Cedarburg School District Flexible Spending Account (FSA) Important Plan Information Please review the following information in preparation for your FSA enrollment! Upcoming FSA Plan Year: 1/1/2019-12/31/2019 Run-Out Period: You have until 3/1/2019 to submit claims for expenses incurred during the current Plan Year. FSA Carry Over Your FSA Plan allows you to carry over up to $500.00 of unused funds from your current Plan Year Health Care FSA or Limited Purpose FSA to be spent in the new Plan Year! Maximum Election Amount: Health Care FSA: $2,650 Limited Purpose FSA: $2,650 (For HSA participants only) Dependent Care FSA: $5,000 (Note: Group insurance premiums are deducted pre-tax automatically. Contact your employer's benefits representative if you have questions.) FSA Deductions: 24 FSA Deductions/ Admin and Year Round Staff 20 or 24 FSA Deductions/ Teachers(depending on your Annual Compensation Election) (Your plan year election will be divided by the number shown above.) Reimbursement Schedule: Eligible claims received Friday by noon will have reimbursements released the following Friday. Reimbursement Method: Checks Email Claim Notifications: Email notifications will be sent to inform you of claims received, reimbursements issued or requests for additional information needed to process your claims. By providing your email address when you enroll, you will automatically receive these notifications. Online Account Access: You may view account details including balance, claims and reimbursements and also access claim forms via the DBS website at www.dbsbenefits.com. You will need the following PIN# to create an on line account if you have not done so already: cedarburgsd Enrollment Method: Enroll online See enrollment instructions on the back of this page. Deadline to Enroll: 12/5/2018... J-\ 7 D1'9'ERSIFIED
Flexible Benefit Plan Online Enrollment Instructions To enroll online you will need an A.S.A.P. (Advanced Strategic Administration Program) account. have an account please skip to the 'How to Enroll' section below. If you already How to Create an A.S.A.P. Account: 1. Logan to the DBS website at DBSbenefits.com 2. Select 'User Login' located at the top right of your screen. 3. Select 'Create New Account' and enter the employer PIN: cedarburgsd 4. Enter the required account information and select 'Submit'. Your on line account will be created and you may now complete the online enrollment. How to Enroll: 1. Enter the Login Name and Password you created when setting up your on line A.S.A.P. account and click 'Login'. 2. Select the 1/1/2019-12/31/2019 plan year on the top of the screen and then select 'Enrollment' from the menu bar. 3. Complete the enrollment information as asked for on the on line enrollment form. 4. Review the 'Legal Terms' and check the box if you agree to the stated terms (required in order to enroll). 5. Next click on the red 'Click Here to Submit Enrollment' button. A window will pop up confirming you have successfully enrolled and providing the details of your enrollment. 6. You will have an option to print the enrollment form by clicking on the 'Print Your Enrollment' box. 7. When finished click on the 'Logout' link at the top of the page. -- /7\ ~L~F~~E~JlrE~~N~
....-. ~ r-=\ D1'9'ERSIFIED L,_~~ Health Care Flexible Spending Account (HCFSA) What is a Health Care Flexible Spending Account? A Health Care FSA (HCFSA) is a program that saves you money by allowing you to pay for eligible medical, dental and vision expenses for you, your spouse and your dependents (including children to age 26), using pre-tax dollars. That means the money you set aside for your HCFSA is not subject to federal income tax, Social Security, Medicare and, in most cases, state and local taxes. Using a HCFSA can save you approximately 20-30% in taxes on your expenses! How does it work? During your employer's open enrollment period, you calculate your annual expenses and determine an election amount that you are comfortable with. Your employer will take pre-tax deductions from your paychecks in equal amounts throughout the entire plan year. Ex: You elect $1,300 and you are paid 26 times per year. Your employer will deduct $50 pre-tax from each paycheck over the course of the plan year. The plan year is the timeframe in which services need to be rendered to qualify for reimbursement. Check your enrollment materials for the plan year your employer has chosen. When you have an eligible expense to be reimbursed, you simply file a claim with DBS. Services must be incurred within the plan year to be eligible for reimbursement. How am I reimbursed for expenses? Filing a claim is easy! Once you have incurred an eligible expense, file a claim with DBS on line at DBSbenefits.com, on your mobile phone or via mail or fax. You need to provide documentation showing the date of service, description of the expense incurred, name of the service provider and the amount of the expense. Dates of service need to be within the HCFSA plan year. A great benefit of the plan is that you have access to your entire election amount on the first day of the plan year. This means that if you have an expense at the beginning of the plan year, you can be reimbursed up to your entire election amount, even though you have not yet contributed that amount, easing the financial burden on you. Why should I ~nroll? > Improve your cash flow and increase, your spendable income Save approximately 20-30% in taxes on your expenses Need more information? Contact DBS at (800) 234-1229 to speak with a representative, You can review plan balance, claims and reimbursement information online at DBSbenefits.com
