Flexible Spending Accounts (FSAs)

Transcription

1 Flexible Spending Accounts (FSAs) The Campbell Soup Company Flexible Spending Accounts (FSAs) can be a valuable benefit to you because they provide you the option to pay for certain eligible healthcare and dependent care expenses on a before-tax basis. Aetna is the claims administrator for the FSAs. Additional Important Information Be sure to read the About This Guide and Plan Administration sections for more important details about the plan and this description. Campbell offers the following FSA options: Healthcare Flexible Spending Account (Healthcare FSA) Dependent Care Flexible Spending Account (Dependent Care FSA) This section describes the FSAs that are available to you and provides information on how the FSAs work, including how and when expenses are paid. Reservation of Rights Campbell reserves the right to amend, modify, reduce or curtail any aspect of any benefit under the plan, or terminate this plan at any time for any reason. The plan does not provide a vested benefit. In addition, Campbell reserves the right to amend any of the plans, programs and arrangements described in Your Campbell Benefits (including changing the method of providing benefits and curtailing or reducing future benefits) or to terminate at any time for any reason, any or all of the plans, programs and arrangements herein described. Neither Your Campbell Benefits nor the benefits described create a contract of employment or a guarantee of employment between Campbell and any employee. Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 229

2 In This Section See Page At a Glance FSA Participation Eligibility Cost of Coverage How to Enroll Enrolling When First Eligible Enrolling During Annual Enrollment Making Mid-Year Enrollment Changes If You Do Not Enroll When Participation Begins When Participation Ends If You Go Out on Leave How the FSAs Work Your FSA Options The Tax Advantage Use-It-or-Lose-It Rule The Healthcare FSA Federal Income Tax Deduction The Dependent Care FSA Federal Income Tax Credit Eligible Expenses Receiving Reimbursement from the FSAs Receiving Your Reimbursement Appealing Claims Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

3 At a Glance Healthcare FSA Your Choices You can contribute between $120 and $2,500 a year on a before-tax basis to pay for eligible, out-of-pocket healthcare expenses. Special Use- It-or-Lose- It Rules FSA Participation Dependent Care FSA You can contribute between $120 and $5,000 a year ($2,500 if married and filing separately) on a before-tax basis to pay for eligible dependent care expenses. If your spouse also contributes to a Dependent Care FSA, the combined annual maximum amount the two of you can contribute is $5,000. Contributions are subject to certain IRS limits with respect to highly compensated employees. With both accounts, you risk losing any remaining account balance if you don t use it for eligible expenses incurred during the plan year (January 1-December 31). You must submit eligible claims by March 31 following the end of the plan year. The healthcare account is separate from the dependent care account. You may choose to participate in one, or both. You cannot move money from one account to the other. This section explains who is eligible to participate in the Campbell FSAs, and how and when to enroll. Eligibility If you are a salaried employee regularly scheduled to work at least 20 hours per week, you are eligible to participate in the Campbell FSAs on your first day of employment. If you are a hourly employee regularly scheduled to work at least 20 hours per week, you are eligible to participate in the Campbell FSAs on the first day following 90 days from your date of hire. If you are a Pepperidge Farm Retail Sales employee, you must be regularly scheduled to work 30 hours per week and you are eligible to participate in the Campbell FSAs on the first day following 90 days from your date of hire. You are not eligible to participate in the Campbell FSAs if you are: An employee who is regularly scheduled to work less than 20 hours per week, or if you are a Pepperidge Farm Retail Sales hourly employee regularly scheduled to work less than 30 hours per week. An employee of a leasing company or temporary employment agency; or An individual who performs services for Campbell as an independent contractor, consultant, or other designation, irrespective of whether such individual is treated as an employee under common-law employment principles. Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 231

