FLEXIBLE SPENDING ACCOUNT

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1 FLEXIBLE SPENDING ACCOUNT YouR Guide to FSA Savings KEEP MORE OF Your Income. ENROLL TODAY!

2 It s Your Money. WouldN T you like to keep more of it? Now you can. Your employer is offering you a flexible spending account (FSA) as part of your benefits package. An FSA allows you to set aside pre-tax dollars to pay for eligible out-of-pocket health care and dependent care expenses. Will you have any of these expenses in the coming year? A Partial List of Eligible Health FSA Expenses: Qualified health care expenses for you, your spouse, qualifying child or relative Office visit co-pays Prescription drugs and many over-the-counter health care products Qualified dental expenses, including x-rays, cleanings and orthodontia Vision care expenses, including contact lenses and laser eye surgery Qualified professional services, including qualified chiropractic and acupuncture expenses Two Ways to Save A health FSA allows you to set aside money on a pre-tax basis to pay for qualified health care expenses, including many over-the-counter medicines or health care-related products such as pain relievers, cold remedies, and bandages. With a dependent care FSA, you can use pre-tax dollars to pay for qualified employment-related dependent care expenses, including preschool, day care, and babysitting expenses. Visit to view a comprehensive list of eligible health care and dependent care expenses. Employment-Related Dependent Care Expenses: Care of a dependent child under the age of 13 who lives with you for more than half of the year, including: Nursery school, pre-school, or day care centers Before and after-school care Care provided in your home Care for your spouse or other qualifying dependent who is physically or mentally incapable of self-care and lives with you for more than half of the year.

3 Increase Your Spending Power with an FSA Your increased spending power and savings depends on your income tax bracket. For example, if you are in the 30% tax bracket, you will save $30 for every $100 that you put into your FSA. So, if you put $1,000 into your FSA, you ll reduce your taxes while increasing your annual spending power by $300. $1,000 X 30% tax rate = $300 increased spending power What Would You do with an Extra $1,050? FSA SAVINGS EXAMPLE With FSA No FSA Employee Taxable Income $35,000 $35,000 Health FSA (annual) ($1,500) $0 Dependent Care FSA (annual) ($2,000) $0 Employee Taxable Income $31,500 $35,000 Subtract Taxes (Est. 30%)* ($9,450) ($10,500) After-Tax Dollars Spent $0 ($3,500) Spendable Income (take-home pay) $22,050 $21,000 Employee Savings $1,050 $0 Savings will vary based on your personal annual tax rate. Please consult your tax advisor for more information. How Much Money Could You Save with an FSA? Enter your salary and FSA information in this worksheet to see how much you can save! FSA WORKSHEET With FSA No FSA Your Taxable Income Health FSA Contributions (annual) $0 Dependent Care FSA Contributions (annual) $0 Your Taxable Income Minus Your FSA Contributions Subtract Taxes (Est. 30%)* After-Tax Dollars Spent on Health Care and Dependent Care Expenses $0 Your Spendable Income (take-home pay) Your Savings $0 *This example assumes a 30% annual tax rate.

4 How the Plans Work Before you enroll, use our online savings calculators to decide how much you want to set aside for qualified out-of-pocket health care and/or dependent care expenses. Your election amount should conservatively match your estimated expenses for the plan year. Complete the enclosed enrollment form and return it to your benefits representative. Your employer may offer online enrollment. Check with your benefits representative for more details. Each pay period an equal portion of your annual election amount will be deducted from your gross pay and transferred to your FSA prior to calculating federal and state income and Social Security taxes.* As you incur expenses, simply submit a request for reimbursement to CONEXIS. It s that easy! How Reimbursement Works Simply complete a request for reimbursement form and submit it along with all proper expense documentation (itemized statements or receipts, EOBs, etc.) to CONEXIS. Upon receipt, a CONEXIS claims processor will review your request following IRS guidelines. Additional information regarding the reimbursement process can be found in the enclosed Participation Guidelines document. Health care and dependent care reimbursement request forms are included in this enrollment kit and are also available from your account homepage at HELP CONEXIS HELP THE ENVIRONMENT You can help CONEXIS reduce paper waste by signing up for direct deposit of your reimbursements. Direct deposit is the easiest, quickest, and most secure way to receive your reimbursements. With direct deposit, you ll receive your reimbursements up to five days sooner than with traditional paper checks. Do even more. Sign up for an online account and we ll send you confirmations for claim submissions and payments, as well as helpful tips and ideas for getting the most out of your FSA. * Pennsylvania does not exempt state withholding for dependent care benefits and New Jersey does not exempt state withholding for employee salary reductions.

5 IMPORTANT PLAN INFORMATION FSA Contributions Your entire annual contribution amount is available immediately at the beginning of the plan year to pay for eligible health care expenses. However, your total FSA election amount is deducted from your paycheck in equal amounts throughout the year. Note: This applies to health care expenses only. Dependent care expenses are reimbursed based on the availability of funds in your account. Election Changes You will be given the opportunity to make new elections during the annual enrollment period at the beginning of each plan year. Per IRS rules, you may only change your election (increase, decrease, or stop your pre-tax contribution) during the plan year if you have a qualified change in status event and your requested change is consistent with the event. Additional rules regarding election changes may apply in certain situations. Please contact your company s benefits representative for more information regarding other qualified changes and consistency requirements, as well as any exceptions that may apply. The Use-It-Or-Lose-It Rule All of the money in your flexible spending account must be spent by the end of your employer s plan year. Unused funds will not be returned to you or carried over to the following year.

6 WE RE HERE FOR YOU 24 HOURS A DAY, 7 DAYS A WEEK! Our industry-leading, Web-based technology provides you with the tools and resources necessary to determine how to maximize your benefits and tax savings by participating in an FSA. We also have an online video presentation that explains how these pre-tax plans work to help you make an informed decision. And our online savings calculators help you estimate your annual expenses as well as your monthly and annual savings. Go to to: View a short video presentation about the benefits of an FSA. Use our savings calculators to determine how much to place in your account(s) and estimate your annual savings. See a comprehensive list of eligible health care and dependent care expenses. Enroll in direct deposit to receive your reimbursements quicker than traditional paper checks. Direct deposit is a quicker, easier and more secure way to receive reimbursements directly to your bank account! Check the status of a reimbursement claim, including the amount of your reimbursement and when it was issued. View your entire health and dependent care FSA payment history, including all pending, approved, and denied claims for the plan year. Forms Included in this Kit: FSA Enrollment Form. Complete this form and return it to your benefits representative before the end of your enrollment period. Remember to ask your employer if online enrollment is available to you. FSA Participation Guidelines. Please carefully review this important document containing rules regarding your participation in health and dependent care FSA plans. Health FSA Request for Reimbursement Form. Dependent Care FSA Request for Reimbursement Form. Additional documentation regarding plan features specific to your plan (where applicable).

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8 1.877.CONEXIS ( ) 6191 North State Highway 161, Suite 400 Irving, TX South Parker, Suite 300 Orange, CA w w w. C O N E X I S. c o m A Word & Brown Company Copyright 2009 CONEXIS. CX