchase of over-the-counter (OTC) products using Flexible Spending Accounts (FSA). Currently, IRS allows over the counter (OTC) drugs and medications that are used to treat sickness and injury as eligible expenses under the Health Care Flexible Spending Account. Effective for tax years January 1, 2011, over-the-counter medicines or drugs (e.g. Advil, Ibuprofen, and cough syrup) are not eligible for reimbursement under an FSA, HRA, or HSA without a doctor s prescription. Insulin is the only medicine that doesn t require a prescription. Supplies you need for medical care (e.g. contact lens solutions, bandages for wounds, thermometers) will continue to be eligible for reimbursement. There are some medical items that may not be allowed unless you have a prescription or letter of necessity from a medical professional for a specific medical condition. We recommend you retain copies of all OTC documentation for your records. Documentation for reimbursement must state the place of purchase, date, amount, item name, and purchases can be claimed within reasonable quantities. Treatment for eligible expenses cannot be for preventative purposes and items purchased for personal care are not eligible for reimbursement. For example: toothpaste, vitamins, supplements and herbal remedies, and other items used for personal hygiene cannot be claimed for reimbursement.

9 Partial List of OTC s Allergy Antihistamines Nasal sprays Antacids Heartburn medicines Cold Remedies Cough drops Decongestants Hemorrhoid treatments Laxatives Motion sickness treatments Smoking cessation products Thermometers Wart removers Non-eligible items Nasal strips Cosmetics Throat lozenges Hand Sanitizers Nasal sprays Sinus Medications Pain Relief Bug bite medication Fever reducers First aid creams (diaper, fever blister, etc.) Products for pain & cramp relief Products for muscle or joint pain Special ointments or sunburn creams Topical creams Diapers Food Items Humidifier Non-Prescription Eyewear Toiletries Personal hygiene/care items Weight loss drugs Items used to promote general health & well being Other Items for Medical Care Anti-diarrheas Anti-fungal Antibiotics Asthma medications Bandages, gauze, rubbing alcohol Carpal tunnel wrist supports Cold/hot packs for injuries Contact lens drops & cleaning solutions Eye products (reading glasses) First aid kits ** OTC Drugs and medicine (with the exception of insulin) are not eligible for reimbursement without a physician's prescription after 12/31/2010. Medical supplies will still be eligible for the Health FSA after 12/31/2010.

10 Dependent Care FSA Eligible DCAP Expenses The Dependent Care Assistance account allows you to pay for employment related expenses that enable you and your spouse to be gainfully employed, seek employment, and/or be a fulltime student. In general, expenses must be for the care of a qualifying individual. Reimbursement may also include eligible expenses for children or elder dependents that rely on you for their care. Some examples of eligible expenses include: care in and outside the home child-care/dependent care centers before and after school care nursery school and preschool expenses preschool tuition day care camps and facilities (only for care and not primarily for educational purposes). Adult day care expenses Expenses for services provided outside the employee s home by dependent care centers must comply with state and local laws. Your care provider must report day care income on their taxes to be considered as eligible. Dependent Care FSA must be for children under 13 years of age, unless they meet the qualifications of physically or mentally incapable of self-care.

11 DCAP Reimbursements The total amount you choose to contribute should be based on your expected child and/or dependent care expenses during the plan year. A single parent, or employee that is married but filing separately is limited to 2,500 for the Plan year. If your spouse has a dependent care account through their employment, the two accounts cannot exceed 5,000 during a given plan year. IRS requires that the amount reimbursed to a participant must first be on deposit in their account. When a claim is filed we first verify that there are adequate funds in the account to pay the entire claim. When sufficient funds are not available, participants are issued the maximum amount available in their account. The remainder of the reimbursement request is paid when additional funds are received through payroll deposits. Ineligible Expenses The following items are examples of expenses that are generally considered as ineligible for reimbursement in a Dependent Care FSA: Educational expenses, except where an eligible child attends preschool or nursery school Field trips, clothing Late payment or finance charges Payments for lessons Tuition expenses Overnight camps Kindergarten expenses

