re: vacation (dependent care) & health reimbursement ... · re: vacation (dependent care) &...
TRANSCRIPT
BOARD OF
ADMINISTRATION LABOR
John Ballantyne
Co – Chairman
Thomas Breslin
Dave Haines
Michael Hand
Michael Morrow
Robert Naughton
MANAGEMENT
James R. Davis
Co – Chairman
Joseph Clearkin
Benjamin Connors
Jack Healy
Frank Lutter
Philip Radomski
CO-COUNSEL
Jennings Sigmond P.C. & Thomas
J. McGoldrick Esq
1811 Spring Garden Street
Philadelphia, PA 19130
Phone 215-568-0430
www.carpenters.fund
March 17, 2017
Re: Vacation (Dependent Care) & Health Reimbursement Account (HRA)
Dear Participant,
The first payment(s) under the newly revised Vacation (Dependent Care) and HRA Plan (if
applicable) will begin in May 2017. Here is what you need to know about these Benefits.
Vacation Benefit / Dependent Care Flexible Spending Account (FSA):
The Vacation Benefit will be issued automatically to eligible participants on each of the
quarterly vacation payment months (February, May, August, and November).
If you elect(ed) Dependent Care FSA benefits on your annual Cafeteria Claim Form, you
will need to submit a Dependent Care Reimbursement Form to the Fund Office. Include
with the Reimbursement Form a statement detailing the services provided, the name of
the provider, tax identification number/social security number, the date of service, and
cost of service with proof of payment. Only submit expenses for eligible dependents.
Providers must sign the Affidavit section of the Reimbursement Form if they are Private
Residence Providers and you do not have supporting documents.
Health Reimbursement Account (HRA) Withdrawal Requests:
An HRA Claim Form must accompany all requests. You will be able to complete the Claim
Form and upload your receipts online at www.carpenters.fund, the carpenters.fund
mobile app or download a copy for mailing purposes. Approved claims will be deposited
on the following quarterly HRA payment months (February, May, August, and November).
Electronic Payment:
The Fund Office will no longer issue paper checks. All payments are now electronic and
will be deposited into the financial institution of your choosing. If the Fund Office already
has your bank account information on file, all payments will be directly deposited into
that account. If no banking information is provided, an account will be created for you at
the Union Building Trades Federal Credit Union. (See insert for more Credit Union
account details). Go to www.carpenters.fund or use the mobile app to update or change
your banking information.
Enclosed:
Health Reimbursement Account (HRA) Claim Form
Dependent Care Reimbursement Form
HRA Claims & Dependent Care Reimbursement Frequently Asked Questions (FAQs)
Credit Union Account information
Timely filing for any claim is one year from the date services were rendered.
HRA Qualified Health Care Expenses ( Please complete and sign below.)
HRA CLAIM FORM
Upload your receipts fast and easy at www.carpenters.fund
Participant Name: _________________________________________________ UBC # or Last Four of SSN: _________________________
Item No.
Date of Service Name of Provider Expense Description (Medical, Dental, Prescriptions)
Claim Amount
1
2
3
4
5
For each expense claimed (Medical, Dental, Orthodontic, Prescription, and Optical), submit a receipt or state-
ment detailing the services provided, the name of patient, the date of service, diagnosis (if available), cost of service with
proof of payment and an Explanation of Benefits (EOB) from any other insurance carrier or plan (if applicable). Expenses
may only be submitted for you and your Eligible Family Members. Include a doctor’s note when required.
For Medical Insurance Premium Reimbursement: Submit pay stubs clearly showing deductions for medical premiums
are after taxes. If it is not clearly stated on the paystub, a letter is required from the employer verifying they are POST-
TAX deductions for health insurance benefits. The letter must include the medical premium cost to the em-
ployee, name of person the payment for health insurance is issued to, check date and company name.
Clearly legible photocopies of original receipts may be uploaded online at www.carpenters.fund
For information regarding eligible medical expenses, please refer to IRS Publication 502 (Medical Dental Expenses). WWW.IRS.GOV
$
I acknowledge that the Plan shall pay or reimburse approved expenses from my account up to the account balance. I also certify that
any eligible medical expenses submitted for reimbursement are for myself, my spouse, or Eligible Family Members and such expenses
have not and will not be reimbursed under any other Health Savings Account, insurance plan or claimed as a deduction on a tax return
or tax deductible Plan.
Total Amount Requested
Participant Signature: _________________________________________________________________Date: ______________________________
Additional claim boxes located on the back of this form.
Item No.