4 Your Regularly Scheduled Work Week For benefits eligibility purposes, your regularly scheduled work week is based on your regular work schedule, not the actual hours you work. If your regularly scheduled work week changes, your eligibility to participate in the FSA may change. Cost of Coverage You must contribute to the FSAs to participate. Your cost depends on the annual amount you elect to contribute to the Healthcare FSA and/or Dependent Care FSA. You pay the full cost of coverage under the FSAs through regular payroll contributions, which are made on a before-tax basis. Your before-tax contributions to FSAs do not affect your other pay-related benefits at Campbell. Limits on Contributions for Highly Compensated Employees Internal Revenue Service (IRS) rules impose limits on contributions to the Dependent Care FSA in certain situations that involve highly paid employees. These rules help ensure that the plan doesn t unfairly favor highly compensated employees. As a result, it may be necessary to significantly reduce contributions for some participants under these rules. You ll be notified if you re affected. In addition, IRS limits the maximum contribution you can make to a Dependent Care FSA to the lesser of your or your spouse s earnings. If your spouse is a full-time student or disabled and incapable of self-care, for purposes of the IRS limit, your spouse will have a presumed income of $250 per month (up to $3,000 per year) in If you have two or more qualified dependents, the presumed income is $500 per month (up to $6,000 per year) in Consequently, an employee with one child who requires care while a spouse attends school full-time for nine months of the year would be limited to annual contributions of $2,250. Keep in mind that even if your spouse s assumed income is $6,000 for the year, you are still subject to the $5,000 per year maximum contribution. How to Enroll You may enroll in the Healthcare FSA and/or the Dependent Care FSA: When you re first eligible; Upon a mid-year qualifying event election change; or During annual enrollment. Please Note A deduction for the FSAs contributions cannot be taken and no contribution will be made in any pay period in which your compensation after taxes, adjustments, and other plan contributions does not cover the full deduction amount you elected during the annual enrollment period or as a result of a subsequent qualified status change. Determining Your FSA Contribution Amount Plan carefully because you cannot change the amount of your contribution to the Healthcare FSA or the Dependent Care FSA during the year, except in limited circumstances as determined by the Plan in accordance with IRS guidelines. You may change your contribution amounts during the year only if you have a qualified status change. Please see Making Mid- Year Enrollment Changes on page 234 for more information. If you do not spend all the money in your account for eligible expenses incurred during the plan year (January 1 - December 31), any unused balance cannot be returned to you or carried forward for use during the following year. Unused balances left in your FSAs are forfeited. See Use-It-or- Lose-It Rule on page 238 for more information. 232 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

5 Enrolling When First Eligible If you are a salaried employee, you will receive your enrollment kit within two weeks after you are hired. If you are a hourly employee, you will receive your kit one month before you become eligible. You will have 30 days from the date on your Enrollment Worksheet to enroll. If you don t enroll and make choices about your FSA options within this 30-day period, you will not participate in the FSAs for the remainder of the plan year. You will not be able to change your participation until the next annual enrollment period. However, you may have an additional enrollment opportunity if you have a qualified status change. (See Making Mid-Year Enrollment Changes on page 234 for more information.) Enrolling for Coverage You can enroll in your Campbell benefits program online. Visit Campbell Benefits Center at to research the plan options available to you. On your first visit, use the following information to login: User ID: Your Social Security number Password: Your month and day of birth (mmdd) Once logged in, you will be asked to set up: A new User ID and Password, and A security question in case you forget your password in the future. If you don t have access to a computer, you may call a Campbell Benefits Center representative at , Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Standard Time. Generally, your elections remain in effect for the entire plan year (January 1 through December 31), unless you experience a qualified status change. (See Making Mid-Year Enrollment Changes on page 234 for details.) Enrolling During Annual Enrollment Each year during the fall, Campbell holds annual enrollment. During this period, you can change your options for the coming plan year. Elections made during annual enrollment take effect on the following January 1 and remain in effect through December 31 of that same year. You need to enroll each year if you want to participate in an FSA. If you don t enroll, you will not be able to participate in the FSA. It is important that you review the options available to you along with any changes that may have been made so that you can choose the option that best meets your needs. After you enroll, review your Confirmation of Enrollment (COE) statement carefully to make sure it accurately shows the elections you made. You may not change your elections during the year unless you experience a qualified status change. Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 233

6 Making Mid-Year Enrollment Changes The coverage you elect under the FSA plan will remain in effect from January 1 (or the date you began participation) through December 31. Generally, you can make changes only during the annual enrollment period; benefit elections made during the annual enrollment period are effective January 1 of the following year. However, because your needs may change when you experience certain life events, you may be allowed to make mid-year enrollment changes in certain situations in accordance with the IRC and as permitted by the plan administrator. Qualified Status Change A qualified status change is an event that may allow you to make certain mid-year changes to your healthcare coverage, including your FSA participation. In general, the changes you may make must be due to and consistent with your qualified change in status, except for changes due to HIPAA and/or Medicare/CHIP enrollment (see the Healthcare Plan Participation section of this Guide for more information). To satisfy the federally required consistency rule, your qualified change in status and corresponding change in coverage must meet both of the following requirements. Effect on eligibility. For the Healthcare FSA, the qualified change in status must affect your eligibility, your eligible spouse s eligibility, or your eligible dependent child s eligibility for coverage under an employer s plan (including plans of other employers). For the Dependent Care FSA, the qualified change in status must affect the amount of dependent care expenses eligible for reimbursement. For example, if your child reaches age 13, his or her dependent care expenses are no longer eligible for reimbursement. Corresponding change. The change must correspond with the qualified change in status. For example, if you have a baby and need to pay for child care, you may enroll for or increase contributions to a Dependent Care FSA, but you may not decrease your contributions. Under the FSA plan, qualified status changes are as follows: Marriage, divorce, legal separation or annulment; Birth or adoption (or placement for adoption) of a child; A child ceases to be an eligible dependent; You or your spouse gain or lose group coverage; A change in your employment status, or the employment status of your spouse or dependent; You have a change in dependent care providers or dependent care provider fees (applies to Dependent Care FSA only; does not apply to Healthcare FSA); Death of a family member; Generally, domestic partners are not considered eligible dependents for the purposes of FSAs, unless they are qualified as tax qualified dependents. Federal law requires that FSAs limit the payment of expenses to those expenses associated with your tax qualified dependents. 234 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