12 Participant Website Website Access The MGM Flex system offers participants the ability to manage their own account information. Participants can log in to their personal accounts to: Create your own password File your FSA claims online Review your reimbursement claims by provider name, date and amount Create your own direct deposit accounts Obtain information on how to use the MGM Flex Card Dependent process to add and request debit cards for eligible dependents Obtain FSA claim forms Refer to a listing of certified merchants for prescription debit card purchases Access to documents with information on how to use your Flex Plan And much more! Once enrolled in the administration system, you will receive an enrollment confirmation with instructions for accessing the website to initiate your account setup and review your account elections. Follow these easy steps to create your own Participant Website: 1) Open your web browser (e.g. MS Explorer) and go to the following website: 2) Under participants, click on Log in Help for assistance on your username and password. This information was also sent to you via your enrollment confirmation. You will be asked to create your password for the account.

13 FSA Worksheet Estimated Eligible Expenses The estimated worksheet will help you decide the amount you will spend for your medical and/or dental expenses during your employer s plan year. In planning, also consider expenses for your eligible dependents. You may claim their expenses even if they are not carried on your employer s medical insurance plan. Medical Expenses Annual Estimate Deductibles, co-pays, coinsurance Diabetic supplies Physician visits/routine exams Prescription drugs Chiropractic treatments ** Eligible over-the-counter medicines/drugs Other: Dental Expenses Routine Cleaning and Exam Filings & Crowns Root canals Crowns/Bridges/Dentures Oral surgery Orthodontia Other: Vision Care Exams Glasses (eyeglasses & prescription) Contact Lenses & Cleaning Solutions Corrective Eye Surgery Other: Total Unreimbursed Medical Expenses Dependent Care Annual Estimate After School Care Other Summer Care Adult Day Care Total Dependent Care Expenses ** OTC Drugs and medicine (with the exception of insulin) are not eligible for reimbursement without a physician's prescription after 12/31/2010. Medical supplies will still be eligible for the Health FSA after 12/31/2010.

14 Your Personal Account You can view up-to-date account information at any time you choose Account: Check your FSA account balances and the payment history of your account. You can also file claims, see claim documentation that is needed, and view your election summary and the plan description for the FSA accounts. Profile: You can review your personal and dependent Information on file in the system. (To add your dependents, click on the Add Dependents option available on the website home page). Notifications: To see a detail of the claims that have been paid you can click View Detail for more information about any claim. Forms: You can download the Health FSA or Dependent Care FSA claim forms at any time. Log on and click on the Forms tab, and select the form to download.

15 Participant Website Homepage Check for Receipt notices (for valid documentation) to verify transactions for claims approval Account Information Available Balance Final Service Date: last day in plan year that claims may be incurred Final Filing Date: last day to be reimbursed for claims incurred during plan year Actions: File Claims or view claims history for current plan year

16 Participant Website Profile Demographics for your personal information address Listing of eligible dependents Direct Deposit Information

17 Election Summary View the Plan Elected (Health Care FSA and/or Dependent Care FSA) Annual election and payroll contribution amounts Plan dates for expenses

18 Account Summary View your: Annual election amount Claims submitted Available balance

19 Claim Filing Options How to File Claims You may file your claims by one of the following methods: 1. If your employer offers the MGM Flex Visa Card: use your Card at the point of purchase towards qualified expenses. 2. Online Claim Filing: file your claims online via our participant website. 3. Paper Claim Filing: file claims using the paper form available on the website under the Forms tab. Health Care Flexible Spending Claims: Your account balance is available for use on the first day of the plan year Funds remaining in your account that have not been spent by the end of the Plan Year will be subject to the use it or lose it rules for IRS regulations Based on your Employer s Plan rules, you will have a specified time period following the last day of your plan year to request reimbursement for expenses incurred, but not claimed, during the plan year Some health care items may be eligible only if you are diagnosed by a medical professional for a specified medical condition. For these expenses, you will be asked to provide a copy of diagnosis and treatment from your physician. Dependent Care (DCAP) Flexible Spending Claims: The MGM Flex Card does not accept charges for dependent care related expenses Claims may be filed by Paper or Manual claims or online through the Participant website Funds must be available in your dependent care accounts prior to reimbursement IRS regulations do not allow pre-funding of DCAP accounts. Always be sure to keep your receipts no matter which option you may choose for claim reimbursement.

