Family Care Spending Account

Transcription

1 Family Care Spending Account Summary Plan Description 208D 6/12 18

2 TABLE OF CONTENTS ABOUT THE FAMLY CARE SPENDING ACCOUNT PLAN... 3 BEFORE TAX BENEFIT... 3 ENROLLMENT... 4 ENROLLING IN THE FAMILY CARE SPENDING ACCOUNT PLAN... 4 ELIGIBILITY... 5 ELIGIBLE EMPLOYEES... 5 ELIGIBLE DEPENDENTS... 5 LEAVE OF ABSENCE (LOA)... 6 MILITARY AND FMLA LEAVE... 6 PROPER LEAVE OF ABSENCE PROCESSING... 6 CONTRIBUTIONS... 7 MINIMUM AND MAXIMUM CONTRIBUTION AMOUNTS... 7 DETERMINING YOUR CONTRIBUTION AMOUNT... 8 USE IT OR LOSE IT RULE... 8 HIGHLY COMPENSATED EMPLOYEES... 8 ABOUT YOUR COVERAGE... 8 WHEN YOUR COVERAGE IS EFFECTIVE... 8 WHEN YOU CAN CHANGE YOUR CONTRIBUTIONS... 9 CANCELING YOUR COVERAGE... 9 WHEN YOUR COVERAGE ENDS HOW THE FAMILY CARE SPENDING ACCOUNT WORKS BEFORE-TAX BENEFIT FAMILY CARE SPENDING ACCOUNT VS. FEDERAL TAX CREDIT FOR DEPENDENT CARE.. 11 REQUIRED CAREGIVER INFORMATION COVERED EXPENSES EXPENSES NOT COVERED BY THE PLAN CLAIMS AND REIMBURSEMENTS SUBMITTING CLAIM FORMS RECEIPTS ACCOUNT INFORMATION OVERPAYMENTS DIRECT DEPOSIT APPEALS ELIGIBILITY APPEALS CLAIMS APPEALS OTHER IMPORTANT PLAN INFORMATION YOUR ERISA RIGHTS PLAN ADMINISTRATION INFORMATION FUTURE OF THE PLAN NO CONTRACT OF EMPLOYMENT GOVERNING DOCUMENTS GLOSSARY OF TERMS FEDERAL TAX CREDIT FOR DEPENDENT CARE VS. FAMILY CARE SPENDING ACCOUNT WORKSHEET... 21

3 This booklet contains a summary of the Family Care Spending Account Plan (referred to as the Plan) sponsored by Sodexo, Inc. (referred to as the Company) and held in trust by the participants of the Plan. The Plan Administrator is the Corporate Benefits Department of Sodexo, Inc. All previously issued summary plan descriptions and summary of material modifications are obsolete. NOTA: Si usted tiene alguna pregunta con respecto a este folleto o al Plan, comuniquese con la persona encargada de los beneficios donde usted trabaja. Para pedir una copia de est librete en Espanol comuniquese al FOR MORE INFORMATION About this topic Contact Questions about specific situations Cigna General questions about the Plan Are Your Records Up-To-Date? Please contact your Human Resources representative or the person who handles your payroll whenever your personal information changes. This includes your name, marital status or Social Security number. To change your street address, go to > Employee Self Service, or call 877 PAYSDXO ( ). For more info ABOUT THE FAMILY CARE SPENDING ACCOUNT PLAN Each year, you can choose to contribute between $200 and $5,000 toward your Family Care Spending Account. For the first 40 weeks you are paid, money is deducted from your pay on a Before-Tax basis and is placed into your account to be used to reimburse you for out-of-pocket or non-reimbursable Dependent care expenses. Effective Jan. 1, 2013, your contributions to the Family Care Spending Accounts will be deducted from your pay on a Before-Tax basis over all 52 weeks of the Plan Year. The Family Care Spending Account is intended to cover costs for child and/or elder care and does not cover any medical or health care costs for your Dependents. BEFORE-TAX BENEFIT A Family Care Spending Account lets you set aside Before-Tax dollars from your pay to cover Dependent care expenses. If you normally incur out-of-pocket Dependent care expenses or are expecting to do so during the year, your Family Care Spending Account will allow you to pay for these expenses with Before-Tax dollars. The taxes you would otherwise have paid represent 3

