Spokane Public Schools Flexible Spending Account (FSA) Online Enrollment Open Enrollment Period: 11/03/ /31/2014

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1 Spokane Public Schools Flexible Spending Account (FSA) Online Enrollment Open Enrollment Period: 11/03/ /31/2014 Follow these 3 easy steps to enroll into your FSA: 1. Visit and log-in to your account A. If new to your employer s Plan, contact Rehn & Associates at INCENT@rehnonline.com 2. From the homepage, click on Enroll Now at the top of the page. 3. Click the Plan Description links to read about each plan. Please note; the list of your eligible plans might be different than the sample below. After you have read the information, click on Begin Your Enrollment Now.

2 It s your money. Now, you can keep more of it! A Healthcare flexible spending account (FSA) can help you pay for eligible healthcare expenses that aren t covered by your health plan. And using an FSA is like getting a discount because you pay for those expenses with money that has not been taxed. It s a great way to keep more of the money you ve earned. An FSA Covers what your health insurance doesn t like deductibles, co-pays, chiropractic care and other eligible expenses Saves you money of the health care you need like dental, vision, prescription drugs and more Makes reimbursement for medical expenses easy the full amount you set aside is available on the first day of the Plan Year. And Now If you don t use it you can roll over up to $500 of unused funds to the next Plan Year! That s Real Savings. Real Simple. Contact your human resources representative for more information.

3 Section 125 Flexible Spending Account Health Care Reimbursement Dependent Care Reimbursement Your Employer sponsors a Flexible Spending Account to allow you to pay for your eligible out of pocket Health Care & Dependent Care Expenses with TAX FREE dollars! With an FSA, you elect to have your annual contribution deducted from your paycheck each pay period, in equal installments throughout the year, until you reach the yearly maximum you have specified. The amount of your pay that goes into an FSA will not count as taxable income, so you will have immediate tax savings. FSA dollars can be used during the plan year to pay for qualified expenses and services. A Healthcare FSA allows reimbursement of qualifying out-of-pocket medical expenses. A Dependent Care FSA allows reimbursement of dependent care expenses, such as daycare, incurred by eligible dependents. Advantages of the FSA plan Let s take a look at two typical examples. While everyone is different, they all enjoy big tax savings. YOUNG COUPLE WITH TWO CHILDREN SINGLE INDIVIDUAL Office Visit Co-pays $ Office Visit Co-Pays $ First Aid Kit $50.00 Prescription Drug Co-Pays $ Chiropractic Visits $ Dental Work $ Orthodontia $2, Eye Exams $80.00 Glasses & Contacts $ Medical Deductible $1, After School & Summer Child Care $5, Massage Therapy $ Total Budgeted Expenses $7, Total Budgeted Expenses $2, Estimated Annual Tax Savings* of $2, Estimated Annual Tax Savings* of $ * Annual savings are determined by multiplying your total budgeted expenses by the percentage of payroll taxes you pay. In these examples, the savings is based on a 30% tax rate.

4 Frequently Asked Questions When is the money available for reimbursement? Under the Health Care Reimbursement Plan, the entire election amount is available for reimbursement at the start of the Plan Year. For the Dependent Care Reimbursement Plan, you are able to be reimbursed up to the account balance available at the time the claim is submitted. What if I don t use all the money I set aside? If you do have funds remaining after the Plan Year and subsequent run-out period have ended, they could be forfeited per IRS regulation. Please check your Summary Plan Description for more information. How am I reimbursed for my expenses? Submit a claim through the Consumer Portal ( or through the Mobile App. If the claim is valid, you will receive payment within a short period of time via check or direct deposit. Can I make changes to or revoke my election during the plan year? Generally, you cannot make changes during the Plan Year. However, you may be able to make a change if you experience a Change in Status event such as a change in marital status, change in the number of dependents or a change in employment. If I participate in a Health Savings Account (HSA) can I still participate in the Health Care FSA Plan? No, you may not participate in BOTH a full-service Health Care FSA and HSA Plan due to regulations regarding first dollar coverage. However, if your employer offers a Limited Purpose FSA Plan (used for dental, vision and possibly some preventative care expenses only) you can make tax-free contributions to both plans. Are there any negatives I should know about? Yes. Because you are not paying social security taxes on what you set aside, your social security benefits may be slightly reduced. Please take a moment and think about this simple way to prepare for expenses incurred by yourself, your spouse and your dependent(s) not covered by your employer s health insurance plan. The Flexible Spending Account (FSA) allows you to use pre-tax dollars for items like office visit co-pays, orthodontia expenses, prescription drugs, dental care, eye care, LASIK, medical supplies, chiropractic care, massage therapy and much more. Website: Mailing: Physical: PO Box 5433 Spokane, WA North Post Street Spokane, WA INCENT@rehnonline.com Phone: (509) Toll Free: (800) Fax: (509)