7 You move into or out of an HMO service area (applies to the Healthcare FSA only; does not apply to the Dependent Care FSA); or You or your spouse takes an unpaid leave of absence pursuant to the Family and Medical Leave Act (FMLA). How to Make Changes You have 31 days from the date of a qualified status change to enroll in or make a coverage change. If you don t make changes within this 31-day period, you can t enroll in or make changes to the FSA coverage until the next annual enrollment period. To make a change, visit Campbell Benefits Center at or call Provided you make your change within 31 days of the qualified status change, your changes will take effect as of the date of the qualifying event. You may only decrease your Healthcare FSA contributions to the greater of: The amount you have already contributed at the time you request the change; The amount already paid to you; The $120 minimum (if you continue participation in the FSA); or $0 (if you discontinue participation in the FSA). To meet IRS regulations and plan requirements, Campbell reserves the right at any time to request written documentation of any event and/or to determine the effective date of the change. The plan administrator also will determine whether a requested change is due to an allowable event during the year and satisfies the appropriate rules. If You Do Not Enroll Changes Must Be Consistent with Your Change in Status Keep in mind that most of the changes you make to your coverage must be consistent with the change in your status. If You: Are a Current Participant in the Healthcare FSA, the Dependent Care FSA or both Are a Newly Hired or Newly Eligible Employee Have a Qualified Status Change What Happens If You Do Not Enroll: If you re already participating in an FSA and do not reenroll in that FSA during the annual enrollment period, you will not participate in the FSA in the new plan year. You will not be able to change your participation until the next annual enrollment period. However, you may have an additional enrollment opportunity if you have a qualified status change. (See Making Mid-Year Enrollment Changes on page 234 for more information.) If you re a new hire or newly eligible employee and do not enroll within the designated 30-day period, you will not participate in the FSA for the remainder of the plan year. See Enrolling When First Eligible on page 233 for more information. If you have a qualified status change that allows you to make a change mid-year and you do not enroll within the designated 31-day eligibility period, you will have to wait until the next annual enrollment period to make any changes. Please see Making Mid-Year Enrollment Changes on page 234 for more information. Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 235

8 When Participation Begins If You: Are a Current Participant in the FSA Are a Newly Hired or Newly Eligible Employee Have a Qualified Status Change When Participation Begins: The coverage you elect during the annual enrollment period takes effect at the beginning of the following plan year (January 1). The coverage you elect as a new hire, or newly eligible employee takes effect as follows: If you are a salaried eligible employee, coverage begins on your date of hire. If you are a hourly eligible employee, coverage begins on the first day following 90 days from your date of hire. You pay the full cost of coverage under the FSAs through regular payroll contributions. The amount you elect will be deducted from your pay in equal installments through the remainder of the year. For example, if you are hired mid-year and elect to contribute $2,500 to the Healthcare FSA, the total $2,500 will be deducted from your pay over the remainder of the year. For example if your contributions begin mid-year and there are 10 remaining pay periods in the year, the contribution deducted each pay period will be $250. The coverage you elect as a result of a qualified status change (such as marriage, divorce, or the birth or adoption of a child, etc.) will take effect as of the day of the qualifying event, if you have already met the plan s eligibility requirements and if you make any eligible changes through Campbell Benefits Center within 31 days of the qualifying event. If you miss the 31-day deadline, you will have to wait until the next annual enrollment period to make any changes. When Participation Ends Generally, your participation under FSAs will end if: Your employment with Campbell ends (whether voluntarily or involuntarily); You no longer meet the eligibility requirements; You stop making required contributions; You choose not to be re-enrolled for coverage in the following plan year; or Campbell discontinues the plan. You may be eligible to continue Healthcare FSA participation through COBRA. See the Healthcare Plan Participation section of this Guide for more information. 236 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

