Flexible Spending Accounts (FSA) are employer-sponsored benefits that al-
low you to set aside a portion of your salary, before taxes, to pay for quali-
fied health care and dependent care (day care) expenses. Because that por-
tion of your income is not taxed, you end up with more money in your pock-
et. The end result is that you decrease your taxable income and increase
your spendable income. If you expect to have health care and dependent
care (day care) expenses that won’t be paid by any other insurance, you
should take advantage of your employer’s Health Care Spending Account
(FSA) and/or Dependent Care Spending Account (DCA). The average person
will save 30% on the cost of eligible expenses already incurred. You do not
have to be enrolled in your company insurance plan to be eligible to partici-
pate in a FSA.
You can enroll even if you receive insur-
ance coverage through your spouse’s
employer.
Essential health care expenses for you and your dependents
not paid by any other insurance are reimbursable through a
Health Care Spending Account. The benefit covers qualified
expenses that you, your spouse, and your dependents in-
cur. Dependent children are covered up to age 26 regard-
less of their tax dependent or full-time student status. For
purposes of the Health Care Spending Account, a dependent
child may be married and live separately from the ac-
countholder. Note, dependents of your dependent child
(including their spouse) are not covered unless these indi-
viduals are being claimed as your tax dependent. Typical
qualified expenses include medical and prescription co-
payments and deductible expenses, vision care expenses,
eligible dental care expenses (cosmetic dentistry not eligi-
ble), and over-the-counter medicines and products. Over-
the-counter medicines and products are reimbursable when
the product is used for medical purposes. Eligible expenses include medicines or prod-
ucts that alleviate or treat injuries or illness. Over-the-counter medicines or products
that merely benefit your general health are not reimbursable without a letter of medical
necessity. Examples of products that require a physician’s prescription or letter of med-
ical necessity include: pain relievers, cough medicine, allergy medicine, vitamins, min-
erals, and calcium. [Reference the FSA Expense Guide for more information.]
The Health Care Spending Account is pre-funded, allowing participants access to funds
up to their annual election amount from the first day of the plan year.
Day care expenses for children through age 12 or for dependents of any age who are
physically or mentally unable to care for themselves are reimbursable through a De-
pendent Care Spending Account. There are two requirements for eligible dependent
care expenses to qualify. First, it is necessary for both you and your spouse to work in
order to remain eligible for reimbursement from the Dependent Care Account. Second,
the total amount of expenses to be reimbursed through the account cannot be greater
than your income or your spouse’s income, whichever is lower.
The maximum yearly deposit amount is
$5,000; this exceeds the Federal Tax
Credit for one child. If you are married
and file a separate return, the maximum
election is $2,500.
The DCS is not pre-funded; you will only
receive reimbursement for dependent
care expenses up to the amount contrib-
uted to date. [Reference the DCA Ex-
pense Guide for more information.]
When you participate in a Health Care FSA, you elect to
have a specific dollar amount deducted from your gross
(before tax) salary each pay period. [This lowers your
taxable income. That means you also increase your take
home pay, or spendable income!]
Let’s look at an example: John Smith earns $30,000 per
year and pays 30% for federal, state, and FICA taxes. He
spends $1,500 per year in health care expenses for de-
ductibles, eyeglasses, and dental visits for his family.
Salary and Expenses Without FSA With FSA
Gross Annual Salary $30,000 $30,000
Pre-Tax Health Expenses - $1,500
Taxable Income $30,000 $28,500
Income Taxes at 30% - $9,000 - $8,550
After-Tax Health Expenses - $1,500
Actual Take Home Income $19,500 $19,950
TOTAL SAVINGS = $450
Accessing Your
Account Online
The CareFlex Participant Portal and
CareFlex Mobile App put account
information at your fingertips 24/7.
Online account features:
• Access account balances.
• View payment card charges.
• Enter a new claim.
• View claims and claims status.
• Access communication center
messages.
• Find answers to frequently asked
questions.
• Find account forms and docu-
ments.
Quick Facts:
• Your entire FSA
Health Care election
is available to you on the first day
of the plan year!
• FSA expenses can be for you and
your tax dependents, regardless
of whose insurance covers an indi-
vidual.
• It isn’t just deductible and copay
expenses that are covered under
an FSA … eligible expenses include
non-cosmetic dental work, eye-
glasses, and alternative care (such
as acupuncture and chiropractic
services).