4 your savings by using the Plan. Although this Plan is designed to provide a tax-saving advantage, you may want to consult a qualified tax advisor for specific advice. ENROLLMENT If you do not enroll in the Family Care Spending Account when your employment begins, you are newly eligible, or during Annual Enrollment, you cannot participate for that year. Even if you participated in the Family Care Spending Account during the previous Plan Year, you must re-enroll each year during Annual Enrollment in order to continue your coverage. You will not automatically be re-enrolled in the Family Care Spending Account if you do not elect to participate during Annual Enrollment. Effective Jan. 1, 2013, newly hired and newly eligible employees can enroll in the Family Care Spending Account through Oct. 31 of the current Plan Year. After that date, employees will be able to enroll for coverage for the next Plan Year during Annual Enrollment. Changes to Family Care Spending Account for 2013 Effective Jan. 1, 2013, your contributions to the Family Care Spending Account will be deducted from your pay on a Before-Tax basis over all 52 weeks of the Plan Year. Additionally, effective Jan. 1, 2013, newly hired and newly eligible employees can enroll in the Family Care Spending Account through October 31 st of the current Plan Year. After that date, employees will be able to enroll for coverage for the next Plan Year during Annual Enrollment. ENROLLING IN THE FAMILY CARE SPENDING ACCOUNT To enroll in the Family Care Spending Account Plan or make changes to your benefits, contact Sodexo Benefits. Each time you contact Sodexo Benefits, you will need to use your Social Security number (SSN) and Personal Identification Number (PIN). If you are eligible, you can contact Sodexo Benefits to: Enroll in the Family Care Spending Account Plan Cancel coverage Get answers to general questions about the Family Care Spending Account Plan Get answers to questions about most other Company sponsored plans There are 4 ways to contact Sodexo Benefits: By visiting the website By calling the toll-free number By calling the TDD (Telephone Device for the Deaf) line By calling the international line if you are out of the country

5 MAKING BENEFIT CHANGES If you need to Call within Change will take effect Change contribution amount 45 days of qualifying event On the Saturday following your change Cancel participation 60 days of qualifying event On the Friday following your change Your PIN Whenever you use your PIN to make benefit choices or changes through Sodexo Benefits, you are authorizing the Company to adjust your benefits and pay. Using your PIN is just the same as if you signed your name on a form, and you are accepting all terms and conditions of the plans in which you enroll. You are the only person who should use your PIN. Keep it in a safe place and do not share it with others. ELIGIBILITY ELIGIBLE EMPLOYEES You can participate in the Family Care Spending Account if it is offered at your unit. You must be either one of the following: A non-temporary, active salaried (class 1-4) employee A non-temporary, full-time hourly employee (class 6) working at least 30 hours per week (20 hours per week in Hawaii) for 6 or more weeks out of each quarter You must also have at least one eligible Dependent and fit into any of the following categories: You are a single parent or guardian You are married and have a working Spouse* Your Spouse is a full-time student for at least 5 months during the year while you are working Your Spouse is physically or mentally disabled You or your Spouse is pregnant and expecting to return to work (or school) following the child s birth** You are the non-custodial parent, with children you claim as Dependents on your IRS 1040 and you pay their day care expenses directly (not through child support) *See the Glossary of Terms for the definition of Spouse. Domestic Partners and their children are not considered eligible Dependents under the IRS regulations. **Because you may only sign up for the Family Care Spending Account when you are first eligible or during Annual Enrollment, you cannot wait until the child is born to enroll in the Plan. To participate in the Family Care Spending Account, you must enroll with a $5.00 minimum weekly contribution and later increase to the appropriate amount once day care has begun. ELIGIBLE DEPENDENTS People you can legally claim as Dependents on your federal income tax return are considered Dependents for the purposes of the Family Care Spending Account if they fit into any of the following categories: 5

6 Your children (natural, adopted, foster, half, step, and/or grand) under age 13. If your child will turn age 13 during the year, you may still claim expenses incurred before his 13th birthday. Parents or relatives unable to care for themselves who get at least half of their support from you and spend at least eight (8) hours a day in your home. Physically or mentally disabled Spouses or other Dependents who get at least half of their support from you and spend at least 8 hours a day in your home. Domestic Partners Not Eligible Under the Internal Revenue Code, domestic partners and their children are not considered eligible Dependents and are not eligible for Family Care Spending Account coverage. LEAVE OF ABSENCE (LOA) Deductions will stop during an unpaid Leave of Absence (LOA), including a Leave of Absence qualified under the Family and Medical Leave Act (FMLA). Your Leave of Absence will be considered unpaid if you are not receiving pay for vacation, personal leave, or sick leave. If you have money in your Family Care Spending Account when you go on an unpaid Leave of Absence, you will still be able to request reimbursement for expenses incurred before your leave began, up to the amount in your Family Care Spending Account. When you return to work, your remaining annual election amount will be recalculated and deducted from your pay incrementally over the remaining weeks in the 40 week period (52 weeks beginning Jan. 1, 2013) during which Family Care Spending Account contributions are taken from your pay. You can voluntarily cancel Family Care Spending Account contributions if you are on an unpaid Leave of Absence. However, unless your leave was a Military Leave or was qualified under FMLA, you will not be able to re-enroll in the Plan until the following Plan Year. MILITARY AND FMLA LEAVE Before you go on an authorized Leave of Absence covered by the Family and Medical Leave Act (FMLA) or a Military Leave of Absence, contact the person who handles benefits for your workplace for information on: Continuing your coverage Canceling your coverage Re-enrolling for coverage when you return to work at the end of your Military Leave, or at the end of your Family and Medical Leave, as applicable Contact the Benefits Answer Line at if you are considering a Military Leave of Absence or have general questions about a Leave of Absence. PROPER LEAVE OF ABSENCE PROCESSING Proper Leave of Absence processing can protect your employment status. Contact the person who handles your payroll if you are going to be away from work for any reason, regardless of 6 Collective Bargaining Certain employees subject to collective bargaining agreements are not eligible to participate in this Plan but may receive benefits in accordance with the applicable collective bargaining agreement.