5 Benny The Prepaid Benefits Card By Rehn & Associates With the card, you don t have to pay cash up front, file claims and wait for reimbursement! Accessing your account is EASY a simple swipe of the Card makes it hassle free AUTOMATIC funds are immediately transferred from your INCENT Plan account when you swipe your card CONVENIENT there are no manual claim forms to submit (however, documentation may be required) SIMPLE TO TRACK your current balance is available 24/7 through the Mobile App or How to Use Your Prepaid Benefits Card SWIPE & GO: Swipe your Benny Prepaid Benefits Card for the FSA-eligible items. FUNDS COME DIRECTLY FROM YOUR FSA: Participating merchant systems will allow the cost of the FSA-eligible items to be deducted from your FSA balance REDUCE PAPER: No receipts will be needed for standard co-pays for office visits and prescription drugs

6 Getting started is easy!!! 1. You ll automatically receive TWO cards in the mail, along with important information on using the cards 2. ACTIVATE and SIGN your cards! Each eligible user signs their own name 3. Start using your card Here are some Card basics to remember: MANUAL CLAIMS ARE STILL ACCEPTED! If the provider doesn t accept the Benny Prepaid Card, simply submit the claim via your Mobile App or through your Consumer Portal at REMEMBER SAVE, SAVE, SAVE! All itemized statements or receipts showing (1) the date of service (2) the service rendered (3) the provider name (4) the amount due. We may contact you to submit this information for certain transactions. FOR BALANCE INFORMATION: Visit or use your Mobile App.

7 Want to check your healthcare account balances and submit receipts anywhere, anytime? THERE S AN APP FOR THAT! The INCENT Plan from Rehn & Associates offers you the ability to easily and securely access your healthcare spending accounts. You can view account balances and detail, submit healthcare account claims, and capture and upload pictures of your receipts anytime, anywhere on any iphone, Android or tablet device. You can also sign up to receive account alerts via text message. But wait, there s more to it... Check current health care account balances View account activity and receive alerts via text message View transaction details File new claims with receipt images Review expense information Submit health care claims and upload receipts using the mobile device s camera Manage expense receipts Promptly file claims for their reimbursement accounts Get started with the INCENT Plan Mobile App in Minutes Simply download the INCENT Plan Mobile App for your Android or iphone (also compatible with ipad and ipod touch ) and log in using the same password you use to access the consumer portal. The INCENT Plan Mobile app provides you with seamless account access since it is an extension of the Consumer Portal and doesn t require you to setup any additional credentials. Now by using your smartphone you can assess your reimbursement account balances, and you ll know how much money you have available to spend on qualified medical expenses at the time of purchase. Rehn & Associates INCENT Plan Phone: (509) Toll Free: (800) INCENT@rehnonline.com