• Your DCA election is available as
funds accumulate in your account.
• DCA expenses can be for your de-
pendents under the age of 13 or
over 13 if mentally or physically
unable to care for himself/herself.
• Easy to manage. You will need to
keep track of your paperwork, but
the CareFlex Participant Portal
makes managing your account
easy.
Eligible Expenses Include:
✓ Dependent care center; must comply with state and
local laws (applicable if more than 6 persons are
cared for).
✓ Services of other providers of care outside the home
(i.e., neighbors, your parents).
✓ Services of a child or dependent care provider who
comes to your home.
✓ Relatives who provide care (except someone who can
be claimed as a dependent or who is a child under the
age of 19).
Eligible Children or Other Dependents Include:
✓ Any child under age 13 who can be claimed as a de-
pendent on your Income Tax Return.
✓ Your spouse or any dependent over 13 who is physi-
cally or mentally unable to care for himself or herself.
✓ Anyone who is physically or mentally unable to care
for himself or herself for whom you contribute more
than half of their support.
Over-the-counter (OTC) drugs and medicines (other than insulin) require
a physician’s prescription or OTC Prescription form to qualify as an eligi-
ble medical expense under a Health Care Spending Account. This provi-
sion impacts how we pay for these qualified expenses.
CareFlex Benefits Card—Pharmacies and drug stores that are certified
as a 90% merchant (over 90% of sales are for qualified health care expenses) will continue to
accept health benefit cards; however, a physician’s prescription or OTC Prescription form will be
required to be submitted to CareFlex to substantiate the expense. Pharmacies that have an In-
ventory Information Approval System (IIAS) may accept health benefit cards to purchase OTC
medicines provided that a physician’s prescription is presented to the pharmacist, the pharma-
cist dispenses the drug in accordance with applicable law, an RX number is assigned, the phar-
macist retains certain records and the records are accessible by the employer’s plan or its agent.
If a pharmacy will not fill the OTC medicine as a RX, you will not be able to use a health benefit
card and will have to pay with another form of payment and submit a claim to CareFlex to re-
ceive reimbursement from your account. Submitted claims must include a completed reimburse-
ment request form, an itemized receipt and a physician’s prescription or completed OTC Pre-
scription form. An adequate itemized receipt contains the name of the product, the date, and the
amount paid. A physician’s prescription must include: the date prescribed, name of patient,
name of the OTC medicine, and the physician’s address and license number. A physician’s pre-
scription or OTC Prescription form will stay on file at CareFlex for the duration of a plan year.
Over-The-Counter Products—OTC products that are not medicines but used for medical pur-
poses (reference the FSA Expense Guide for more information) are reimburs-
able without a prescription under a Health Care Spending Account. Health
benefit cards can be used to pay for eligible OTC products at merchants that
have an Inventory Information Approval System (IIAS) or are certified as a
90% merchant. Purchases made at 90% certified merchants will require an
itemized receipt to be submitted to CareFlex to substantiate the expense. If
not paid with a health benefit card, you can submit a claim to CareFlex for
reimbursement from your account. Submitted claims must include a complet-
ed Reimbursement Request form and an itemized receipt. An adequate item-
ized receipt contains the date, the name of the product, and the amount paid. If your receipt does
not include this information, you will need to copy the label from the product or its packaging, cir-
cle the correct amount on your receipt, and submit with your completed Reimbursement Request
form.
Dual-Purpose Products—Certain OTC products are considered dual-purpose, such as vitamins
and supplements. This is because for some individuals the product is used to alleviate a medical
condition, while others use the product for general health and well-being. These dual-purpose
products may be eligible for reimbursement, but require a Medical Necessity form stating your
specific diagnosis or medical condition, a recommendation to take the specific OTC medicine to
treat your condition, and documentation of the product and cost. Please note: submitting a Medi-
cal Necessity form with your claim does not guarantee that the expense will be approved.
Excluded Items—OTC products that are not medicines or merely benefit your general health are
not reimbursable without a Medical Necessity form.
An OTC Prescription/Medical Necessity Form can be downloaded from the CareFlex website
www.careflex.com. A Pharmacy Locator can also be accessed from the website.
