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 / support@careflex.com

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.