7 the period of time. Request to be placed on an authorized leave if your reason for missing work qualifies under the Company Leave of Absence policy. Failure to follow these guidelines may result in termination of your employment. CONTRIBUTIONS Family Care Spending Account contributions are based on a 40-week period (effective Jan. 1, 2013, the amount you select will be deducted over all 52 weeks of the Plan Year). The amount on your pay statement should be: For employees paid weekly, your annual Family Care Spending Account election divided by 40 (52 beginning Jan. 1, 2013) For employees paid bi-weekly, your annual Family Care Spending Account election divided by 20 (26 beginning Jan. 1, 2013) Use your pay statement to verify that your contributions are correct. MINIMUM AND MAXIMUM CONTRIBUTION AMOUNTS Family Care Spending Account contributions are based on a 40-week period (52 weeks beginning Jan. 1, 2013). The minimum contribution is $5.00 per week. The maximum contribution depends on your marital status and tax-filing status as outlined below. The maximum contribution amount is your total annual Family Care Spending Account contribution election divided by 40 (52 beginning Jan. 1, 2013), but in no cases greater than $125 per week ($96 per week beginning Jan. 1, 2013). If you are single or file a joint tax return, the maximum amount you can put into your account during a Plan Year is the smallest of the following: $5,000 Your earned income Your Spouse s earned income* If you are married but file a separate return, the maximum amount you can put into your account during a Plan Year is the smallest of the following: $2,500 Your earned income Your Spouse s earned income* *A Spouse who is either a full-time student or disabled is deemed by the Internal Revenue Service to have a maximum earned income of $3,000 if he has one Dependent, or $6,000 if he has two or more Dependents. If Your Coverage Ends Prior to Completing 40 Weeks of Contributions Employees who have not completed their 40 weeks of Family Care Spending Account contributions (52 weeks effective Jan. 1, 2013) can only file claims for expenses that were incurred before the date their coverage ended. Employees who have completed their 40 weeks (52 weeks effective Jan. 1, 2013) of Family Care Spending Account contributions can file claims for expenses incurred throughout the entire Plan Year. You can only receive reimbursement for the amount you have contributed. 7

8 DETERMINING YOUR CONTRIBUTION AMOUNT When you set up your Family Care Spending Account, you must decide how much to put in your account each pay period. The amount you choose is automatically deducted from your base pay before Social Security (FICA), federal taxes, and in most cases, state and local income taxes are taken out. Contributing for the Full Year To determine how much to put in your account, take a look at how much you spent on eligible Dependent care expenses during the previous year. Next, consider how much you expect to spend during the coming Plan Year. If you are enrolling for a full year, divide that number by 40 (52 beginning Jan. 1, 2013) if you are paid weekly, or by 20 (26 beginning Jan. 1, 2013) if you are paid bi-weekly. You should estimate your expenses carefully because you forfeit any money remaining in your account at the end of the year. To help you estimate your expenses, use the worksheet available at Contributing for Part of the Year If you are a new employee and enrolling in the Family Care Spending Account after the Plan Year has begun on Jan. 1, remember to estimate what you expect to spend on Dependent care only through the remaining time in the Plan Year. Contributions will be deducted from your pay only through the remaining weeks in the 40-week period (52-weeks effective Jan. 1, 2013) during which Family Care Spending Account deductions are taken. Expenses incurred for Dependent care before you enrolled in Sodexo s Family Care Spending Account cannot be reimbursed. USE IT OR LOSE IT RULE Because of the tax advantages of the Family Care Spending Account, the IRS has set strict guidelines for any portion of your contributions that is not used. The amount you choose to contribute to the Family Care Spending Account should be your best estimate of expected eligible out-of-pocket expenses for the coming year. Any money remaining in your account at the end of the year is forfeited. However, reimbursement requests and receipts for the previous Plan Year will be processed if received by March 31 of the following Plan Year. You cannot carry it over into a new account for the next year, and the money cannot be returned to you. Any money remaining in your account will go into the Company s Family Care Spending Account Plan Trust where it will be used for Plan administration expenses. HIGHLY COMPENSATED EMPLOYEES If you are a Highly Compensated Employee, the law requires Family Care Spending Account contribution amounts to be limited in some cases. If you are affected, you will be notified by letter and your contributions will be adjusted. Of course, you may be able to apply the federal tax credit to a portion of your expenses. For more information, refer to IRS Tax Form 2441 and the Federal Tax Credit for Dependent Care vs. Family Care Spending Account Worksheet on page 20, or consult a qualified tax advisor. ABOUT YOUR COVERAGE WHEN YOUR COVERAGE IS EFFECTIVE Newly Hired Employees If you are a newly hired employee, your eligibility period and the date your coverage begins are listed on your personalized Fact Sheet. If you have enrolled within your eligibility period, coverage will begin on your coverage effective date. 8

