Group 1 Automotive Employee Benefits & Policies. Other Benefits. Employee Assistance Program Flexible Spending Accounts Pre-tax Earnings Vision Plan

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1 Group 1 Automotive Employee Benefits & Policies Other Benefits Employee Assistance Program Flexible Spending Accounts Pre-tax Earnings Vision Plan

2 Group 1 Automotive Employee Benefits & Policies Vision Service Plan 1 Flexible Spending Accounts Taxes no one likes to pay them but they are a fact of life. Most people, however, would want to take advantage of an opportunity to save hundreds of dollars a year on childcare and medical bills and at the same time give less money to Uncle Sam right? The company has provided a way for you to do so. That s why Group 1 offers the opportunity for you to establish Flexible Spending Accounts. What Are Flexible Spending Accounts? A: Flexible Spending Accounts are the result of a provision of a federal tax law, Section 125, that allows you to deposit a tax-free portion of your gross income into a savings-like account which is then used to pay you for unreimbursed health care, as well as certain dependent care expenses. There are two types of accounts available: A Health Care Account and A Dependent Care Account How Do They Work? A: Based on your family s predictable healthcare/day care spending expenses, you elect to contribute a portion of your annual gross earnings to your account(s). The annual election amount is then divided equally over the number of pay periods you have in a year. Each payday, that predetermined sum is deducted from your check on a pretax basis and deposited into your spending account(s). Health Care Flexible Spending Account participants will be provided with a Visa debit card to pay for qualified out-of-pocket expenses. When using the debit card it is important to keep receipts, as Aetna may still ask for substantiation. You may also submit a request for reimbursement (a claim) by completing a Health Care FSA Claim Form along with proper documentation, and you will receive a check from your Flexible Spending Account(s). Why Should I Use a Flexible Spending Account? A: You save federal, state and FICA taxes on the money that you set aside to pay for qualifying expenses. By using pretax dollars, you can save as much as 15% to 40% on qualifying daycare or unreimbursed medical services and supplies expenses that you would normally have paid for with after-tax funds. The following is an example of the increase you can experience in your take-home pay by using Flexible Spending Accounts. Example of Possible Savings Using Flexible Spending Accounts With Flexible Spending Accounts Without Flexible Spending Accounts Annual Gross Income $55,000 $55,000 Health Care Account Contribution (1,200) 0 Dependent Care Account Contribution (5,000) 0 Taxable Income 48,800 55,000 Estimated 27% (13,176) (14,850) Out-of-Pocket Medical Expenses 0 (1,200) Daycare Expenses 0 (5,000) Net Disposable Income 35,624 33,950 Net Increase in Disposable Income with Flexible Spending Accounts = $1,674

3 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 2 Health Care Account This account is designed to reimburse participants up to $2,500 in out-of-pocket health care expenses per plan year. Eligible expenses include deductibles, co-payments, dental expenses, orthodontics, vision care (eye exams, glasses, RK and Lasik procedures, contact lenses, and contact supplies), hearing care, prescription drugs, and qualified over the counter (OTC) drugs and medical items as well (see partial list, attached). Please note, OTC items will no longer be eligible for reimbursement after 1/1/2011. For a complete list of eligible expenses, please go to and click on Eligible Health Care Expenses or call Ineligible expenses include expenses that are not medically necessary or are cosmetic in nature. The account is available to your spouse and dependents, regardless of whether they are covered by any other Group 1 Automotive plans, as long as they are claimed on your federal tax return. Dependent Care Account You may be reimbursed up to $5,000 of daycare expenses per plan year, per family filing joint tax return (excluding tuition, educational expenses or overnight camps). Both you and your spouse must work or you must be a single working parent. If one spouse works part time or is a full time student, the account maximum is limited to the income of the part-time employee or the imputed income of the full-time student. Your caregiver cannot be your dependent child under age 19. Qualifying dependents are children under age 13, a disabled spouse or other dependents who are physically or mentally incapable of self-care, including parents for whom you take a tax deduction. You cannot claim expenses in a Dependent Care Account and claim the same dollars under the Dependent Care Tax Credit. Note: Generally speaking, if your household income is less than $28,000, using the Dependent Care Tax Credit may be financially advantageous. For more information on eligible dependent care expenses, please go to and click on Eligible Dependent Care Expenses or call Rules and Regulations The federal regulations governing Section 125 of the Internal Revenue Code include certain special rules that apply specifically to Flexible Spending Accounts, as follows: USE IT OR LOSE IT Under this rule, any unused amounts in your account at the end of the plan year are forfeited to Group 1 Automotive. You cannot convert this money to cash or roll it over to the next plan year. You may submit claims from the current plan year (March through February) up until three months after the plan year ends (May 31 st ). This rule means you must be very careful when estimating the amount of money you allocate to your spending account. You should only allocate funds you know you will spend. Note: Dependent care claims are reimbursed only up to the account balance. Status Change Your enrollment is for one plan year only and in most instances, you cannot change your enrollment during that year. However, if you incur a family status change, you can change your plan participation, as long as the change is consistent with the change in family status. For example, if you had another child, you would need to be increasing your flex contributions, rather than stopping or decreasing them. If your status changes, you have 31 days to notify Human Resources, so that you may change your election.