9 If You Go Out on Leave If you go out on an unpaid leave of absence under the FMLA, take a military leave to serve in the U.S. armed forces, or your coverage otherwise ends, please see If You Go Out On Leave and COBRA in the Healthcare Plan Participation section for information about your rights. How the FSAs Work FSAs offer you a convenient way to pay for eligible expenses on a before-tax basis. If you elect to make contributions to a Healthcare FSA or a Dependent Care FSA, these contributions are deducted from your pay on a before-tax basis. Then when eligible expenses are incurred by you and/or an eligible dependent, these expenses can be paid from your account. Your FSA Options There are two FSA options under the Campbell plan: The Healthcare FSA: for your eligible out-of-pocket healthcare expenses, and The Dependent Care FSA: for your eligible child or elder care expenses that allow you (and you spouse, if you re married) work or attend school full-time. If you are eligible, you can participate in the Healthcare FSA, the Dependent Care FSA or both. See The Healthcare FSA on page 238 and The Dependent Care FSA on page 242 for additional information on how each account works. The Tax Advantage The ability to pay for eligible healthcare and/or dependent care expenses with before-tax dollars is the primary advantage of an FSA. The contributions you make to the FSA are deducted from your pay before taxes. As a result, your taxable income is reduced and you pay lower federal income taxes, Social Security taxes and in most cases (depending on the tax laws of your state and city) state and local taxes. The following example shows how paying for eligible expenses using before-tax dollars from an FSA can actually increase your after-tax income and save you money. Let s assume your annual income is $40,000, you re married, and you contribute $1,000 to your Healthcare FSA or Dependent Care FSA. If you use the FSAs If you don t use the FSAs Your annual income $40,000 $40,000 Eligible expenses paid -$1,000 $0 from your FSA Adjustable gross income $39,000 $40,000 Federal taxes -$4, $4,670 After-tax income $34, $35,330 Eligible expenses paid $0 -$1,000 with after-tax dollars Remaining $34, $34,330 after-tax income Tax savings $ $0 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 237

10 The above example is based on 2013 federal income tax rates, assuming the taxpayer is married, files a joint tax return, claims three exemptions, and takes the standard deduction. Social Security and Medicare taxes are based on a combined 7.65% tax rate. The impact on state income taxes is not included above. Please Note: In some states, state income taxes may apply to amounts contributed to a spending account. Effect on Social Security Benefits Your contributions to an FSA reduce your taxable income, which could result in a slight reduction in any future Social Security benefits you may be eligible to receive. Generally, your savings on current taxes under the FSA will be greater than any eventual reduction in Social Security benefits. For more information contact your local Social Security Administration office or go to Use-It-or-Lose-It Rule You have until March 31 of the year following the plan year (January 1 - December 31) to submit eligible claims for reimbursement from the FSAs incurred during the plan year. Because you contribute to the Healthcare and Dependent Care FSAs with before-tax dollars, there are specific guidelines about what happens to any remaining balances after these periods. Under the IRS, if you have a balance remaining in either the Healthcare FSA or Dependent Care FSA, after submitting all claims incurred during the eligible period, that balance will be forfeited. It s important that you plan carefully before you decide how much to contribute to the FSAs. For example, if you contribute $500 to the Healthcare FSA, and your eligible expenses incurred through the end of the year (and submitted by the required date) are just $450, then you would forfeit the remaining $50 in your Healthcare FSA. Forfeited contributions are used to offset plan administrative expenses. The Healthcare FSA You can contribute from a minimum of $120 up to a maximum of $2,500 a year on a before-tax basis to pay for eligible out-of-pocket healthcare expenses. How Eligible Expenses are Reimbursed Through the Healthcare FSA When you incur an eligible expense, you pay the expense out-ofpocket and submit a claim for reimbursement from your account. If you participate in an Aetna medical and/or dental option, some expenses may be submitted automatically for reimbursement through the streamlined claims submission feature. The total dollar amount of your annual contributions can be reimbursed for eligible expenses when these expenses are incurred, even if the money has not yet accumulated in your account. Use-It-or-Lose-It Under the IRS, if you have an unused balance remaining in either account at the end of the year, that balance will be forfeited. Check your account balance online at The Healthcare FSA Is Separate from the Dependent Care FSA You cannot transfer money from one account to the other. You cannot pay eligible healthcare expenses from the Dependent Care FSA; or eligible dependent care expenses from the Healthcare FSA. Please Note: If you fail to provide substantiation when requested by Aetna, you will be required to repay the amount of unsubstantiated/ineligible expense. If your spouse has a Healthcare FSA under the Campbell plan or with another employer, you cannot claim reimbursement for any expenses your spouse has claimed under the other plan. 238 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