What if I don't use my entire election amount by the end of the plan year? It is uncommon for participants to have money remaining in their account at the end of the plan year but it is important to plan carefully. If you do have remaining funds, the unused funds may be forfeited and become the property of your employer, depending on the provisions of the plan. This is known as the use-or-lose provision. Some employers offer a carryover provision, allowing you to carry over up to $500 of unused funds into the new plan year, while others offer a grace period that allows additional time to incur expenses. If you are unsure if your plan offers either option, please contact DBS at (800) 234-1229. What is a run-out period? The run-out period is the period of time that you have after the end of the plan year to submit claims for expenses incurred during the plan year. Please check your enrollment materials for the runout period your employer has chosen. Additional Health Care FSA Information If you are enrolled in a HCFSA, you are not able to contribute to from the HCFSA cannot be reimbursed through any other during the plan year. This applies source. This includes any to you and your spouse's HSA. insurance company, insurance FSA may slightly affect your Social Security retirement benefit because you are lowering your annual gross income. For most people, the effect is minimal. In certain situations, you may modify your election amount upon a "change in status" such as those listed below. There. are several conditions and/or limitations that apply. Contact your employer if you believe. that you may qualify for an election change. Change in marital status (marriage, divorce, death of spouse) Change in number of dependents (birth, adoption, death of dependent) Expenses reimbursed a Health Savings Account (HSA) Participation in a Health Care Can I change my Health Care FSA election durins the plan yect1r?, plan, other Flexible Benefit Plan, Medical Savings Account Change in employment status Change that causes your dependent to no. longer meet dependent, eligibility (MSA), Health Reimbursement You take leave under Arrangement (HRA), Health FMLA Savings Account (HSA) or another reimbursement plan. If you are a highly compensated employee, an owner of the company or a family member of an owner, federal law may impose limits on your eligibility to participate in the plan. DBSbenefits.com Dl~ERSIFIED ~ Diversified Benefit Services, Inc. P.O. Box260 Hartland, WI 5302S (800) 234-1229
D1'9'ERSIFIED Dependent Care Flexible Spending Account (DCFSA) What is a Dependent Care Flexible Spending Account? A Dependent Care FSA (DCFSA) is a program that saves you money by allowing you to pay for qualified dependent care expenses using pre-tax dollars. That means the money you set aside for your DCFSA is not subject to federal income tax, Social Security, Medicare and, in most cases, state and local taxes. Using a DCFSA can save you approximately 20-30% in taxes on your expenses! How does it work? During your employer's open enrollment period, you calculate your annual dependent care expenses and determine an election amount that you are comfortable with. Consider the times when your dependent is not receiving care such as vacation time. Your employer will take pre-tax deductions from your paychecks in equal amounts throughout the entire plan year. Ex: You elect $2,600 and you are paid 26 times per year. Your employer will deduct $100 pre-tax from each paycheck over the course of the plan year. The plan year is the timeframe in which services need to be rendered to qualify for reimbursement. Check your enrollment materials for the plan year your employer has chosen. When you have an eligible expense to be reimbursed, you simply file a claim with DBS. Services must be incurred within the plan year to be eligible for reimbursement. How much can I contribute? The maximum amount that can be contributed during the tax year is $5,000 ($2,500 if you are married and filing a separate return). The amount payable also may not be greater than the amount of your earned income or the earned income of your spouse. Special rules may apply in the case of a spouse who is a student or incapable of caring for himself/herself. Who qualifies as a depe~dent? A tax dependent under the age of 13 whom you have custody of more than half the year. A tax dependent (spouse, parent or child) that is physically or mentally incapable of self-care regardless of age and who resides with you more than half the year. Need more information? Contact DBS at (800) 234-1229 to speak with a representative. You can review plan balance, claims and reimbursement information online at DBSbenefits.com