Date of Service Name of Provider Expense Description Claim Amount
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Qualified Health Care Expenses ( Please complete all applicable spaces)
$ TOTAL
Participant Name: ___________________________________________________ UBC # or Last Four of SSN:_________________________
Upload your receipts fast and easy at www.carpenters.fund
Health Reimbursement Account (HRA)
How do I become eligible for a Health Reimburse-
ment Account (HRA)?
You are eligible for an HRA Account if: (1) you satisfy
the general Plan rules for eligibility for health benefits
for active employee contributions and (2) the wage
and benefit package for your work has a “Cafeteria
Benefit” contribution of $1.00 per hour or more or the
Board allocates a portion of the Health & Welfare con-
tribution for your work to an HRA account.
What expenses can the Health Reimbursement
Account (HRA) pay?
Current tax laws require that the Plan limit HRA bene-
fits to payment of health care expenses. The HRA ac-
count can be used to reimburse you for eligible health
care expenses:
Incurred and paid for you, your eligible Spouse
and your eligible Children for eligible goods or ser-
vices after December 31, 2016.
for diagnosis, cure, mitigation, treatment or pre-
vention of disease or treatments affecting any
part or function of the body;
which are not otherwise compensable by (or the
responsibility of) an insurance carrier, a plan or
other third party, and
Could be claimed as a medical expense deduction
on a federal income tax return (without regard to
limitations on deductibility based on a percentage
of your income).
How do I claim benefits from my HRA?
You can claim reimbursement from the HRA after a
credit is made to an HRA for you. Once a credit is
made to your account, you can submit claims for eligi-
ble health care expenses to the Fund office using the
HRA Claim Form.
You can submit claims as you pay eligible expenses.
The Plan will collect claims and reimburse you on a
quarterly basis up to the balance in your HRA. All
claims for a calendar year must be submitted to the
Plan within one year after the date of service.
For expenses over $500, you can submit the bill to the
Fund Office for payment directly to a provider as long
as your account has sufficient fund to cover the ex-
pense.
A claim for HRA expense reimbursement must be
made on a Plan Form or submitted online at
www.carpenters.fund and include the documentation
required to support a deduction of the expense as a
medical expense deduction under IRC Section 213
(disregarding the limitation based on adjusted gross
income in that section) and such other information as
deemed necessary by the Plan. The current regula-
tions under IRC Section 213 require that you substan-
tiate medical expenses with written documentation
showing:
the name and address of each person to whom
payment was made.
the date and amount of each payment, and
a statement or itemized invoice from the individu-
al or entity to whom payment was made showing
the medical nature of the expense.
The Plan will need bills and evidence of payment to
support your claim and show that it was not compen-
sated by insurance or other means. It can require ad-
ditional information beyond the claim form to assure
that your claim is eligible for reimbursement. A claim
can be denied for failure to submit supporting docu-
mentation on a timely basis.
For a list of HRA Eligible Expenses for Reimbursement,
please visit the Cafeteria Plan & HRA Benefit page at
www.carpenters.fund
You must submit all claims for reimbursement of Dependent Care Expenses incurred during a calendar year by February
1st of the following calendar year or the amount may be forfeited.
Qualified Dependent Care Expenses ( Please complete and sign below.)
DEPENDENT CARE
Upload your receipts fast and easy at www.carpenters.fund
Participant Name: ________________________________________________ UBC # or Last Four of SSN: ___________________________
Item No.
Date of Service
End Date of Service
Name of Provider Provider Tax ID or SSN Expense Covers
(Dependent Name)
1
2
3
For each Dependent Care Expense claimed for reimbursement, submit a statement detailing the services pro-
vided, the name of the provider, tax identification number or social security number, the date of service, and the cost of
service with proof of payment.
Expenses may only be submitted for qualifying dependents. Providers must sign the Affidavit below if they are Private
Residence Providers and you do not have these supporting documents.
Clearly legible photocopies of original statements may be uploaded online at www.carpenters.fund.
You are encouraged to consult your personal tax advisor or IRS Publication 503 (Child and Dependent Care Expenses) at WWW.IRS.GOV for fur-
ther guidance as to what is or is not a Dependent Care Expense if you have any doubts.
I acknowledge that the Plan shall pay or reimburse approved expenses from my account up to the account balance. I also certify that
any eligible Dependent Care Expenses submitted for reimbursement are for Qualified Dependents and such expenses have not and will
not be reimbursed under any other Dependent Care Flexible Spending Account, insurance plan or claimed as a deduction on a tax re-
turn or tax deductible Plan.
