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® A Division of ADP National Accounts FSA It Pays to Participate ! Flexible Spending Accounts ProBusiness, A Division of ADP National Accounts What Are Flexible Spending Accounts? And Why Should I Participate?

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®

A Division of ADP National Accounts

FSA

It Paysto Participate!

Flexible SpendingAccounts

ProBusiness, A Division of ADP National Accounts


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What Are Flexible Spending Accounts? And Why Should I Participate?

  • Flexible Spending Accounts (FSA) allow you to set aside pre-tax dollars to pay for certain health and dependent care expenses.

  • Flexible Spending Accounts (FSA) are a “tax free” benefit through the IRS

  • Flexible Spending Accounts (FSA) are a great way to reduce your taxable income


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Tax Participate? Savings Example

Without FSA With FSA

Gross Monthly Salary $3,000 $3,000

Pre-tax Contribution to Reimbursement Account - 0 - - $ 300

Taxable Salary $3,000 $2,700

Less: FICA & Federal Tax* $1,050 $ 945

Take Home Pay $1,950 $1,755

After Tax Expenses - $ 300 - 0 -

Net Take Home Pay $1,650 $1,755

Increase in Monthly Spendable Income N/A $ 105

Increase in Annual Spendable Income N/A $ 1260

* State tax savings are available in most states but are excluded from this example.

Your tax savings may vary based on your tax bracket and income.


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Your Flexible Spending Account Components Participate?

  • Health Care Spending AccountUn-reimbursed or uncovered eligible health care expenses (copayments, Rx, dental/vision, deductibles)

  • Dependent Care Spending AccountEligible dependent care including child care, disabled spouse & incapacitated parent expenses

  • Premium Payment PlanPay for your share of employer-sponsored insurance premiums


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How Do Flexible Spending Accounts Work? Participate?

  • Calculate and decide on your plan year election

  • Complete an enrollment form authorizing deduction on a pre-tax basis from each paycheck. Your contributions will be placed into your account throughout the plan year

  • As you incur* expenses, submit and the necessary receipts anda claim form to ProBusiness

  • ProBusiness will reimburse you for your expenses

    * Incurred means a Plan Participant has been provided services that gives rise to an expense, not when the Plan Participant is formally billed, charged for, or pays for the services.


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Planning is Important! Participate?

  • Be conservative when establishing your plan contributions

  • Target 80% of your estimated expenses

  • Only services incurred during the plan year are eligible

  • You have a grace period to submit claims after the plan year is over


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Changing Your Flexible Spending Account Election Participate?

Once enrolled and your period of coverage begins,

your election is irrevocable except in these instances:

  • During open enrollment

  • You experience a qualified family status change


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What Are Qualified Status Changes? Participate?

  • Marital status change

  • Number of dependents

  • Employment status

  • Dependent satisfies or ceases to satisfy the requirements for unmarried dependents

  • Residence

  • Adoption Assistance


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® Participate?

A Division of ADP National Accounts

Health Care

Reimbursement

Account


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Orthodontia treatment Participate?

Rx co-payments

Acupuncture

Chiropractic

Contraceptive Prescriptions

Psychiatrist/Counseling

Durable Medical Equipment

Over the Counter (OTC) Drugs or Medicines used for medical care

Deductibles

Co-insurance

PPO, HMO or EPOco-payments

Dental expenses

Eye glasses, contact lenses

Contact solutions, cleaners

Diabetic supplies

Health Care Expense Eligibility


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Ineligible Health Care Expenses Participate?

  • Cosmetic Treatments

  • Cosmetic Prescriptions

  • Teeth Bleaching

  • Health Club Memberships

  • Herbs and Vitamins

  • Dietary Supplements

  • Union Dues or Insurance Premiums

    * This is only a partial list of health care expenses that are not eligible for reimbursement from your Health Care Reimbursement Account.


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Health Care Spending Account Claims Participate?

To receive reimbursement, your

documentation must include:

  • Date of service

  • Diagnosis or description of Service

  • Dollars outstanding after insurance or other payment (money you owe)


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® Participate?

A Division of ADP National Accounts

Dependent Care

Reimbursement

Account


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Can I Use The Participate?Dependent Care Account?

YES, as long as...

  • You & your spouse are gainfully employed or looking for work OR

  • You are a single, working parentOR

  • Your spouse is a full-time student for at least 5 months during the calendar year


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Eligible Dependent Care Expenses Participate?

Care through kindergarten

  • If the provider cannot separate the cost of care from the cost of schooling, the entire amount is reimbursable.

  • If the provider separates the cost of care from the cost of schooling, only the cost of care is reimbursable.


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Eligible Dependent Care Expenses Participate?

  • Care before & after normal school hours

    • Beginning with 1st grade, it is mandatory that the cost of care and the cost of schooling be separated. Only the cost of care is reimbursable. Care before & after normal school hours qualifies.

  • Day camps

  • Au pair or nanny expenses(including their associated payroll taxes)

  • Day care for a disabled spouse or dependent parent that lives with you


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® Participate?

A Division of ADP National Accounts

A Division of ADP National Accounts

Reimbursement

Process


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Reimbursement Process Participate?

Submit a Claim Form:

  • For Health Care: include Explanation Of Benefits statements, co-payment receipts, “super bills” that include description of service, date(s) of service and out of pocket costs (copies are recommended)

  • For Dependent Care: include receipts for expenses or have the care provider sign the claim form. The provider’s tax ID number or social security number must be provided on the claim form.


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Don’t Forget . . . Participate?

If you are submitting a paper claim . . .

  • To sign the claim form

  • To indicate the $ amount being requested

  • Supporting claim documentation – the IRS does not allow:

    • cancelled checks

    • credit card receipts

    • balance-due statements


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Paper Claim Reimbursement Process Participate?

  • Fax your signed reimbursement form & documentation to us @ 800-269-5231

  • Reimbursements will occur according to the reimbursement schedule in your welcome packet

  • Questions?

    • Visit our Web Site: www.probusiness.com

    • E-Mail us at: [email protected]

    • Call us: 1-800-269-0020


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Enroll Using the World Wide Web! Participate?

  • Access the ProBusiness’ Web site from work or home at www.probusiness.com

  • Refer to the step-by-step on-line instructions

  • Once enrolled you will receive:

    • Confirmation your data was received

    • A welcome kit with a confirmation statement and reimbursement schedule following open enrollment


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® Participate?

A Division of ADP National Accounts

FSA

It Paysto Participate!

Enroll in your

Flexible Spending Account Plans today!


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