enrollment information · 2020-04-23 · chino valley unified school district important medical...
TRANSCRIPT
April 23, 2020
Re: ACT, CHAMP, Confidential, Psychologist and Board Members Health and Welfare Online
Open Enrollment
Dear Benefit Eligible Employee:
Online open enrollment for benefit-eligible employees will be held Monday, April 27 through
Friday, May 8, 2020.
For more information on pricing and plan summaries please go to the district website at
http://cvusd.schoolwires.net/page/958.
Enrollment Information:
• If you are NOT making changes to your current elected benefits, NO ACTION IS
REQUIRED ON YOUR PART. Your current health and welfare benefits will continue
through June 30, 2020. If no changes are made to your current health and welfare benefits,
they will remain in place for the 2020-2021 fiscal year.
• If you are making a change for yourself and/or your dependent(s), you must log in during
open enrollment to access the BenefitFocus website at https://chinovalley.hrintouch.com.
BenefitFocus detailed instructions are provided in this packet.
• For BenefitFocus Website Technical questions, please call: 877.336.8082, Monday
through Friday, 5:00 a.m. to 6:00 p.m., Pacific Standard Time.
• All newly added dependents will need proof of eligibility, (2018 or 2019 tax return,
additional options would be marriage certificate for spouse and birth certificates for
children). These document(s) can be uploaded on the website or submitted to the Benefit
Staff by email no later than Friday, May 8, 2020.
• If you are opting out of medical benefits, you MUST complete and sign a Waiver of
Participation and provide proof of other insurance coverage. The Waiver of Participation
form is included in this packet. Please submit the form and proof of coverage by email to
the Benefit Staff.
Questions on Benefits?
• For Kaiser specific questions, please contact Kaiser customer service at 800.464.4000.
• For Blue Shield specific questions, please contact Blue Shield Concierge at 855.724.7698.
• For Delta Dental specific questions, please contact Delta Dental at 800.765.6003.
• For Vision Service Plan (VSP) specific questions, please contact VSP at 800.877.7195.
• For Medical Eye Services (MES) specific questions, please contact MES at
800.877.6372.
Need Assistance? We’re here to help!
• The Chino Valley Unified School District (CVUSD) Benefits staff and the representatives are
here to help. Benefits staff contacts are listed below.
CVUSD Benefits Staff:
Lisa Fjeldsted, [email protected], services last names A-G, ext. 1244
Rosemarie Cuevas, [email protected], services last names H-Q, ext. 1238
David Valdivia, [email protected], services last names R-Z, ext. 1246
Lisandra Maldonado, [email protected], ext. 1236
OPEN ENROLLMENT DEADLINE IS FRIDAY, May 8, 2020 AT 4:30 P.M.
EMPLOYEE PLANS AND RATES
Type Provider Monthly (12) Annual
Single $644.44 $7,733.28
Employee + Spouse $1,399.67 $16,796.04
Employee + Children $1,273.80 $15,285.60
Family $1,903.16 $22,837.92
Single $553.04 $6,636.48
Employee + Spouse $1,198.59 $14,383.08
Employee + Children $1,091.00 $13,092.00
Family $1,628.96 $19,547.52
Single $656.85 $7,882.20
Employee + Spouse $1,379.38 $16,552.56
Employee + Children $1,182.33 $14,187.96
Family $1,937.72 $23,252.64
Single $578.28 $6,939.36
Employee + Spouse $1,214.39 $14,572.68
Employee + Children $1,040.89 $12,490.68
Family $1,705.94 $20,471.28
Single $1,405.97 $16,871.64
Employee + Spouse $2,952.52 $35,430.24
Employee + Children $2,530.73 $30,368.76
Family $4,147.60 $49,771.20
Single $1,321.62 $15,859.44
Employee + Spouse $2,775.37 $33,304.44
Employee + Children $2,378.89 $28,546.68
Family $3,898.75 $46,785.00
Single $857.41 $10,288.92
Employee + Spouse $1,800.57 $21,606.84
Employee + Children $1,543.34 $18,520.08
Family $2,529.36 $30,352.32