9 Newly Eligible Employees If a change in employment status qualifies you for the Family Care Spending Account, your eligibility period is generally the 45 days following your status change. If you contact Sodexo Benefits within 45 days of your status change, your coverage will begin on the Saturday following the day you contact Sodexo Benefits. WHEN YOU CAN CHANGE YOUR CONTRIBUTIONS You cannot change your contribution amount until the next Annual Enrollment unless you have a qualifying event. The following qualifying events may allow you to change your Family Care Spending Account contribution amount: Birth, adoption or placement of a child for adoption Becoming the legal guardian of a child Loss of Spouse s job or benefits Marriage or divorce Change in status of your job or your Spouse s job from full-time to part-time or from parttime to full-time Spouse begins employment Spouse becomes a full-time student (proof of full-time student status is required) You or your Spouse takes an unpaid Leave of Absence Job transfer that involves a change in Dependent care arrangements Death of a Dependent or Spouse A change in your Dependent s eligibility that causes a loss of benefits A change in your (or your Spouse s) work schedule that causes a loss or gain of benefits A status change that affects the deductibility of Dependent care amounts under IRC Section 129, even if you do not otherwise have a qualifying event for example, if you are on a paid Leave of Absence and the expenses are no longer necessary for you to continue to work, you can cancel your Family Care Spending Account contributions Change in Coverage In all cases, the change in your coverage must be directly related to your qualifying event. For example, if your Dependent reaches age 13, resulting in a loss of eligibility, you may only reduce your contribution. A significant cost change to the Dependent care expense for example, if your provider (who is not related to you) increases day care costs, you may increase your Family Care Spending Account contributions If you have a qualifying event and want to increase or decrease your deductions, you need to fill out a Change in Family Status Form available at or by calling and submit it to Sodexo Benefits within 45 days of the event. Your payroll deductions will change with the next paycheck after your form has been processed. You may be asked to provide documentation to support your request. CANCELING YOUR COVERAGE You cannot voluntarily cancel your Family Care Spending Account before the end of the Plan Year unless you have a qualifying event. For a list of qualifying events, see When You Can Change Your Contributions on page 9. 9

10 WHEN YOUR COVERAGE ENDS Your and/or your Dependent s coverage under the Plan ends on the earliest of the following events: The last day of an authorized Leave of Absence if you have not returned to work, or on the day you notify your manager that you will not return to work, whichever is earlier The Friday coinciding with or following your request to cancel coverage because of a qualifying event The day your active employment ends (vacation or severance do not extend employment). Deductions will stop with your last paycheck. However, if you continue to receive a paycheck as a result of a severance package, deductions for the Family Care Spending Account may continue. Contact the Benefits Answer Line at for more information. The day you or your covered Dependent is no longer eligible for the Plan The last week-ending date for which your coverage is paid. The day the Plan is terminated. The day of your death. The date determined by the Plan Administrator, if you (or your covered Dependent) commit a fraudulent act for purposes of obtaining coverage or filing claims The day you retire. Ineligibility to Participate If for any reason other than those stated above, you become ineligible to participate in the Plan, your coverage ends on the date that you no longer meet the eligibility requirements previously described; this applies to your Dependents as well. HOW THE FAMILY CARE SPENDING ACCOUNT WORKS BEFORE-TAX BENEFIT When you participate in the Family Care Spending Account, your contributions are made before taxes are taken from your pay. Your Family Care Spending Account contributions are not subject to federal taxes. Because you are reimbursed from your Family Care Spending Account with money that has not been taxed, you are saving the amount you would have otherwise paid in taxes on your Family Care Spending Account contributions. Some states and localities may also treat contributions to the Plan as exempt from certain taxes. To see if Family Care Spending Account contributions are exempt from state taxes in your state, contact your qualified tax advisor. 10

