FLEXIBLE SPENDING ACCOUNTS Health Care FSA Dependent Day Care Assistance Plan BIG SAVINGS FOR YOU!

FLEXIBLE SPENDING ACCOUNTS Health Care FSA Dependent Day Care Assistance Plan BIG SAVINGS FOR YOU!

SECTION 125 FLEXIBLE BENEFIT PLAN The dollars you put in Flexible Spending Accounts are TAX FREE, SAVE YOU MONEY and are AVAILABLE IMMEDIATELY Your pre-tax deductions Are Taken To Fund Your Account, Each Pay Period You can Participate and Defer HEALTH CARE FSA Up to an Employer-specified maximum amount per Plan Year DEPENDENT DAY CARE ASSISTANCE PLAN Up to $5,000 if MARRIED filing jointly or Single Head of Household $2,500 if Married filing separately Your Spending Account pays for eligible expenses for services that take place during the initial Plan Year: 01/01/2009 12/31/2009 2

FLEXIBLE SPENDING ACCOUNTS??? NOT PARTICIPATING IN THE FLEX PLAN?? Your gross pay is taxed All of Your Take Home Pay is further reduced by your Out of Pocket Costs You have less spending money PARTICIPATING IN THE FLEX PLAN? Your Annual Election reduces your taxable pay! Your net take home pay is HIGHER You keep more $$$$$ in your pocket! 3

BENEFIT OVERVIEW HEALTH CARE FSA Up To An Employer-Specified Maximum Dollar Amount (Full Amount Available Day 1) Health Plan Copayments Prescription Drugs Over the Counter Drugs Dental Vision Hearing Deductibles DEPENDENT DAY CARE ASSISTANCE PLAN $5,000 / $2,500 Annual Maximum Payroll Deduction Amount Only Dependent Day Care Expenses incurred while you work Eligible Tax Dependents Children ages 12 and under Disabled Spouse Parents incapable of self-care 4

YOUR HEALTH CARE FSA 5

ELIGIBLE HEALTH CARE EXPENSES Orthodontia treatment Rx co-payments Chiropractic Contraceptive Prescriptions Psychiatrist/Counseling Durable Medical Equipment Lasik Eye Surgery Co-insurance PPO, HMO or EPO co-payments Deductibles Contact solutions, cleaners Dental expenses Vision expenses Eye glasses, contact lenses Diabetic supplies Over the Counter Drugs 6

INELIGIBLE HEALTH CARE EXPENSES Expenses that are not MEDICALLY NECESSARY are not eligible and may not be reimbursed from your FSA. Following is a partial list of INELIGIBLE expenses. Always contact the MEDCOM with questions about eligible expenses. Cosmetic Treatments Cosmetic Prescriptions Teeth Bleaching Herbs and Vitamin Supplements Over the Counter Drugs not used to treat a medical condition Insurance Premiums 7

YOUR DEPENDENT DAY CARE ASSISTANCE PLAN 8

ELIGIBLE DEPENDENT DAY CARE EXPENSES Covers CUSTODIAL CARE for your eligible dependents as follows Children 12 or younger Day Care or Nanny expenses for Custodial Care Before and After school care for your children Day Camps Custodial Day Care for disabled Spouse Day Care for dependent parent(s) living with you and incapable of self-care while you work 9

INELIGIBLE DEPENDENT DAY CARE EXPENSES Day Care for your dependents, if you or your spouse are not working Expenses paid to a caregiver with no Social Security or Tax ID Number Expenses not filed on your tax return (You must file IRS Form 2241) Tuition Registration Fees Day Care or Babysitters after work hours Expenses incurred if your spouse is unemployed (unless a full time student or disabled) There are other ineligible Expenses - Contact Medcom if you have questions 10

CALCULATING YOUR PRE TAX DEDUCTION 11

ANALYZE YOUR COSTS CAREFULLY (YOU WON T LOSE YOUR MONEY) REIMBURSABLE MEDICAL EXPENSES Rx Expenses $25 co-pay x 12/year $ 300 Physician Expenses $20 co-pay x 10/year $ 200 Specialist Expenses $30 co-pay x 2/year $ 60 Vision Expenses $ 240 (1 set of glasses/exam) Dental Expenses $ 200 (1 Crown @ 40% coinsurance) Total Reimbursable Medical Expenses $1,000 B. REIMBURSABLE DEPENDENT CARE EXPENSES Monthly Expense $100 x 10 $1,000 C. TOTAL FSA & DAY CARE EXPENSES $2,000 12