Single $805.96 $9,671.52
Employee + Spouse $1,692.53 $20,310.36
Employee + Children $1,450.73 $17,408.76
Family $2,377.60 $28,531.20
DELTA Delta Dental PPO Composite $122.52 $1,470.24
Single $29.02 $348.24
2-Party $52.17 $626.04
Family $69.56 $834.72
VSP Composite $22.79 $273.48
MES Composite $12.70 $152.40
LIFE VOYA Composite $5.45 $65.40
(1) Add the annual costs (from the chart above) of benefits you have chosen
example: Kaiser 20 (employee + children) + Delta + VSP + Life = $17,094.72
(2) Look on the chart below to determine District's annual share for the number of hours you work
example: A 8 hour/day employee works 100%, District contribution = $8,911.00
(3) Employee annual share:
(1) minus (2) = $8,183.72
(4) Monthly Out-of-Pocket:
(3) divided by 10 months = $818.37
Hours/Day % FTE
District's Annual
Contribution for 7/01/20
thru 6/30/21
4.00 0.50 $4,455.50
6.00 0.75 $6,683.25
8.00 1.00 $8,911.00
VISION
Instructions for Calculating Your Monthly Out-Of-Pocket Payroll Deductions:
Kaiser DHMO $20
CSEBA Plan 11
BLUE SHIELD
Blue Shield
Access+ HMO $20 Plan 3
Blue Shield
Trio ACO HMO $20 Plan 3
DENTALSAFEGUARD
Plan Closed To
New Enrollees
BLUE SHIELDBlue Shield
TANDEM PPO PLAN 2
BLUE SHIELD
Blue Shield
HSA TANDEM
(ASO PPO Savings Plan 1)
NEW
PLAN
CHINO VALLEY UNIFIED SCHOOL DISTRICT
PPO BLUE SHIELDBlue Shield
ASO PPO PLAN 2
HSA BLUE SHIELD
Blue Shield
HSA
(ASO PPO Savings Plan 1)
ACT / PSYCHOLOGIST (CERTIFICATED) 2020-2021
Plans
HMO
KAISER
Kaiser $20
CSEBA Plan 8
NEW
PLAN
EMPLOYEE PLANS AND RATES
Type Provider Monthly (12) Annual
Single $644.44 $7,733.28
Employee + Spouse $1,399.67 $16,796.04
Employee + Children $1,273.80 $15,285.60
Family $1,903.16 $22,837.92
Single $553.04 $6,636.48
Employee + Spouse $1,198.59 $14,383.08
Employee + Children $1,091.00 $13,092.00
Family $1,628.96 $19,547.52
Single $656.85 $7,882.20
Employee + Spouse $1,379.38 $16,552.56
Employee + Children $1,182.33 $14,187.96
Family $1,937.72 $23,252.64
Single $578.28 $6,939.36
Employee + Spouse $1,214.39 $14,572.68
Employee + Children $1,040.89 $12,490.68
Family $1,705.94 $20,471.28
Single $1,405.97 $16,871.64
Employee + Spouse $2,952.52 $35,430.24
Employee + Children $2,530.73 $30,368.76
Family $4,147.60 $49,771.20
Single $1,321.62 $15,859.44
Employee + Spouse $2,775.37 $33,304.44
Employee + Children $2,378.89 $28,546.68
Family $3,898.75 $46,785.00
Single $857.41 $10,288.92
Employee + Spouse $1,800.57 $21,606.84
Employee + Children $1,543.34 $18,520.08
Family $2,529.36 $30,352.32
Single $805.96 $9,671.52
Employee + Spouse $1,692.53 $20,310.36
Employee + Children $1,450.73 $17,408.76
Family $2,377.60 $28,531.20
DELTA Delta Dental PPO Composite $122.52 $1,470.24
Single $29.02 $348.24
2-Party $52.17 $626.04
Family $69.56 $834.72
VSP Composite $22.79 $273.48
MES Composite $12.70 $152.40
LIFE VOYA Composite $5.45 $65.40
(1) Add the annual costs (from the chart above) of benefits you have chosen
example: Kaiser 20 (employee + children) + Delta + VSP + Life = $17,094.72
(2) Look on the chart below to determine District's annual share for the number of hours you work
example: A 8 hour/day employee works 100%, District contribution = $8,201.00
(3) Employee annual share:
(1) minus (2) = $8,893.72
(4) Monthly Out-of-Pocket:
(3) divided by 10 months = $889.37
Hours/Day % FTE
District's Annual
Contribution for 7/01/20
thru 6/30/21
4.00 0.50 $4,100.50
6.00 0.75 $6,150.75
8.00 1.00 $8,201.00
CHINO VALLEY UNIFIED SCHOOL DISTRICT
PPO BLUE SHIELDBlue Shield
ASO PPO PLAN 2
HSA BLUE SHIELD
Blue Shield
HSA
(ASO PPO Savings Plan 1)
MANAGEMENT / CONFIDENTIAL / BOARD MEMBERS 2020-2021
Plans
HMO
KAISER
Kaiser $20
CSEBA Plan 8
VISION
Instructions for Calculating Your Monthly Out-Of-Pocket Payroll Deductions:
Kaiser DHMO $20
CSEBA Plan 11
BLUE SHIELD
Blue Shield