11 FAMILY CARE SPENDING ACCOUNT VS. FEDERAL TAX CREDIT FOR DEPENDENT CARE The credit is a percentage, based on your adjusted gross income, of the amount of work-related Dependent care expenses you paid to a care provider. There is a maximum dollar limit of Dependent care expenses you can use for this credit. The amount of the maximum dollar limit depends on the taxable year and the number of qualifying Dependents. These dollar limits must be reduced by the amount of any Family Care Spending Account benefits you receive. To calculate your savings by comparing the Family Care Spending Account vs. the Federal Tax Credit for Dependent Care, use the Federal Tax Credit for Dependent Care vs. Family Care Spending Account Worksheet on page 20. Example of Family Care Spending Account (FCSA)Tax Benefit Assume an employee is paid $500 weekly (about $26,000 per year ). Her Dependent care costs are $100 per week or $5,200 per year. Her taxes include federal, Social Security, and state taxes with no exemptions. Without FCSA With FCSA Weekly salary $ $ Money put into FCSA per paycheck - $0 -$ Taxable income $ $ Taxes at 27.5%* -$ $ Take-home pay $ $ Dependent care expenses -$ From FCSA Remaining cash $ $ Extra cash $0 $27.50 By using her Family Care Spending Account, this employee saves $27.50 each week. Over the course of a year, that adds up to an extra $1,100. Your actual savings may differ depending on your income and filing status. *This is an approximation. Taxes normally would include FICA, state, local, and other applicable taxes. The Family Care Spending Account is not a tax credit, but it will reduce your taxes in most cases by allowing you to pay your Dependent care expenses on a Before-Tax basis. Which option is best for you depends on a number of factors, including your tax filing status and your number of eligible Dependents. Choosing the Family Care Spending Account or the Federal Tax Credit for Dependent Care is entirely your decision. It s a good idea to consult your tax advisor. You can use both the Family Care Spending Account and the Federal Tax Credit for Dependent Care as long as you do not claim the same Dependent care expenses twice. The expenses eligible for the federal tax credit for Dependent care are reduced dollar-for-dollar by the money you put into your Family Care Spending Account. REQUIRED CAREGIVER INFORMATION 11

12 The Internal Revenue Service (IRS) requires your Caregiver s Social Security number or tax ID number on your income tax return. This is true whether you use the Family Care Spending Account or the federal tax credit for Dependent care on you income tax form. Federal law requires the Caregiver provide his Social Security number or tax ID number, and reimbursements cannot be processed without it. You can get this number by giving your Caregiver IRS Form W-10, an IRS form available through an IRS office. Make sure your Caregiver fills it out and returns it to you. Internal Revenue Service (IRS) COVERED EXPENSES Eligible expenses are the expenses you have so that you (and your Spouse, if you re married) can work, look for work, or go to school full time. You may also be able to deduct additional Dependent care expenses if you are responsible for the care of Dependents who are incapacitated or children under 13 who qualify as your Dependents under the Internal Revenue Code. For more information on qualified Dependents, refer to Eligible Dependents on page 5. Because the Family Care Spending Account involves taxes, the IRS determines what qualifies as an eligible expense. Covered expenses include: Pre-school, day camp, care before or after school, and adult day care (but not nursing homes) Day care in your home or someone else s home as long as the Caregiver is not your Spouse, your Dependent, or your own child under the age of 19 A licensed child care or adult care center that meets all state and local regulations An unlicensed Day Care Center that cares for six or fewer children or adults A housekeeper whose duties include watching your child(ren) or disabled relatives while you work EXPENSES NOT COVERED BY THE PLAN Dependent care expenses that cannot be reimbursed through the Family Care Spending Account include: Unlicensed Day Care Centers that care for seven or more children or adults Care given by your Spouse or another person you claim as a Dependent for income tax purposes Overnight camp Babysitters for times you are not at work or at school Nursing homes or institutions if the disabled Dependent lives there Kindergarten or private school tuition 12