How am I reimbursed for expenses? Filing a claim is easy! Once you have incurred an eligible expense, file a claim with DBS online at DBSbenefits.com, using your mobile phone or via mail or fax. You are reimbursed up to your account balance for service dates that have occurred (future service dates cannot be reimbursed). If the expense exceeds your current account balance, the remaining amount is reimbursed when there are more funds available in your account. What happens if I don't use my entire election amount by the end of the plan year? It is uncommon for participants to have money remaining in their account at the end of the plan year. If you do have remaining funds, the unused money may be forfeited and become the property of your employer, depending on the provisions of the plan. This is known as the use-or-lose provision. Can I change my Dependent Care FSA election durirg the plan year? In certain sinratlcns, 1/0U may modify your election amount upon a "change in status" sueh as those 1,isted. below lhere are several conditions and/or limitations that api::;,ly. Contact your employer it y,ou believe that vou rnav qualify, tor an election change. Change in marital status (marriage, divorce, death of spouse) Can I use funds set aside for my Dependent Care FSA to pay for medical expenses? No, funds from the DCFSA can only be used for qualified dependent care expenses. Additional Dependent Care FSA Information,, To qualify, dependent care We recommend you consult expenses must be incurred your tax advisor to determine during the hours you and, if whether you are receiving a married, your spouse both work, greater tax benefit utilizing seek employment or attend school the DCFSA versus the federal full-time. dependent care tax credit. If you take a leave of absence Participation in a DCFSA may -~ Change in number of dependents (birth, adoption, death of dependent) Change in employment status. Change that causes your dependent to no longer meet dependent eligibility Court judgment, decree Grder,: or from your employer, contributions slightly affect your Social Security will stop as the account is retirement benefit because you You take leave under intended to pay for expenses are lowering your annual gross FMLA to allow you to work. income. For most people, the Overnight camps, kindergarten or higher grade tuition, fees for effect is minimal. If you are a highly compensated lessons, lunch/food fees and employee, an owner of the field trips are ineligible for company or a family member reimbursement. of an owner, federal law may You must file Federal Tax Form 2441 with your income taxes if impose limits on your eligibility to participate in the plan. you participate in the plan. DBSbenefits.com D1'9'ERSI Fl ED Diversified Benefit Services, Inc. eo. B0x2e0 Hartland, WI 53029 (800) 234-1229
D1'9'ERSIFIED Limited Purpose Flexible Spending Account (LPFSA) What is a Limited Purpose Flexible Spending Account? It is a flexible spending account you can enroll in when you have a Health Savings Account. It allows you to be reimbursed tax-free for dental and vision expenses. How is the LPFSA Funded? You choose how much you want to deduct tax-free from each paycheck. For example, if you are going to spend $1,300 on dental/vision expenses during the plan year and are paid 52 times per year, the pre-tax deduction per check will be $25. taxes on the expenses that are incurred. You have immediate., access to~ all of the LPFSA,; ' '. funds, so you can receive.. advanc~dfoimburse~~ntsifyou ihcur ~;pe.ns~s early ' (,..iri the plan year. This allows --~ ' ' you to preserve your H.SA ' ' money for future use..... ~,. '' If you incur $900 for '. a crown and $400 for What can the LPFSA be used for? The LPFSA can be used for out-of-pocket dental and vision expenses. The following are examples of expenses for you, your spouse or dependents (including children up to age 26). Dental Expenses (cleanings, x-rays, fillings, caps, crowns, braces, bridges) Vision Expenses (eye exams, glasses, frames, lenses, contact lenses, saline solutions, LASIK surgery) How are claims submitted for reimbursement? Submitting claims is easy and can be done via mail, fax, online or smartphone. You need to provide proper documentation showing the date of service, nature of the expense incurred, name of the service provider and the amount of the expense. Service dates need to be within the LPFSA plan year. What if all of the money is not used? Plan conservatively as expenses need to be incurred during the LPFSA plan year. Unused funds may be subject to the use-or-lose provision, depending on your plan design. Where can more information be obtained? DBSbenefits.com Contact DBS toll-free at 1-800-234-1229 to speak with a representative. Once you are enrolled into a LPFSA, you can review plan balance, claims and reimbursement information online at DBSbenefits.com.
D1'9'ERSIFIED Claims Filing Options that meet your needs. File Online+it's fast,. convenient ar)d secure Using your laptop or PC, you can submit your claims on line 24{7. DBS's exclusive A.SAP. (Advanced Strategic Administration Program) is a safe and quick way to see claim information and get reimbursed from your Health Care FSA (HCFSA), Dependent Care FSA (DCFSA), Limited Purpose FSA (LPFSA), or Health Reimbursement Arrangement (HRA). 1. Login to your online account at DBSbenefits.com 2. Select the Benefit Plan Type (FSA, HRA) 3. Select "Claims> Claims View/Submit> Submit" 4. Complete the required information 5. Attach an image with supporting documentation (.pdf or.jpg) 6. Submit File on the go-use our Mobile Phone App Filing using your smartphone or tablet is simple. 1. Login using your A.SAP. name and password, click "File a Claim" 2. Take a picture or use an existing photo, click ''.A.ttach Image" 3. Select the Benefit Plan Type 4. Enter dollar amount, answer questions, click "Submit" Visit your favorite app store to download. File via mail or fax More traditional filing is available, too. 1. Download a claim form at DBSbenefits.com 2. Select the "Participant Resources Tab> Forms" 3. Complete the form and attach copies of your documentation 4. Mail to Diversified Benefit Services, P.O. Box 260, Hartland, WI 53029 DBSbenefits.com 5. Or fax to 262-367-5938 For assistance, please call DBS at (800) 234-1229 or visit DBSbenefits.com