Total Amount Requested
Participant Signature: ________________________________________________________________Date:______________________________
REIMBURSEMENT FORM
AFFIDAVIT:
Your daycare provider only needs to sign this if they are a Private Residence Provider and you do not have the supporting
documents as described above.
I hereby certify that I provided adult or child daycare services to the above individual(s) in accordance to the amounts and
dates that are requested.
Provider’s Signature: _________________________________________________________________Date:______________________________
$
How do I become eligible for the Dependent Care
FSA?
You are eligible for the Dependent Care FSA if: (1) you
are eligible for a Vacation Benefit under the Plan, and
(2) make a timely election to allocate a portion of the
Vacation Benefit payments to the Dependent Care
FSA.
How do I elect the Dependent Care FSA?
You can elect Dependent Care FSA benefits during the
annual election period in the month of December.
You must complete a Reimbursement Form from the
Fund Office to allocate part of your Vacation Benefit to
the Dependent Care FSA and return it to the Fund
Office by the annual deadline.
How does the Dependent Care FSA work?
You can allocate Vacation Benefit money to the De-
pendent Care FSA up to an annual maximum under
Section 129 of the Internal Revenue Code (IRC). The
maximum current annual limit generally is $5,000 per
year. The limit is $2,500 if you are married and reside
together, but file a separate federal income tax return
and also cannot exceed the lesser of the earned in-
come (as defined in IRC Section 32) of you or your
spouse (with a special limit for student and disabled
spouses). The more practical limit is the sum of your
Vacation Benefit payments which are the most you
can allocate to the Dependent Care FSA.
If you elect to allocate Vacation Benefit money to the
Dependent Care FSA, a non-interest bearing depend-
ent care account will be set up to keep a record of
claims and payments for the Dependent Care Reim-
bursements to you. The Dependent Care FSA is not an
actual account; it is merely a bookkeeping account in
the Fund office.
When you complete a Vacation / Dependent Care
form with an allocation to the Dependent Care FSA,
your quarterly Vacation Benefit payments will be allo-
cated to the Dependent Care FSA until the FSA alloca-
tion is funded.
How do I claim reimbursement under the Depend-
ent Care FSA?
When you incur an eligible Dependent Care Expense,
you submit a claim to the Fund Office on the Depend-
ent Reimbursement Claim Form, which may require
details on the provider and proof of payment or a
debt for a Dependent Care Expense.
If your Dependent Care FSA balance is sufficient,
you will be reimbursed for your Dependent Care
Expenses on the next scheduled processing date.
If your claim was for an amount that was more
than your current Dependent Care Account bal-
ance, the excess part of the claim will be carried
over into following months, to be paid out as your
balance becomes adequate.
However, you cannot be reimbursed for any ex-
penses above your annual payments to your De-
pendent Care FSA or for any expense incurred
after the close of the Plan Year.
You will be notified in writing if any claim for benefits
is denied.
You must submit all claims for reimbursement of De-
pendent Care Expenses incurred during a calendar
year by February 1st of the following calendar year or
the amount may be forfeited.
For more information about the Dependent Care FSA
please visit the Cafeteria Plan & HRA Benefit page at
www.carpenters.fund
Dependent Care Flexible Spending Account (FSA)
www.ubtfcu.org
800-848-2438
Vacation, Dependent Care & HRA Benefits
You have the option of having your Vacation, Dependent Care & HRA Benefit deposits forwarded to the credit un-ion for your immediate use. If you would like this option, please contact the Carpenters Benefit Funds of Philadel-phia office at (215) 568-0430. Deposits are sent to the credit union on a quarterly basis and are available for immediate withdrawal. You can access your funds by calling the credit union and they will mail a check to your address. You will need provide two (2) forms of identification, one from a Primary source and one from a Secondary source (see examples below).
Primary: Current photo driver’s license, valid photo state/government issued ID with, or passport.
Secondary: Social Security card, utility bill issued in the past 90 days that shows current address, or Union Card.
Credit Union Membership
Please Note: In order to take advantage the services and benefits of the credit union, (debit card, online access, bill pay service) you need to fill out the credit union membership application. (Note: this application is available on the credit union website listed above). Membership in the credit union offers a full array of banking services at no cost to you. More detailed information about their products and services is available on their website. You will have the option to have your Local Union Dues automatically deducted from your account. Members of your immediate family (by blood or marriage) are also eligible for credit union membership.
If you already have banking information on file with the Benefit Fund Office and would like to switch to
the credit union account, please visit the forms page at www.carpenters.fund to remove your Direct Deposit account information.