4 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 3 Date of Expenses Any expenses submitted for reimbursement must be incurred 1. during the current plan year (March through February), and 2. while you are a Flexible Spending Account participant. Eligible claims must be submitted no later than three months after the end of the plan year to be eligible for reimbursement. Terminations In the event that your employment terminates, you may file claims against your account(s) as long as the incurred dates for your expenses occur before your termination date. If you wish, you can continue making contributions into your Health Care Account by participating in COBRA. If you elect COBRA and contribute to the Health Care Account, this will allow you to continue filing claims for dates of service up to the end of the plan year, even after being terminated. Leaves of Absence If you take a leave of absence during the year, you may continue making contributions to your Health Care Account while on leave, or you may stop making contributions. If you stop making contributions, you will not be able to file claims for expenses incurred during your leave. Other Rules Health Care and Dependent Care Accounts must be separate funds and cannot be co-mingled. You cannot transfer money from one account to the other. You must provide the Tax ID number of your dependent care provider on your dependent care claim form and on your federal tax filing. Your dependent is a person who you legally claim on your income tax return. Enrolling in the Flexible Spending Accounts You can enroll in this plan during the annual enrollment period (if eligible). New employees hired during the year can join the Dependent Care Account on their eligibility date. To enroll in the Health Care Account employees must have at least six months of service as of the first day of the new plan year to be eligible to participate. If an employees sixth month of service is obtained during the plan year, the employee must wait until the next annual open enrollment to begin participation. Enrollment will continue for one year only. You must re-enroll in the Flexible Spending Accounts each year if you want to participate. Because of the Use It or Lose It rule, described previously, it is important to carefully calculate what you know you will spend during the calendar year. Your unused account balance will not roll over from one year into the next. Your submission of online elections authorizes the company to deduct your contributions on a pretax basis. If you do not enroll online, your deductions will not be entered and you will not be included as a Flexible Spending Accounts participant. Enroll online at or by calling FSA Debit Card When enrolling in the Flexible Spending Healthcare Account, you will automatically receive an FSA Debit Card. Whenever you incur an FSA eligible expense simply present the card at a valid merchant or healthcare provider. The expense is automatically withdrawn from your FSA debit card balance. However, you still must retain your receipts for verification purposes. In the event that your employment terminates, you may file claims against your account(s) as long as the incurred dates for your expenses occur before your termination date. Direct Deposit

5 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 4 Reimbursement to you has never been easier. By signing up for Flexible Spending Account Direct Deposit your reimbursements can be automatically deposited in your bank account. This applies to both the healthcare and dependent care flexible spending accounts. Go online to access the Forms Libraries on or to obtain the FSA Direct Deposit Form.

6 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 5 A Partial Guide to Health Care Expenses Eligible for Reimbursement The following is a list of eligible health care expenses. This list is not all-inclusive. For specific questions contact Aetna FSA at To be eligible, the expenses must be medically necessary and may not have been reimbursed by any other benefit plan. See Other Exclusions (Nonreimbursable Expenses) for more information. Deductibles & Co-payments Assistance for Disabled Persons Dental Expenses Braille or other special books/items or cost of specially equipping home or car for access by disabled person* Routine & preventive services; x-rays Guide animals (purchase & care) Orthodontia & appliances Special alert systems Restorative & major services, including fillings, Fees & Services crowns, implants, bridges Dentures & periodontal services Physicians, surgeons, anesthesiologists, OB/GYN or other specialists Vision Care Expenses Ambulance (air & ground) Exam (optometrist or ophthalmologist) Nursing (including room & board) Rx glasses & contact lenses & supplies Fertility treatment Corrective surgery (RK & Lasik) Sterilization & reversal Prescription Drugs, including prescription Legal abortion vitamins and birth control pills Diabetic Supplies, including test strips, insulin, Medically necessary cosmetic services (e.g., lancets, etc. following accident or mastectomy, etc.) Medical Equipment Chiropractic services Wheelchairs or lifts Alternative/Holistic Services Crutches Medically necessary treatment by licensed or Oxygen equipment & supplies certified practitioners, including acupuncture Air purifier/filters* and massage therapy (need a doctor s note or Rx including frequency of visits and duration.) Glucose Monitor Other Special beds or mattresses* Medical records Blood pressure monitor Hearing Expenses, including testing and Travel necessary to seek medical treatment hearing aids, plus batteries and repairs (limitations apply) Counseling & Psychiatric Treatment Organ/tissue donation expenses Psychiatrists & psychotherapists Special diet* Psychologists Support garments* & wigs Legal fees related to commitment of mentally Orthotics ill person Excluded: Marriage/family counseling Prosthesis, artificial limbs Therapy Orthopedic shoes Treatment for alcoholism or drug/chemical dependency Physical therapy; speech therapy Prescription smoking cessation Prescription weight loss program Disability testing & consultations*reimbursement may be limited to the difference between the cost of a normal item and a special need item. Additional documentation may be required. Physical Examinations School & work physicals Annual physical exam, including pap smears, mammograms and prostate screening