13 CLAIMS AND REIMBURSEMENT The money in your Family Care Spending Account must be used for expenses incurred during the Plan Year in which it was contributed to your account. Your reimbursement request must be received by March 31 of the following Plan Year in which the expenses were incurred. You will forfeit any money left in your account after March 31. SUBMITTING CLAIM FORMS Each time you want to be reimbursed from your Family Care Spending Account, submit a completed and signed Family Care Flexible Spending Account Reimbursement Request Form along with the documentation that proves the expenses you have paid. If your Reimbursement Request Form does not already include the Sodexo account number, use Please photocopy your receipts or tape them in the center of a plain piece of paper, and use only one receipt per page. You have three options for submitting your reimbursement request: Mail your Reimbursement Request Form and documentation to the address on the form Fax your Reimbursement Request Form and documentation to the fax number listed on the form Submit your reimbursement request online at Claim forms can be obtained by visiting You also can request a form by calling Cigna Customer Service at e Reimbursement Once your claims have been processed, Cigna will issue you a reimbursement check for your eligible expenses. Processing takes from 5-10 days. If your account doesn t have enough money to cover your claim, you don t have to resubmit the claim. You ll receive partial payment up to the amount available in your account. And you ll receive additional, automatic reimbursements as you make contributions, until the claim is paid in full. If you have multiple submissions before the end of the payment period, you will receive one reimbursement check for all requests submitted. You ll get an explanation of payment with each reimbursement check, as well as periodic account statements reporting your annual goal amount, the year-to-date contributions you ve made, the year-to-date reimbursements you ve received, and your current available account balance. RECEIPTS You must submit receipts with each Reimbursement Request Form. Handwritten receipts are acceptable as long as they re readable. Canceled checks (photocopy front and back) made out to the Caregiver are also acceptable. All receipts must clearly show the following information: Employee name Name of Dependent who received care Name of Caregiver Social Security number or tax identification number of Caregiver Signature of Caregiver if the receipt is handwritten Cost, dates and description of the services provided Submit only photocopies with your Reimbursement Request Form. Keep the original receipts. ACCOUNT INFORMATION You can check your Family Care Spending Account account balance at any time by: 13

14 Logging on to mycigna.com through your computer or mobile device and selecting Reimbursement Requests under the MANAGE CLAIMS & BALANCES tab Calling Cigna at OVERPAYMENTS If you receive reimbursements that exceed the amount to which you are entitled under the Plan, Cigna and the Plan Administrator may request the overpayment be returned, as necessary. DIRECT DEPOSIT If you want your reimbursements deposited directly into a savings or checking account, you need to enroll in Direct Deposit. You can enroll online at If you do not have Internet access, complete and mail a Direct Deposit Authorization Form available in your Family Care Spending Account handbook that was mailed to you or you may call Cigna Customer Service at to request a form. Cigna Customer Service If you have a concern regarding your request for reimbursement under your Family Care Spending Account, you can call Cigna at and explain your concern to one of the Customer Service representatives. You also can express that concern in writing. Cigna will do its best to resolve the matter on your initial contact. If Cigna needs more time to review or investigate your concern, they will get back to you as soon as possible, but in any case within 30 days. If you are not satisfied with the results of a coverage decision, you can start the appeals procedure. APPEALS You can file an appeal if you believe that: Your request for enrollment in the Family Care Spending Account has been administered improperly Your claim for Family Care Spending Account benefits has been denied incorrectly ELIGIBILITY APPEALS If you believe that your request to participate in the Family Care Spending Account has been administered incorrectly, you can request a review of the situation by sending a written appeal within 60 days of notification to: Sodexo Benefits Appeals Coordinator P.O. Box Jacksonville, FL A decision will be given by Sodexo Benefits within 10 business days providing all information needed to make the decision is provided by the claimant or other third party. If you are not satisfied with Sodexo Benefit s review, you are entitled to a final review by filing a written appeal with the Plan Administrator at: Sodexo, Inc. Benefits Operations 9801 Washingtonian Blvd., Suite 119 Gaithersburg, MD

15 You must make your written appeal to the Plan Administrator within 60 days of the date you receive the first level appeal denial letter from Sodexo Benefits. Detail your reasons for the appeal and include any copies of documents or records that support your position. A decision will be given by the Plan Administrator within 10 business days providing all information needed to make the decision is provided by the claimant or other third party. CLAIMS APPEALS If your claim for benefits from the Family Care Spending Account Plan is denied in whole or in part, you or your authorized representative may appeal the denial by requesting a review of the claim by Cigna. Your appeal must be in writing and be sent to the following address: Cigna National Appeals Organization P. O. Box Chattanooga, TN If you are unable or choose not to write, you may ask Cigna to register your appeal by telephone. Call Cigna at You must make your written appeal to Cigna within 365 days of the date you receive the initial denial letter or the date your claim is denied, whichever is earlier. Your appeal letter should include the reasons for the appeal and copies of any documents or records that support your position. Cigna will respond in writing within 30 days of receiving your appeal. If you are not satisfied with the review, you may request a second and final review of your claim. You must make your written appeal to Cigna within 365 days of the date you receive the letter denying your first appeal. Your letter requesting a second appeal should include the reasons for the appeal and copies of any documents or records that support your position, including any factors that you believe were not considered on the first appeal and any additional pertinent information that may have been received after you filed your first appeal. To submit a second appeal, follow the instructions outlined in the first appeal denial letter or submit your request to: Cigna National Appeals Organization P. O. Box Chattanooga, TN Cigna will review your claim and make a final decision. You will receive written notice of this decision within 30 days of the date Cigna received your appeal. Notice of Benefit Determination on Appeal Every notice of a determination on appeal will be provided in writing and, if an adverse determination, will include: information sufficient to identify the claim; the specific reason or reasons for the adverse determination reference to the specific Plan provisions on which the determination is based a statement that the claimant is entitled to receive, upon request and free of charge reasonable access to and copies of all documents, records, and other Relevant Information as defined 15