GENERAL TAX SAVINGS EXAMPLE Without FLEX With FLEX Gross Annual Salary $26,000 $26,000 Health FSA 0-1,000 Dependent Day Care 0-1,000 Taxable Salary $26,000 $24,000 Less FICA & Federal Tax -$4,520 -$3,994 Take Home Pay $21,480 $20,006 Out of Pocket Medical / Day Care -2,000 0 Net Take Home $19,480 $20,006 SAVINGS $ 526 The above tax savings are understated. Your actual savings will vary depending on your salary, filing status, state tax savings, etc. 13

MEDCOM S DEBIT CARD HELP S YOU USE YOUR MONEY 24/7 www.emedcom.net 14

RECEIPT SUBSTANTIATION Debit Card Transactions Where a Receipt Will Not be Requested Exact Copayment Match with Group Medical Plan Repetitive Medical FSA Transaction Same Dollar Amount, Same Provider Initial documentation must be filed with Medcom OTC Purchases at Drugstore.com A special FSA Store stocked with eligible items OTC and Rx Purchases at and stores (and additional merchants effective January 1, 08) RECEIPTS are Requested for ALL OTHER Transactions 15

NO PIN NO ATM Your Card is NOT eligible for use at ATM s Must only be used at health or day care related providers, such as Hospitals Physician offices Dental offices Vision Service providers Pharmacies Daycare Centers The purchase will be denied at point of sale if unauthorized use is attempted 16

USING YOUR DEBIT CARD SWIPE to Pay for Eligible Health FSA & Dependent Care Expenses PIN can not be used CREDIT transaction each time you use Card Card Transactions immediately post for payment KEEP ALL RECEIPTS for all transactions EXACT Copay, SKU-filtered, or pre-approved Recurring Transactions Automatically approve Complete and return a RECURRING EXPENSE form to establish 1 st Recurring Claim RECEIPTS are requested for ALL OTHER transactions Sufficient response submitted, Transaction Approved! FAX Receipt Request Letters WITH RECEIPTS to Medcom 17

DEBIT CARD INELIGIBLE EXPENSES IRS requires taxes to be paid on ineligible expenses Ineligible expenses are considered a debt owed to the Flex Plan and must be repaid Funds may be used for other eligible expenses If ineligible expenses not repaid Card deactivated Paper claims required Paper claim Offset by ineligible expense, or Payroll Deducted by Employer Employee W2, if ineligible expense not collected 18

PAPER CLAIMS HEALTH FSA include Explanation of Benefits from your insurance carrier, copayment receipts or medical statements with service date(s), out of pocket costs, item or service description. DAY CARE attach receipts for expenses including the provider s name and tax ID number or social security number, dates of service and cost of care RECEIPTS MAY NOT INCLUDE - Cancelled Checks, Credit Card Receipts, Balance-Due Statements FILING DEADLINE Claims INCURRED DURING PLAN YEAR Employees have limited time following the end of the Plan Year to submit claims on expenses already incurred 19

ENROLL TODAY! CALCULATE YOUR HEALTH FSA OR DAY CARE ELECTION COMPLETE AN ENROLLMENT FORM AUTHORIZING DEDUCTIONS ORDER A DEPENDENT CARD, IF APPLICABLE A maximum of two debit cards per participant household at no additional charge YOUR ELECTION CAN NOT BE REVOKED UNLESS YOU HAVE A QUALIFIED FAMILY STATUS CHANGE Marital status change Number of dependents Employment status Dependent loses or gains eligibility ENJOY YOUR TAX SAVINGS!!! 20

CONTACT US Mailing Address Medcom Flex Division P O Box 10269 Jacksonville, FL 32247-0269 Office 904.596.4500 Toll-Free 800.523.7542 Fax 904.421.3696 21