7 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 6 Over-the-counter Reimbursement - Not Reimbursable after 1/1/2011 unless prescribed by a physician. Beginning with the 2004 plan year, the Internal Revenue Code has expanded to include amounts paid by a participant for over the-counter (OTC) medicines and/or drugs purchased without a prescription. However, the purchase of such medicines and/or drugs must be for medical care as defined under Section 213(d) of the Internal Revenue Code, and not merely to maintain or enhance your general good health. Accordingly, expenses incurred by you or your qualified dependents for the purchase of OTC medicines and/or drugs to treat a medical condition without a prescription are reimbursable from your healthcare FSA account, tax free, upon the substantiation of: Purchase date within the plan year (receipt required); Name of the medicine and/or drug name (name on receipt required); Completion of a claim form with OTC purchases detailed line by line; and The participant s certification that such medicine or drug is for medical care. The decision as to how much to include in your annual FSA pledge for OTC medicines and/or drugs is a personal decision based on your own needs and health history. Examples of Eligible Over-the-Counter Medicines and Drugs Acne Preparations Cold Medicines Anesthetics Cold Sore Preparations Antacids Cough Medicines Antibiotics Hemorrhoid Preparations Antifungals Lice Preparations Analgesics Ophthalmic Preparations Asthma Preparations Pain Relievers (e.g. aspirin, ibuprofen) Antihistamines Psoriasis Agents Smoking Cessation Aids/Canker Sore Wound Care Products Preparations Examples of Ineligible Over-the-Counter Medicines and Drugs Dietary Supplements Toiletries Homeopathic Medicines Vitamins Nutritional Supplements Other Exclusions (Nonreimbursable Expenses) Over-the-Counter supplies (e.g., skin care, personal hygiene, sunglasses or clips) Cosmetic expenditures (e.g., teeth whitening, dermabrasion, chemical peels or spider vein treatment) General Wellness expenses (e.g., health club dues, special foods, vitamins, exercise programs and equipment or weight loss programs) Insurance Premiums (e.g., replacement insurance for contact lenses or other health plan policies) Other: Shipping & handling charges, missed appointment, late payment or interest charges

8 Group 1 Automotive Employee Benefits & Policies Flexible Spending Accounts 7 Flexible Spending Account Plan Worksheet This worksheet will help you think through what your expected out-of-pocket costs are for the coming calendar year. That way, you can determine whether the Flexible Spending Account Plan makes sense for you. Ask yourself What do we spend each year in healthcare costs that are not reimbursed by insurance? Do we satisfy our individual deductibles every year? How many copays do we typically pay? Does anyone need new eyeglasses this year? Would I like to get RK or Lasik surgery? What expenses are not covered by insurance that can be reimbursed by flex? In each category, remember to include out-of-pocket costs for yourself and other family members. HEALTH CARE COSTS Items are listed below that will help you determine your out-of-pocket costs for the coming year. It may help you to also refer to the partial guide to allowable medical expenses, included with your enrollment materials. Estimated Annual Health Care Account Out-of-Pocket Expenses Medical (services & supplies, preventive care, hearing expenses) Copays $ Deductible Coinsurance Prescription Drugs (including prescription vitamins & birth control pills) Over-the-Counter Medicines Dental (preventive, x-rays, fillings, crowns, dentures, periodontal services) Copays Deductible Coinsurance Braces, Appliances Vision (exams, prescription glasses & contact lenses, supplies) Copays Deductible Coinsurance Corrective Surgery (RK & Lasik) Other Expenses Total Health Care Out-of-Pocket Expenses $ Per Year DEPENDENT CARE COSTS As you estimate annual dependent care costs for the coming year, also take into account the time during which you will not need dependent care (vacation, spring break, etc.). Dependent Care Account Estimated Annual Out-of-Pocket Expenses $ Total Dependent Care Out-of-Pocket Expenses $ Per Year

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