All enrollees will receive a CareFlex Benefits Card to access
funds. The full election amount is available on the card on
the first day of the plan year to pay eligible expenses.
The card swipe process works like any MasterCard® trans-
action, but will only work to transfer funds for properly cod-
ed transactions. Transactions at merchants not providing
authorized services will be denied. Transactions that exceed
your annual election amount will also be denied. The Care-
Flex Benefits Card is valid for a three-year period, allowing
next plan year’s election to be loaded on the card.
Your card is programmed to work only at pharmacies, dis-
count stores, and grocery stores that submit a health care
transaction total to CareFlex. To locate certified merchants,
use the Pharmacy Locator provided on our website:
www.careflex.com. Remem-
ber to save your itemized re-
ceipts! At times documentation
is requested to verify purchas-
es. Keeping itemized receipts on
file makes it easier when the
time comes.
Medical Services—When you pay for health care, be sure
to always present your health insurance ID card first to en-
sure proper processing of your services.
• Copays: If you are asked to pay a copay, you may pay
with the CareFlex Benefits Card, or you may pay out of
pocket and request reimbursement from your account.
Save your itemized receipt to submit as documentation.
• Additional Charges: If you’re asked to pay additional
charges, do not pay your provider until the claim is pro-
cessed by your health insurance plan and you receive your
Explanation of Benefits (EOB). This helps avoid overpay-
ment. Compare your EOB with the provider bill to verify
the amount being charged by your provider is the same as
the patient balance on the EOB. Then, pay with your Care-
Flex Benefits Card, or pay out of pocket and request reim-
bursement from your account.
The Pharmacy—When purchasing prescriptions, be sure to
always present your health insurance ID card first to ensure
proper processing of your charges. You may pay with your
CareFlex Benefits Card, or pay out of pocket and request
reimbursement from your account. Save your itemized re-
ceipts to submit as documentation.
•
•
•
•
IIAS (Inventory Infor-
mation Approval Sys-
tem): technology used
by retailers to ensure
benefit card transactions are eligi-
ble health expenses. Every item in
the store's scanner database is
flagged for plan eligibility. Note:
no documentation will be required
for verification of expenses pur-
chased at a merchant with IIAS.
90% Rule: certifies at least 90%
of gross sales in the prior tax year
were for eligible health expenses.
Note: you will be required to sub-
mit documentation to verify ex-
penses purchased at a merchant
who is 90% certified.
Settling Outstanding Previous Plan Year Expenses
Your benefit card will only recognize new plan year funds. Once the new
plan year begins, do not use your benefit card to pay for dates of service
incurred in the previous plan year. If you receive an invoice during the
new plan year for dates of service in the previous plan year, pay with
another form of payment and submit a manual claim to CareFlex for
reimbursement from previous plan year funds. NOTE: All reimbursement
requests received after the run out period will be denied.
Changing an Election – The elections you make at the be-
ginning of the plan year will remain in effect until the end of
the plan year. Changes to elections are only permitted if
your family status changes. A change in family status is
generally defined as a birth, adoption, or death of a depend-
ent; marriage or divorce; or if you or your spouse experience
a change in employment. Acceptable changes in status for a Dependent Care Spend-
ing Account include a change in the child care/elder care provider or a significant
change in the cost of coverage, such as a cost increase charged by your current day-
care provider. A change in status allows a participant to increase or decrease an elec-
tion amount consistent with the event. Changes to an election must be made within
30 days of the date of the status change. CareFlex will verify that your event qualifies,
requesting additional documentation if necessary.
The IRS allows pre-tax contributions as long as benefits do not favor highly compen-
sated employees. Testing will be completed following the open enrollment period to
verify benefits do not disproportionately favor highly compensated employees. Partici-
pants will be notified if elections require a change.
Run-Out Period – The Run-Out Period allows additional time after the last day of the
plan year to submit manual claims for dates of service incurred during the plan year.
Plan year funds are no longer available on the CareFlex Benefits Card after the last
day of the plan year. The Run-Out Period allows time for participants to submit ex-
penses to be manually reimbursed from available funds remaining in the plan year.
[Reference your Plan Design communication for the run-out period timeframe.]
Unused Account Balance – Any funds remaining after the conclusion of the plan
year, including the run-out period, will be forfeited. The plan does not allow for the
payment of late claims or the return of unused funds. Review your employer’s plan
design to determine time frames for submitting claims after the end of the plan year
or after you terminate employment/coverage.