11 Automatic Claim Submission If you enroll in an Aetna medical and/or dental option and you participate in the Healthcare FSA, your eligible claims will automatically be submitted to your healthcare account for reimbursement. You will still be required to submit paper claims for any eligible expenses incurred under non-aetna options (e.g., MetLife, Express Scripts, etc.) and for other eligible healthcare expenses. If you do not want auto-claim submission, you can make an opt-out request by calling Campbell Benefits Center at If you have a domestic partner enrolled in a medical or dental option who is not a tax dependent, you must call Campbell Benefits Center at to disable the automatic claim submission feature for Healthcare FSA reimbursement. Your Eligible Dependents For the purposes of the Healthcare FSA, your eligible dependents are only those individuals who are considered your dependents for federal income tax purposes, which generally include: Your legal spouse; Your dependent children; and Any other person considered your dependent for federal income tax purposes. Please Note: Domestic partners may not be considered tax dependents Federal law requires that FSAs limit the payment of expenses to those expenses that are associated with dependents you claim as exemptions on your federal income taxes. A domestic partner (and the children of a domestic partner) would only be considered eligible dependents under the FSA if you claim them as exemptions for federal income tax purposes. Under the Healthcare FSA, you can pay for eligible expenses on behalf of yourself or your eligible tax dependents even if the tax dependent is not covered under your medical or dental plan. Federal Income Tax Deduction The Healthcare FSA is an alternative to applying your out-of-pocket expenses toward a deduction on your federal income tax return. You cannot use the same expenses for both purposes. The chart below provides a brief comparison of the two alternative tax treatments under current tax law. Only you can determine which approach is best for you. Campbell cannot provide tax advice. You are advised to consult your own tax advisor. At-a-Glance Comparison Using the Healthcare FSA Using Expenses as a Tax Deduction Minimum Contribution $120/year Expenses must exceed 7.5% of your adjusted gross household income for the year Maximum Contribution $2,500/year None Impact on Income Contributions reduce taxable income Deduction amount excluded from adjusted gross income Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 239

12 Social Security Taxes Using the Healthcare FSA Contributions free from Social Security taxes Using Expenses as a Tax Deduction Deduction does not reduce Social Security taxes Itemization No need to itemize Must itemize Timing Must decide contribution amount before expenses incurred Deductions after all expenses incurred Forfeitures Forfeit unused contributions No risk of forfeiture Treatment of Your Healthcare FSA When You Leave Campbell If you leave Campbell before the end of the year, you can continue to be reimbursed for eligible expenses that were incurred up to your termination date as long as you submit the expenses by the applicable deadline. (Please see Receiving Reimbursement from the FSAs on page 246 for more information.) You can also elect to continue your Healthcare FSA through COBRA, but only until the end of the plan year in which you leave. Under COBRA continuation coverage you make your contributions on an after-tax basis and any eligible expenses incurred through the end of the plan year can be submitted for reimbursement. Please see the Healthcare Participation section for more information on COBRA continuation coverage. Eligible Expenses The IRS defines the expenses that are eligible for reimbursement under the Healthcare FSA. Please keep in mind that there are differences between expenses eligible under the federal healthcare tax deduction and those eligible under the Healthcare FSA. Eligible expenses include only those incurred when you were participating in the Healthcare FSA. For more information about eligible expenses, visit the IRS web site at and view IRS Publication 502, Medical and Dental Expenses. While certain sections of the Publication do not apply for purposes of the Healthcare FSA, you may find the section entitled What Medical Expenses Are Deductible helpful in that it lists certain expenses eligible for the federal healthcare tax deduction and which may be eligible for reimbursement from your Healthcare FSA. For example, expenses paid during the year are eligible for the tax deduction, but for purposes of your Healthcare FSA, you may be reimbursed generally only for expenses you incur during the year, no matter when you pay for them. When Expenses Are Incurred Expenses are generally incurred when the services are provided, not when you pay. Certain payments for orthodontia are an exception to this rule. If you are required to make advance payments in order to receive services, the advance payments that you make may be eligible for reimbursement. Please Note: Insurance contributions (i.e., premiums) are not reimbursable under the Healthcare FSA, although they are eligible for the federal healthcare tax deduction. Listed below are some of the more common expenses generally considered by the IRS to be deductible healthcare expenses for federal income tax purposes and therefore eligible for reimbursement through the Healthcare FSA. Please Note: the deductibility of these expenses is always subject to IRS review. Campbell can t guarantee that the same expenses will always be eligible (or ineligible) for reimbursement from the Healthcare FSA. If the IRS changes its ruling concerning the deductibility of a particular expense, Campbell will accept that ruling effective on the date prescribed by the IRS. Changes by the IRS to the tax-deductible status of an expense do not allow you to stop or start contributions to the Healthcare FSA. 240 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