20 MGM Flex Card The MGM Flex Card makes using your Health FSA quick and easy. Just swipe it to pay for your eligible expenses and the funds are automatically deducted from your account. If your Employer offers the MGM Flex Card, it is an automatic way to pay for qualified health care expenses. It is not a credit card, but can be used to pay for your eligible health flexible spending account (FSA) purchases. The value of the participant s annual contribution is loaded on the Card, and amounts of qualified purchases will be automatically deducted from your account. The Card may be used for eligible flexible spending account (FSA) expenses as determined by Section 213(d) of the Internal Revenue code. You may use the Card for co-pays at hospitals, physician offices, pharmacies, dental offices, vision service locations, and wherever they accept MasterCard or Visa cards. Only eligible expenses incurred during the current plan year and/or grace period can be claimed as eligible expenses. Over the counter products (OTC s) are eligible to purchase with the Card, but the items must be used for treating symptoms of injury and illness. Examples of OTC items include: cold and allergy remedies, first aid supplies, pain remedies, etc. Personal care items are not eligible for Card use.

21 Online Claim Filing Logon to Participant Login offers help for the username and password

22 Participant Home Page Access the option for Online Claims under the Accounts tab to file your claims online

23 Online Claim Form Enter all requested information to process your claim and submit to MGM for processing

24 Manual Claims Claim forms for Health Care FSA and Dependent Care FSA may be downloaded from the participant portal. Under the Forms Tab, choose the applicable form for your claim. Complete the correct reimbursement claim form Submit an Explanation of Benefits (EOB) or your valid documentation Make copies of your documentation and/or EOB Do not send your original documentation, but retain originals for your records Fax or mail to MGM for processing You can elect to receive your reimbursement by direct deposit or check

25 How to Substantiate Claims Submit valid documentation for Flex Expenses Health Care Claims: The Internal Revenue Service requires that ALL health care claims be documented for approval in order to be eligible for reimbursement. Valid substantiation documentation for health care expenses will have the following: Name of service provider Name of patient Date of service or sale Description of service or product Amount of unreimbursed service or sale

26 Invalid Substantiation A sales receipt normally shows only the date and amount of a transaction. These receipts do not provide the patient s name, a description of the service or show the actual date the service was performed. Dependent care claims: Valid substantiation documentation for dependent care claims may be in the form of a receipt from the day care provider that shows: Provider name and information Dependent s name Date span of service (i.e., January 1-31, 2010) Amount of reimbursement Example of invalid documentation for Flex Expenses A sales receipt is not valid substantiation documentation based on IRS guidelines

27 Debit Card Auto-Substantiation If your employer provides the MGM Flex Card for your health FSA, you may be asked to provide documentation to substantiate certain expenses charged on the Flex Card. Prescription drugs, over-the-counter items and other FSA approved items. You can use your Flex Card to purchase these items at merchant s locations that have obtained a certification from IRS. These merchants belong to an IIAS (Inventory Information Approval System) network. When you purchase eligible items from these merchants, your Flex Card is auto substantiated, and you will not be asked for documentation. Co-Payments for health related expenses. When you use your Flex Card to pay the co-pay for services from your medical provider, you will not be asked for documentation. Recurring Expenses When you have prescriptions that are filled monthly, orthodontic monthly payments or other recurring eligible expenses, you will need to provide MGM with valid substantiation documentation for the initial charge. Once the expense is approved as valid, we will mark the transaction as recurring in our administration system. It will then be auto substantiated and no further documentation will be required for the remainder of the plan year. Please remember... recurring expenses have to be approved each plan year. Online Claims When filing claims online, you will complete the information requested on the online claim form. Once all information has been supplied, print the confirmation page and mail or fax the form to MGM Benefits for processing. A copy of the substantiation documentation must be included before the claim will be processed for payment. Claims will not be processed for reimbursement until the substantiation documentation is received. Please do not the confirmation page or documentation. Manual Claims. Substantiation documentation must accompany the manual claim forms for health FSA and/or dependent care FSA claim forms. Please fax or mail to MGM Benefits for processing. When you choose the option to file your claims online or by a manual claim process, you must provide documentation to substantiate the reimbursement request.

28 Learn more about Flexible Spending Accounts at MGM Benefits Group 2121 N. Glenville Drive Richardson, Texas (800) (Phone) (469) (Fax) MGMFlex-8 (5/2010)