Contents About FSA 3 How FSA Works 4 Eligible Expenses 5 Setting Up Your FSA 6 Qualifying Life Status Change 9 Restrictions 10 Dependent Care Assistance Plan 11 Eligibility 13 Determining Annual Election Amount 14 Dependent Care Plan Versus Tax Credit 16 Sample Savings Calculator 17 Qualifying Life-Status Changes 18 Restrictions 19 Enrolling in the Plan 20 Reimbursement Procedures 21 Claim Procedures 24 2004-03-23 2
Flexible Benefits Plan Helps You Pay for predictable, out-of-pocket expenses like unreimbursed medical expenses and dependent day care on a pre-tax basis Set aside money before taxes Rapid claims turn-around 2004-03-23 3
How a Health Care Spending Account Works Made possible by Section 125 of the IRC Employer-sponsored plan Set aside money pre-tax for unreimbursed health care expenses 2004-03-23 4
Deductibles, co-pays, co-insurance Prescription drugs Eye exams, contact lenses and cleaning solutions Dental and orthodontia Much, much more!! Eligible Expenses 2004-03-23 5
Set-up Health Care Spending Account Decide how much to set aside from each check Stay within the plan maximum Include dependent expenses even if not covered by employer s plan Use the Savings Calculator on the CONEXIS website 2004-03-23 6
Determine Annual Election Amount Divided By: Number of pay periods Monthly = 12 Semi-monthly =24 Bi-weekly = 26 Weekly = 52 = Deduction per pay period 2004-03-23 7
Leave the Rest to CONEXIS CONEXIS handles all administration Incur expenses, file claims, obtain reimbursements up to annual election Pay no taxes on reimbursements 2004-03-23 8
Change in marital status Change in number of dependents Spouse s employment or coverage changes Change in number of work hours Change of work site Change of residence Dependent ceases to qualify as a dependent Qualifying Life-status Changes 2004-03-23 9
Restrictions Use your account balance or lose it Must use up account balance for services rendered during the plan year Unused balances help offset employer costs Plan carefully! 2004-03-23 10
How a Dependent Care Assistance Plan Works Set aside money pre-tax for dependent daycare expenses Made possible by Section 125 of the IRC Employer-sponsored Plan 2004-03-23 11
Who is Eligible? Child under the age of 13 Disabled dependent Adult dependent 2004-03-23 12
Not your dependent under age 19 Inside your home State-approved daycare facility Eligible Daycare Providers 2004-03-23 13
Determine Annual Election Amount Divided by: Number of pay periods Monthly = 12 Semi-monthly =24 Bi-weekly = 26 Weekly = 52 = Deduction per pay period 2004-03-23 14
Leave the Rest to CONEXIS CONEXIS handles all administration Incur expenses, file claims, obtain reimbursements up to annual election Pay no taxes on reimbursements 2004-03-23 15
Dependent Care Plan versus Tax Credit Dependent Care Assistance Plan or Income Tax Credit, not both If you earn more than $25,000, this plan will probably save you money Consider consulting a tax advisor 2004-03-23 16
Sample Savings Calculator 2004-03-23 17
Change in marital status Change in number of dependents Spouse s employment or coverage changes Change in number of work hours Change of work site Change of residence Dependent ceases to qualify as a dependent Qualifying Life-status Changes 2004-03-23 18
Restrictions Use your account balance or lose it Must use up account balance for services rendered during the plan year Unused balances help offset employer costs Plan carefully! 2004-03-23 19
Enrolling in the Plan Use our Savings Calculator Complete the enrollment form Plan carefully Services must have been provided or expenses must have incurred during the plan year 2004-03-23 20
Reimbursement Procedures Obtain claim forms from your HR representative or download from website Complete forms entirely to avoid delays 2004-03-23 21
Filing a Claim Include appropriate documentation Explanation of Benefits Itemized statement Not allowed by IRS: Cancelled checks Balance forward statements Credit card receipts 2004-03-23 22
Receipts are not required Complete the appropriate claim form Dependent Care Claims 2004-03-23 23
Claims Submission If you have access to a scanner, you may submit claims through the website: http://www.conexis.org You may fax claims via CONEXIS s toll-free fax number: 877-353- 2948 Mail claims to: CONEXIS Cafeteria Plan Services P.O.Box 227197 Dallas, TX 75222 2004-03-23 24