13 Examples of Eligible Healthcare Expenses Here is a list of some of the more common healthcare expenses that are eligible for reimbursement under the Healthcare FSA. This list is subject to change at any time. Deductibles, coinsurance and copayments you pay under the medical, prescription drug and dental plans; Medical expenses including physical exams, doctors charges, hospital bills, laboratory fees, x-rays; Vision care expenses including routine eye exams, eyeglasses, frames, contact lenses and supplies, prescription sunglasses and LASIK surgery; Annual physicals; Dental expenses, including charges over the maximums; Hearing aids and other related expenses; Crutches and wheelchairs; Smoking cessation programs and related prescription drugs; Diagnostic instruments including blood pressure monitors, glucose monitor and related equipment and cholesterol test equipment; Over-the-counter drugs, with a prescription, as permitted under applicable law or regulation; Abortion, if legal where performed; Acupuncture; Ambulance service; Birth control pills; Breast pumps and supplies that assist lactation; Drugs requiring a doctor s written prescription that are not covered by insurance; Over-the-counter items as permitted under applicable law or regulation; Insulin (which may be reimbursed without a prescription); and Weight-loss programs, if prescribed by a physician to treat a diagnosed medical condition such as obesity, hypertension, or heart disease. Examples of Expenses that Are Not Eligible Here is a list of some of the more common expenses that are not eligible for reimbursement under Healthcare FSA. This list may change at any time based on IRS guidance. Cosmetic surgery procedures, unless necessary to eliminate a deformity related to a birth defect, a personal injury resulting from an accident or trauma or a disfiguring disease; Cosmetic dentistry; Doctor s charges or prescription drugs for cosmetic surgery; Expenses for recreation, health clubs and nutrition; Weight-loss programs unless prescribed by a physician for a specific medical condition; Qualified long-term care services; Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 241

14 Illegal operations or treatments; Nursing care for a normal, healthy baby; Over-the-counter drugs or items, without a prescription, unless specifically permitted under applicable law or regulation; Over-the-counter vitamins, supplements, cosmetic products or bottled water; Premiums paid for health, dental or long-term care; Premiums paid for Medicare; Premiums paid for policies that provide coverage for loss of earnings, accidental death, loss of limbs, loss of sight, etc.; Expenses reimbursed from other sources; Expenses claimed as itemized deductions on your federal tax return; and Expenses incurred when you were not participating in the Healthcare FSA. The Dependent Care FSA Generally you can contribute from a minimum of $120 up to a maximum of $5,000 a year per household on a before-tax basis for eligible child or elder care expenses that permit you (and your spouse, if you re married) to work or attend school full-time. The Dependent Care FSA is for eligible dependent care expenses only. The account is not for dependent healthcare expenses. Special Rules on Maximum Contributions There are IRS limits that may affect the amount you can contribute to your Dependent Care FSA: The amount of your contribution cannot be greater than your income or your spouse s income, whichever is lower. Therefore if your spouse earns less than $5,000 a year, you cannot contribute more than his/or her income. If your spouse is a full-time student, has no income or is incapable of self-care, his or her monthly income is assumed to be $250 if you have one eligible dependent or $500 if you have two or more eligible dependents. If you and your spouse both participate in a Dependent Care FSA, the most you can be reimbursed for dependent care expenses from both plans combined is $5,000 per year. If you are married, but file separate income tax returns, your maximum contribution amount is $2,500 a year. Limits for Highly Compensated Employees IRS rules impose limits on contributions to the dependent care FSA in certain situations that involve highly paid employees. These rules help ensure that the plan doesn t unfairly favor highly compensated employees. As a result, it may be necessary to significantly reduce contributions for some participants under those rules. You ll be notified if you re affected. If you participate in the dependent FSA, it is your responsibility to make sure that you remain in compliance with these IRS limits. You will be solely responsible in the event that your contributions to the Dependent Care FSA exceed these limits. 242 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