8 ELIGIBLE EXPENSES: ELIGIBLE EXPENSES (LIST NOT ALL INCLUSIVE) Acupuncture Eyeglasses (prescribed) Orthopedic Devices Alcoholism Treatment Eye Examination Fees Osteopath Fees Ambulance Eye Surgery (cataracts, LASIK, etc.) Oxygen Artificial Limbs/Teeth First Aid Supplies Periodontist Fees Birth Control Products Gastric Bypass Surgery Physical Therapy Chiropractors Health Monitors Pill Boxes Christian Science Practitioner s Fees Hearing Devices and Batteries Podiatrist Fees Cholesterol Tests and Monitors Heat Wraps Prescription Drugs Contact Lenses and Solution Home Blood Tests Psychiatric Care Co-Payments Home Drug Tests Psychologist & Psychiatrist Fees Cost for Mental Illness Confinement Home Health Care Quit Smoking Programs and Patches Deductibles Insulin Radiology Dental Fees (medically necessary) Laboratory Fees Routine Physicals Dentures Medicine Dropper/Spoon Rx drug supplies (syringes, needles, etc.) Denture Adhesives Motion Sickness Devices Smoking Cessation Programs Diabetic Supplies Oral Surgery Speech Therapy Diagnostic Fees Orthodontia Thermometers Durable Medical Equipment Office Visits Travel to Doctor/Healthcare Facility Endodontic Fees Obstetrics & Fertility X-Rays & MRI ITEMS REQUIRING A PHYSICIAN S LETTER OF MEDICAL NECESSITY AND/OR PRESCRIPTION: Acne Medication Exercise Equipment Pain Relievers Allergy and Sinus Medication First Aid Creams Personal Trainer Antacids Allergy and Sinus Medication Reconstructive Surgery in Connection Anti-Itch Medications Hormone Therapy with Birth Defects, Disease or Accident Antiseptics Hypnotism Sleeping Aids Bedpans & Ring Cushions Laxatives Special Schools for Disabled Children Bronchial Asthma Inhalers Lice Treatment Wart Removers Bunion and Blister Treatments Massages Weight Loss Programs and Fees Cold Sore Medication Massagers Pertaining to a Specific Disease Cough, Flu and Cold Remedies Nausea Medication Wigs for Hair Loss caused by Disease Decongestants Nasal Spray Vaporizers/Humidifiers Ear Wax Removal Drops Nasal Strips & Snore Relief Vitamins, Minerals and Supplements HEALTHCARE EXPENSES THAT DO NOT QUALIFY FOR REIMBURSEMENT: Aromatherapy Dental Bleaching Insurance Premiums Baby Bottles and Cups Family & Marriage Counseling Baby Oils Feminine Hygiene Products Prescription Drugs from another Country Baby Wipes Floss Sunglasses (non-prescription) Breast Enhancement System Hair Restoration Toothbrushes and Toothpaste Cosmetic Surgery & Procedures Health Club or Gym Memberships DEPENDENT CARE ELIGIBLE EXPENSES: After School Camp Daycare (Child & Adult) Pre-School Tuition Adult Caregiver Nanny Summer Camp (not overnight) LIST SUBJECT TO CHANGE WITHOUT NOTIFICATION

9 REIMBURSEMENT PLAN ESTIMATING WORKSHEET DEDUCTIBLES & CO-PAYS: ESTIMATED ANNUAL EXPENSE: Medical Plan Deductibles: $ Dental Plan Deductibles: $ Vision Plan Deductibles: $ Office Visit Co-pays: $ Prescription Drug Co-pays: $ Dental / Vision Co-pays: $ EXPENSES NOT FULLY COVERED BY INSURANCE: Physician s Services / Office Visits: $ Surgery (must be medically necessary): $ Prescription Drugs: $ Diabetic Supplies: $ Psychiatrists, Psychologists: $ Physical or Speech Therapy: $ Hearing Care (hearing aids, batteries, etc.): $ Chiropractic: $ Massage Therapy: $ Acupuncture: $ DENTAL, VISION & OTHER EXPENSES: Major & Basic (fillings, root canals, crowns, etc.): $ Dentures: $ Orthodontia: $ Glasses: $ Contact Lenses: $ Contact Lens Solution: $ LASIK Eye Surgery: $ Other Eligible Expenses (see list on reverse side): $ TOTAL ESTIMATED ANNUAL EXPENSES: $ DIVIDE BY NUMBER OF ANNUAL PAY PERIODS: AMOUNT DEDUCTED PER PAY PERIOD: $