16 a statement describing any voluntary appeal procedures offered by the Plan and the claimant s right to bring an action under ERISA section 502(a) upon request and free of charge, a copy of any internal rule, guideline, protocol or other similar criterion that was relied upon in making the adverse determination regarding your appeal information about any office of insurance consumer assistance or ombudsman available to assist you in the appeal process a final notice of an adverse determination will include a discussion of the decision Relevant Information Relevant information is any document, record or other information which: was relied upon in making the benefit determination; was submitted, considered or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination; demonstrates compliance with the administrative processes and safeguards required by federal law in making the benefit determination; or constitutes a statement of policy or guidance with respect to the plan concerning the denied treatment option or benefit for the claimant s diagnosis, without regard to whether such advice or statement was relied upon in making the benefit determination. Legal Action You have the right to bring a civil action under section 502(a) of ERISA if you are not satisfied with the outcome of the Appeals Process. In most instances, you may not initiate a legal action against Cigna until you have completed the level-one and level-two appeal processes. If your appeal is expedited, there is no need to complete the level-two process prior to bringing legal action. OTHER IMPORTANT PLAN INFORMATION YOUR ERISA RIGHTS As a participant in the Plan, you are entitled to rights and protection provided by the Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA, all Plan participants are entitled to: Examine, without charge, at the Plan Administrator s office and other specified locations, all Plan documents, including insurance contracts, and copies of all documents filed by the Plan with the U.S. Department of Labor, if any, such as detailed annual reports and Plan descriptions. Obtain copies of all Plan documents and other Plan information upon written request of the Plan Administrator, who can require a reasonable charge for the copies. Receive a summary of the Plans annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of the annual report summary. In addition to creating rights for the Plan participants, ERISA imposes duties upon the people responsible for the operation of the Plan. The people who operate the Plan, called fiduciaries, have a duty to do so prudently and in the interest of you and other Plan participants. Fiduciaries who violate ERISA may be removed and required to make good any losses they have caused the Plan. 16

17 No one, including your employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining welfare benefits or exercising your rights under ERISA. If your claim for a welfare benefit is denied, in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the Plan Administrator review and reconsider your claim. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file a suit in a federal court. In such cases, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive them, unless they were not sent for reasons beyond the Plan Administrator s control. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file a suit in a state or federal court. If the Plan s named fiduciaries misuse the Plan s money or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file a suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay costs and legal fees, for example, if it finds your claim is frivolous. Upon written request, the Plan Administrator will furnish any Plan participant with information as to whether a particular subsidiary is included in the Plan, and, if so, the subsidiary s address. If you have any questions about the Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact: The nearest Office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory. The Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, NW, Washington, DC

18 PLAN ADMINISTRATION INFORMATION Type of Plan Plan Identification Number 519 Plan Administrator Welfare Benefit Plan Employer Number Fiduciary Agent for Service of Legal Process Sodexo, Inc. Corporate Benefits Department 9801 Washingtonian Blvd. Gaithersburg, MD Sodexo, Inc Washingtonian Blvd. Gaithersburg, MD Senior Vice President & General Counsel Sodexo, Inc Washingtonian Blvd., 12 th Floor Gaithersburg, MD Plan Year January 1- December 31 Plan Trustee Plan Funding Marc Blass Vice President & Assistant Corporate Treasurer Sodexo, Inc Washingtonian Blvd., 12 th Floor Gaithersburg, MD The Plan is self-funded and is financed by contributions from participants, which are held in a trust. 18

19 FUTURE OF THE PLAN Employees who participate in the Plan agree to accept the provisions of the Plan as they are today, or as they may be amended in the future. Participants will be informed in a timely manner of any major Plan changes. The Company intends to continue the Plan indefinitely. However, because unforeseen circumstances may arise, the Company reserves the right to terminate the Plan and to amend or modify the provisions of the Plan at any time. The Plan may be amended from time to time as authorized by the Senior Vice President and Chief Human Resources Officer. The Plan gives the Plan Administrator sole, absolute, and final discretion to determine eligibility for Plan benefits, to construe the terms of the Plan, and to resolve any factual issues relevant to eligibility. NO CONTRACT OF EMPLOYMENT The Plan is not intended to be, and may not be construed as constituting, a contract or other arrangement between you and the Company to the effect that you will be employed for any specific period of time. Either you or the Company may terminate the employment relationship at any time for any reason. 15 GOVERNING DOCUMENTS The Plan Document will govern in the event there is any conflict between the provisions of the Plan and this summary plan description. GLOSSARY OF TERMS Annual Enrollment A period of time each fall when you can enroll for benefits or change your benefit selections. The changes take effect the following Plan Year. Before-Tax Contributions Contributions that are taken out of your pay before your income taxes are calculated. Caregiver An IRS eligible person or Day Care Center that you pay to take care of your Dependent(s) while you are at work. Company Sodexo, Inc. Day Care Center Any facility that provides full-time or part-time care for more than 6 people (other than residents of the facility) on a regular basis during the year, and receives a fee, payment, or grant for providing such services regardless of whether or not the facility is operated for a profit. Dependent An individual you claim on your income tax return who relies on you for financial support according to the Internal Revenue Code. Family Care Spending Account A Flexible Spending Account provided by Sodexo that lets employees put money from their paycheck (before it is taxed) into an account to pay for eligible Dependent care expenses. 19