15 This section includes additional key points about how the Dependent Care FSA works: Federal Income Tax Credit The Dependent Care FSA will save you money by lowering the amount of your income subject to federal (and, in most cases, state and local) income taxes. However, the IRC prevents you from taking the federal dependent care tax credit on your personal income tax form for expenses already reimbursed through your FSA. Usually, if your family s annual taxable income is $15,000 or more, it s more tax-effective to have expenses reimbursed from the Dependent Care FSA than to take the tax credit. The maximum amount of dependent care expenses that can be used in calculating the federal dependent care tax credit is $3,000 in 2013 for one dependent and $6,000 in 2013 for two or more dependents. The Dependent Care FSA, however, allows you to contribute up to $5,000 on a before-tax basis, regardless of the number of dependents. In some cases, you may be able to use both the tax credit and Dependent Care FSA. However, any dependent care expenses otherwise eligible for the federal dependent care tax credit will be reduced, dollar-for-dollar, by the amounts you receive from your Dependent Care FSA. The following chart provides a brief comparison of the two alternative tax treatments under current tax law. Only you can determine which is better for you based on your personal financial situation. You may want to consult a tax advisor before making a decision. Campbell cannot provide you with tax advice. At-a-Glance Comparison Using the Dependent Care Using the Tax Credit FSA Minimum Contribution $120/year None Maximum Contribution $5,000/year ($2,500 if married filing separately) regardless of the number of eligible dependents Maximum expense applicable toward credit is $3,000 in 2013 for one dependent; $6,000 in 2013 for two or more dependents Impact Social Security Taxes Contributions reduce your taxable income; contribution amounts may be lowered to comply with certain IRS nondiscrimination tests Contributions are free from Social Security taxes A percentage of expenses is applied as credit against taxes owed Credit does not reduce Social Security taxes Itemization No need to itemize tax return Must itemize tax return Timing Must decide contribution amount before expenses incurred Credit is determined at end of year after expenses incurred Forfeitures Forfeit unused amounts No risk of forfeiture Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 243

16 How Eligible Expenses Are Reimbursed through the Dependent Care FSA When you incur an eligible expense, you must submit a claim for reimbursement from your account. You can only receive reimbursement for eligible expenses up to the amount that you have actually contributed to your account, and only for services that you have actually received prior to claiming reimbursement. As contributions are deducted from your pay throughout the year, you ll automatically be reimbursed for any outstanding expenses you ve submitted, up to the amount you have contributed. The IRS requires that your claim include a receipt with the name, address, telephone number, and taxpayer identification number (or Social Security number) of the caregiver. Without this information, the care generally won t qualify as an eligible Dependent Care FSA expense. Your Eligible Dependents For the purposes of the Dependent Care FSA, your eligible dependents generally include: Children under age 13 who live with you for more than half the year; or Any dependent age 13 or older (including your spouse) who is physically or mentally incapable of self-care, who lives with you for more than six months out of the year and whom you claim as a dependent for federal income tax purposes. If you are submitting claims for dependent care expenses incurred outside your home, your dependent must spend at least eight hours a day in your home. Your Spouse s Status. If you re married, you can participate in a Dependent Care FSA only if your spouse is: Employed, whether part time, full time, or self-employed; Looking for gainful employment; A full-time student; or Physically or mentally incapable of self-care and is the dependent for whom you re claiming expenses. Treatment of Your Dependent Care FSA If You Leave Campbell If you leave Campbell before the end of the year, you can continue to be reimbursed for expenses incurred up to your termination date, up to the balance in your account as long as you submit the expenses by the applicable deadline. (Please see Receiving Reimbursement from the FSAs on page 246 for more information.) IRS Publication 503 provides detailed information about eligible and ineligible expenses under the Dependent Care FSA. You can view this publication by logging on to via the Internet. Please Note: If you fail to provide substantiation when requested by Aetna, you will be required to repay the amount of the unsubstantiated/ineligible expense. Eligible Expenses The IRS defines the expenses that are eligible for reimbursement under the Dependent Care FSA. Generally, you can use the Dependent Care FSA for employment-related dependent care expenses. Eligible expenses include only those incurred when you were participating in the Dependent Care FSA. 244 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