Access your
account online!
• Go to
www.mywealthcareonine.
com/careflex/.
• Sign in with your Username
and Password.
• If it is your first time visiting
the site, select Register in the
top right of the page to create
access.
• Instructions for creating online
access can be downloaded
from the CareFlex website
www.careflex.com.
We make it easy to access and use your account funds.
There are two ways to pay for eligible expenses:
1. Use Your CareFlex Benefits Card—This is the simplest
way to pay for eligible expenses! Pay using your Care-
Flex Benefits Card and keep your itemized receipts and
statements as documentation.
2. Pay Out of Pocket and Request Reimbursement:
▪ Pay using your own personal credit card, cash, or
check and keep your itemized receipts and statements
as documentation.
▪ Then, log on to your online account to file for reim-
bursement. Upload documentation to your online claim
or print the claim submission form and email or fax
documentation.
▪ Or, you can email, fax, or mail a reimbursement re-
quest form with documentation to CareFlex.
Appropriate documentation for Health Care expenses in-
cludes: a prescription label, an itemized receipt (must in-
clude the provider name, date and description of expense),
an itemized provider statement (must include the provider
name/address, patient name, date of service, description
of service, and patient responsibility), or a medical insur-
ance Explanation of Benefits (EOB). NOTE: Cancelled
checks, credit card receipts and/or non-itemized re-
ceipts are not acceptable proof of services.
The same rules apply for Dependent Care expenses. How-
ever, the Reimbursement Request Form can act as a re-
ceipt from the provider when the provider completes,
signs, and dates the form. If there is not a provider signa-
ture, you must submit a detailed provider invoice or state-
ment. [Note: Provider Tax ID or Social Security Number
required.] If your dependent will be in the same day care
for the entire plan year, a Dependent Care Provider Form
can be completed and signed by the provider and submit-
ted to CareFlex. Participants are responsible for notifying
CareFlex if a change is made to the dependent care provid-
er.
CareFlex sends email notifications to participants who have
provided their email address. For online claims, a notifica-
tion will be sent once you file a claim notifying you that the
claim has been received. Another email will be sent once
your claim has been reviewed and processed. For paper
reimbursement requests, an email will be sent once the
claim has been entered in our system. Participants can
track their claims through the CareFlex Participant Portal.
205 West Dares Beach Road, Prince Frederick, MD 20678
Toll Free Phone (888) 577-2762 / Fax (410) 414-8432 / [email protected]
For additional information, please contact
How do I keep track of my ac-
count balance?
You can track your account online through
the CareFlex Participant Portal
www.mywealthcareonline.com/
careflex/. Instructions for creating
online access can be downloaded from the
CareFlex website www.careflex.com.
What is the CareFlex Benefits Card?
The CareFlex Benefits Card is a stored value card that uses funds directly from your
Flexible Spending Account. Your benefit card is activated upon its initial use for eligible
expenses. Present your card to pay for services to providers accepting credit cards. The
benefit card is a signature based debit card and can be used as a credit card or debit
card. There is a PIN number associated with the card that can be accessed through the
CareFlex Participant Portal. The card swipe process works like any MasterCard® transac-
tion, but will only work to transfer funds for properly coded transactions.
Can I order a benefit card for a dependent?
It is not necessary to have a benefit card for dependents, but sometimes useful for
spouses or dependents away from home. To order a benefit card for an eligible depend-
ent, please complete an Additional Card Request Form (form can be downloaded from
the CareFlex website www.careflex.com). The completed and signed form can be
emailed, faxed, or mailed to CareFlex.
How to plan an election?
Calculate the total dollar amount you expect to spend on health care expenses and de-
pendent care expenses (if applicable) over the course of the plan year. [A simple work-
sheet can be downloaded from the CareFlex website www.careflex.com to assist you
in this process.] Once you have determined your annual expenses, divide that amount
by the number of times you are paid in a year. The same amount will then be deducted
from your paycheck on a pre-tax basis each pay period.
Who is the Plan Administrator?
Plans are administered by CareFlex LLC, an administrative services company. CareFlex
manages the plans and issues the CareFlex Benefits Card. CareFlex conducts audits on
purchases made with the card and will request documentation as needed to maintain
compliance with plan rules.