Access+ HMO $20 Plan 3
Blue Shield
Trio ACO HMO $20 Plan 3
DENTALSAFEGUARD
Plan Closed To
New Enrollees
BLUE SHIELDBlue Shield
TANDEM PPO PLAN 2
BLUE SHIELD
Blue Shield
HSA TANDEM
(ASO PPO Savings Plan 1)
NEW
PLAN
NEW
PLAN
CHINO VALLEY UNIFIED SCHOOL DISTRICT IMPORTANT MEDICAL PLAN INFORMATION FOR 2020/2021 SHORT PLAN SUMMARY
Kaiser Permanente
Plans
Kaiser HMO 20
(CSEBA Plan 8)
$20 Office Visit
Max Out of Pocket $1500 / $3000
$100 ER / 100% Hospitalization
Chiropractic and Acupuncture Benefits
$10 Rx 30 Day / $20 Rx 100 Day
EPIC Hearing Benefit
Kaiser DHMO 20
(CSEBA Plan 11)
$20 Office Visit
Max Out of Pocket $3000 / $6000
20% Coinsurance Hospitalization
Chiropractic and Acupuncture Benefits
$10 Rx 100 Day $500 / $1000 Deductible
EPIC Hearing Benefit
HMO Plans Blue Shield Access +
HMO 20 Plan 3
$20 Office Visit
Max Out of Pocket $500 / $1500
$50 ER (waived if admitted) / 100% Hospitalization
$0 / $30 / $60 Rx Copay with Blue Shield Prescription Network
Chiropractic and Acupuncture Benefits
Concierge 855.724.7698
EPIC Hearing Benefit
Blue Shield Trio ACO
HMO 20 Plan 3
$20 Office Visit
Max Out of Pocket $500 / $1500
$50 ER (waived if admitted) / 100% Hospitalization
$0 / $30 Rx with Blue Shield Prescription Network
Chiropractic and Acupuncture Benefits
Concierge 855.724.7698
EPIC Hearing Benefit
PPO Plan Blue Shield ASO PPO
Plan 2
$250 / $500 Deductible
90% / 70% Coinsurance
$10 / $20 / $35 Rx Copay with Blue Shield Prescription Network
Max Out of Pocket $2000 / $4000
100% Preventative Care
Chiropractic and Acupuncture Benefits
Concierge 855.724.7698
EPIC Hearing Benefit
Health Savings Account Blue Shield ASO PPO
Savings Plan 1 / HSA
$1500 / $3000 Deductible
90% / 70% Coinsurance
$10 / $25 / $40 Rx Copay with Blue Shield Prescription Network
Max Out of Pocket $3000 / $6000
100% Preventative Care
Chiropractic and Acupuncture Benefits
Concierge 855.724.7698
EPIC Hearing Benefit
Dental Plan Delta Dental PPO No plan design changes
Vision Plans VSP Exam and Prescription Glasses $25
Frame/Contact $150/$150 (20/21)
MES Exam and Prescription Glasses $25
Frame/Contact $150/$150 (20/21)
New Plans Blue Shield Tandem
H.S.A and Tandem PPO
New Tandem H.S.A. and Tandem PPO Plans now available
See flyer and rates for details
For Questions call the Concierge at 855.724.7698
FOR FULL SUMMARY INFORMATION PLEASE VISIT OUR WEBSITE AT: https://www.chino.k12.ca.us/Page/1002
WAIVER OF PARTICIPATION CERTIFICATED _____ CLASSIFIED _____ Employee Name: _____________________________________ Social Security # XXX-XX- _ _ _ _ Benefit Plan Year: _______________________________
• I am aware that the medical plans offered to me meet the Affordable Care Act (ACA) actuarial minimum value requirements of 60% or greater.
• I am also aware that my required contribution toward the cost of single coverage in the lowest cost plan offered, that meets the minimum value test, does not exceed 9.5% of my W-2 income with the District.
• I further understand that if I am waiving coverage to participate in the State or Federal Exchange I am not eligible for any cash in lieu benefits or any district contribution whatsoever.
At this time, after careful review, I elect not to enroll in the major medical coverage. Or I AM COORDINATING WITH CVUSD SPOUSE: _______________________________ (NAME) Employee Signature: ____________________________ Date: ________________ PLEASE PROVIDE PROOF OF OTHER COVERAGE IF WAIVING COVERAGE AT THIS TIME (i.e. copy of current medical card) NOTE: BY DECLINING THIS GROUP MEDICAL COVERAGE (UNLESS EMPLOYEE AND/OR DEPENDENTS HAVE GROUP MEDICAL COVERAGE ELSEWHERE) I ACKNOWLEDGE THAT MY DEPENDENTS AND I MAY HAVE TO WAIT UP TO TWELVE (12) MONTHS TO BE ENROLLED IN THIS GROUP MEDICAL UNLESS I HAVE A QUALIFYING EVENT THAT MEETS THE EMPLOYERS ELIGIBILITY REQUIREMENT.