17 For more information about eligible expenses, visit the Internal Revenue Service (IRS) web site at and view IRS Publication 503, Child and Dependent Care Expenses, which includes information on expenses which are deductible on your federal tax return and which may be eligible expenses for the Dependent Care FSA. Listed below are some of the more common expenses generally considered by the IRS to be deductible dependent care expenses for federal income tax purposes and therefore eligible for reimbursement through the Dependent Care FSA. Please Note: the deductibility of these expenses is always subject to IRS review; Campbell can t guarantee that the same expenses will always be eligible (or ineligible) for reimbursement from the Dependent Care FSA. If the IRS changes its ruling concerning the deductibility of a particular expense, Campbell will accept that ruling effective on the date prescribed by the IRS. Changes by the IRS to the tax-deductible status of an expense do not allow you to stop or start contributions to the Dependent Care FSA. Examples of Eligible Dependent Care Expenses Here is a list of some of the more common dependent care expenses that are eligible for reimbursement under the Dependent Care FSA. This list is subject to change at any time. Care at licensed nursery schools or day camps (excluding most expenses for grades kindergarten and above or overnight camps). To qualify, the school or center must comply with state and local laws and receive a fee for its services if it cares for seven or more children; Payment to a housekeeper who is primarily responsible for providing day care; Payment to someone who provides care in your home, as well as related taxes you pay on that person s behalf; Care provided at an adult day care facility (but not expenses for an overnight nursing home facility) for any eligible dependent; Day care provided by before-school or after-school programs; Day care provided inside or outside your home by anyone other than your spouse, a person you list as your dependent for income tax purposes, or your child under age 13; Household services related to the care of an eligible dependent who lives with you; and Any other qualified dependent care expense as defined by the IRC. Examples of Expenses that Are Not Eligible The following expenses are not eligible for reimbursement through the Dependent Care FSA: After-school care provided coincidentally with a program for which the primary purpose is education for example, an after-school religious training program; Care in unlicensed day care centers or care by providers who won t provide you with their taxpayer identification number or Social Security number; Care that s not needed for you to work for example, baby-sitting fees during non-working hours; Child care expenses that enable you or your spouse to do volunteer work; Education expenses for a child in kindergarten or above; Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 245

18 Expenses paid to one dependent you claim (or could claim) on your tax return to care for another dependent (for example, paying one child to care for a younger child) if the person you re paying is under age 19 or can be claimed as an exemption on your federal income tax return; Healthcare expenses for dependents (these are reimbursed through the Healthcare FSA not the Dependent Care FSA); Overnight camp expenses; Transportation expenses to or from a day care center; Amounts paid for the care of a person in a nursing home or convalescent facility; Otherwise eligible care that s not provided by an eligible provider; Items you claim as a credit for federal tax purposes; Expenses incurred when you were not participating in the Dependent Care FSA; Expenses you incur for a dependent that does not qualify as an eligible dependent; and Any other dependent care expenses that does not qualify under the Internal Revenue Code. Please Note: This list may change at any time based upon IRS guidance. Receiving Reimbursement from the FSAs Filing a Claim for Reimbursement When you have an eligible expense, you will need to pay for the expense out of pocket at the time of service, and submit a claim to Aetna under the following circumstances: You have the auto-claim submission feature and you incur a healthcare expense under a non-aetna option (e.g., MetLife, Express Scripts or a spouse s plan); You incur a healthcare expense under an Aetna option but have opted out of the autoclaim submission feature; or You have a claim under the Dependent Care FSA. To obtain a claim form, visit the Campbell Benefits Center website and click on Print Claim Forms. On the claim form, you will need to: Complete the employee section of the claim form; Fill in the expense information section; Itemize your expenses; Attach the appropriate receipts, statements, or Explanation of Benefits from your medical plan or insurance carrier (for healthcare claims) as appropriate; and Sign and date the form, and keep a copy for your records. Additionally, please note that the Dependent Care FSA requires that your receipt include the care provider s name, address, and taxpayer identification number (or Social Security number). Without this information, the care will not qualify as an eligible Dependent Care FSA expense. 246 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)

19 Where to Send Your Claim for Reimbursement Send your completed Healthcare FSA or Dependent Care FSA claim form and attached receipts to Aetna at the following address or fax number: Aetna FSA P.O. Box 4000 Richmond, KY Fax to: (1-888-AET-FLEX) You have until March 31 of the following year to submit a claim for reimbursement. If you are submitting your claim by mail, the postmark date must be March 31. Receiving Your Reimbursement Healthcare and Dependent Care FSA paper claims are processed daily by Aetna and are paid either through direct deposit or check. Visit and log onto Aetna Navigator to set up direct deposit, make changes and view your FSA account information. Appealing Claims If a claim under any of the FSAs is denied, either in whole or in part, you can appeal the denial by following the appropriate procedures described in the Plan Administration section of this Guide. Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees) 247

20 248 Salaried and Hourly Employees (excluding Napoleon and Paris Hourly Employees)