20 Highly Compensated Employee A Highly Compensated Employee is an individual who: Owned more than 5% of the interest in the business at any time during the year or the preceding year, regardless of how much compensation that person earned or received, or For the preceding year, received compensation from the business of more than $110,000 (if the preceding year is 2010 or 2011, or $115,000 if the preceding year is 2012), and, if the employer so chooses, was in the top 20% of employees when ranked by compensation. Plan The Sodexo Family Care Spending Account Plan Year January 1 to December 31 Reimbursement Request Form A form that you fill out to receive reimbursement from your account. Spouse A person of the opposite sex who is a husband or wife. Use It or Lose It Rule IRS rule that says if you don t use the money you ve contributed to your account before the end of the Plan Year, any remaining amount of money in your account will be forfeited. Requests for reimbursement of eligible expenses incurred during the previous year must be received by March 31st of the following year. 20

21 FEDERAL TAX CREDIT FOR DEPENDENT CARE VS. FAMILY CARE SPENDING ACCOUNT WORKSHEET Under the rules that apply to Dependent care assistance plans (Family Care Spending Account), the Company must furnish employees with a general description of the child care credit under Code Sec. 21, as well as a general statement of the circumstances under which an employee might find it more advantageous to forego Family Care Spending Account participation in favor of the income tax credit. To make an informed decision, you may wish to perform a more particular analysis in the light of your own circumstances. It s also a good idea to consult your qualified tax advisor. The following sample form is designed to help you make the necessary tax calculations to support your decision to participate or not in the Family Care Spending Account by weighing the after-tax consequences of taking the salary reduction against taking the federal tax credit. The approach that yields the lowest net tax after credits (q) is the better approach. 1. Number of exemptions claimed on federal income tax return. 2. Federal income tax filing status: Married, filing jointly Married, filing separately Head of household Single 3. Annual gross income...$ 4. Annual child care expense..$ 4A. New tax after credits with estimated child care credit (assumes you don t participate in the Family Care Spending Account) (a) Annual gross income...$ (b) Less adjustments to gross income...$ (c) Adjusted gross income [(a) (b)]...$ Deductions and exemptions: (d) Itemized or standard deductions...$ (e) No. of exemptions x $ =...$ (f) Total deductions & exemptions [(d) + (e)]...$ (g) Taxable income [(c) (f)]...$ Taxes: (h) Federal income tax [(g) + Tax Table rate]...$ (i) Social Security tax...$ (j) Total taxes [(h) + (I)]...$ 21

22 Estimated tax credits: (k) Child care credit...$ (l) Earned income credit...$ (m) Other credit...$ (n) Total credits against tax [(k) + (l) + (m)]...$ (o) Net taxes [(j) (n); enter 0 if negative]...$ Negative credit: (p) If (j) (n) is negative, enter negative amount, but not to exceed (l)...$ (q) Net tax after credits [(o) + (p)]...$ 4B: Net tax after credits with tax-free Family Care Spending Acocunt reimbursements (Assumes you participate in the Family Care Spending Account) (a) Annual gross income...$ (b) Family Care Spending Account salary reduction......$ (c) Gross income subject to tax [(a) (b)]...$ (d) Less adjustments to gross income...$ (e) Adjusted gross income [(c) (d)]...$ Deductions & exemptions: (f) Itemized or standard deductions...$ (g) No. of exemptions x $ =...$ (h) Total deductions & exemptions [(f) + (g)]...$ (i) Taxable income [(e) (h)]...$ Taxes: (i) Federal income tax [(i) x Tax Table rate]...$ (j) Social Security tax...$ (k) Total taxes [(i) + (j)]...$ Estimated tax credits: (l) Earned income credit...$ (m) Other credit...$ (n) Total credits against tax [(l) + (m)]...$ (o) Net taxes due [(k) (n); enter 0 if negative amount, but not to exceed (l)...$ Negative credit: (p) If (k) (n) is negative, enter negative amount, but not to exceed (l)...$ (q) Net Tax After Credits [(o) + (p)]...$ 22

23 June D