Flexible Spending Accounts (FSA) 2013

1. Flexible Spending Accounts (FSA) 2013

2. KEY INFORMATION New Benefits Card FSA Medical/Dependent Care on ONE Card Plan Year: January 1, 2013 – December 31, 2013 Grace Period for Incurring Expenses: Until March 15, 2014 Run-Out Period for filing: April 15, 2014 Your FBA Debit MasterCard is automatically issued at time of enrolling in the plan FBA Customer Service Contact Us at 800-437-3539

3. Making Your Election • You must enroll online through e-Benefits Works to participate in the Flexible Spending Accounts each year. • Quick Tips! • Plan Ahead for major expenses like dental work or Lasik surgery. • Do not set money aside for previous expenses. Your FSA balance can only be used for expenses that are incurred during the current plan year. Use the Estimate Your Expenses Worksheet in the FSA Summary of Benefits

4. Health Care Eligible Items • Examples • Copays/Deductibles • Prescription Drug Copays • Glasses/Contacts/Contact Lens Supply • Diabetic Supplies • Orthodontic Expenses • Fertility Treatments • Nicotine gum/patches The Healthcare FSA Maximum is $2,500

5. Dependent Care Eligible Items • Examples • Babysitters or Nannies • Licensed day care centers • Private Preschools • Before and after school care • Day care for elderly or disabled dependent The Dependent Care FSA Annual Maximum is $5,000

6. FBA Debit MasterCard • Convenience Features • Works like a pre-paid credit card; no pin number required. • Your card will be activated upon the first swipe. • Additional cards are available for your eligible dependents. • Monitor your account balance and transaction history at www.flex-admin.com. • Your Healthcare account is pre-funded with your annual election on the card. • Your dependent care account is funded as payroll deposits are made. Please visit www.sig-is.org for a list of IIAS Merchants

7. Card Transaction Substantiation Transaction Substantiation Requests 1st Letter: Generated within 1-2 Days of the transaction 2nd Letter: Reminder letter sent after 20 days if no documentation has been received 3rd Letter: Letter sent after 40 days stating your card has been temporarily deactivated until proper documentation is received. Submit the requested documentation along with a completed Transaction Substantiation Form or a copy of the letter you received.

8. Submitting for Reimbursement of Manual Claims Follow These Easy Steps • Gather your documentation for eligible expenses • Complete the Healthcare or Dependent Care Expense Claim Form • Submit your Form and documentation to FBA as instructed on the form • Documentation must include: • Date of Service • Provider Name/Patient’s Name • Amount Charged • Nature of the Expense

9. Quick Tips! Forms are available on CNet. Claims/Substantiation Requests: Remember to file your claims with a completed claim form and to respond to all requests for card substantiation. Please allow 2-3 business days for the processing of your submitted claims once they have been received. Weekly Reimbursements: Reimbursement checks will be mailed directly to your home address. Direct Deposit reimbursements are available within 1-2 business days after processing.

10. Wrap Up For more detailed information on any of the plans offered, review the Summary of Benefits on CNet.