Employee Benefit Online Enrollment Instructions
What is Benefitfocus?
Benefitfocus is CSEBA’s health benefits self-service website.
Benefitfocus Online Access
Benefitfocus provides you with secure and easy access to important benefit information.
Access Benefitfocus Online
1. First, access the portal at https://chinovalley.hrintouch.com to create your online account. 2. Select the Create an Account link to begin the account creation process. Enter the following required information into the
corresponding fields:
• Last Name
• Date of Birth
• Last 4 Digits of your SSN 3. Complete the Security Check and click Next
4. Create your Username and Password. All required fields are indicated by an asterisk. After you enter all required information,
please enter your email address and phone number (home/cell).
5. Create a Secret Question and Answer. You will be asked to provide multiple questions/answers. 6. Select Save.
Navigating the System
Once you log into the system, you can easily access your information from the Home Page.
Viewing the Home Page
The first time you log in, you will see benefit enrollment information. You can also access other information, such as your
Dependents and your Login information. You can explore the links on the Home page either before or after you enroll in benefits.
Guiding You Through the Process
1. The Home page shows you the information you need to complete. Select the Get Started button to begin. 2. Navigate from page to page by selecting the Next or Previous buttons. 3. Select Cancel on any screen to return to the Home page. 4. Save your elections on each benefit Summary page when you have entered all required information. Look over your
information closely. If you need to change any information, select the Edit links next to the corresponding section. Select Save once you have made all necessary changes.
5. Dependents: If adding a new dependent, you will be asked to upload a Proof of Eligibility document directly to the platform (if applicable).
6. Review your benefit election information. Select Complete Enrollment once you have finished with your benefit enrollment process.
Note: If you have not completed and saved your benefit elections, you will receive a warning message, which allows you to return to
your benefit elections to complete and save them before leaving the current screen.
You will be returned to the Home page and receive the Congratulations message at the top of the screen. Please review and print
your Employee Detail Report for your records. You may make any changes online anytime during the Enrollment period.
For Technical Questions: 1.877.336.8082 / Monday through Friday, 5:00am to 6:00pm / Pacific Standard Time.
2020 / 2021 OPEN ENROLLMENT Understanding your KAISER coverage
Below you will find to links to Kaiser resources and the hours of availability
Chino Valley Unified School District
https://www.brainshark.com/kpaccountmanagement/vu?pi=zI8z3otvvz2Un7z0
Office Hours
Chino Valley USD
Wednesday April 27, 2020 @ 12:00 pm to 1:00 pm
Wednesday April 27, 2020 @ 3:00 pm to 4:00 pm
https://kponline.webex.com/meet/diana.g.nunez
Join by phone:
o +1-408-418-9388 United States Toll
o Access code: 579 037 496
For more information on benefits and services, call our Member Service Contact Center at:
• 1-800-464-4000, 24 hours a day, 7 days a week (closed holidays).
-----------------------------------------------------------------------------------------------------------
With social distancing in place to help keep everyone healthy, Blue Shield
launched virtual open enrollment so that you can manage your health
coverage options in the safety of your own home.
To learn about your Blue Shield health coverage options:
• Watch an open enrollment presentation on your time. Learn about how Trio HMO is
better than ever with new enhancements for 2020. The presentation will also cover your
newest plan option, Tandem PPO, how to access your plan information and how to get
your questions answered even as we are all sheltering-in-place.
• Submit your questions about your health plans, network access, and other plan details
to Shield Concierge and you will get a call back with answers. Incluso hablamos
español. Or you can call Shield Concierge at (855) 724-7698.
• Book a private, one-on-one consultation with CSEBA’s expert Blue Shield representative
when it’s convenient for you – best for complex and personal health coverage
questions. Schedule here.
• As always, you can access your plan documents, the latest news about your Blue Shield
health coverage and all your virtual open enrollment tools at CSEBA’s Blue Shield
website.
your freedom to choose.
Want the flexibility of a PPO but with lower rates? Tandem PPO may be the perfect choice for you.* Tandem is a plan that’s designed to offer you choice, quality, and flexibility. It relies on a specially selected network of providers committed to keeping your premiums as low as possible.
Provider network Blue Shield’s Tandem PPO Network extends throughout California. It offers you
access to a quality network of providers that includes all specialties and levels of care. Like other PPO plans, Tandem PPO offers you the flexibility to choose any
doctor or specialist – in or out of the network. However, you will save money when you see a doctor in the Tandem network.
Your primary care physicianAfter enrolling in a Tandem PPO plan, you will be matched with a primary care physician (PCP) in the Tandem PPO Network. Having a PCP means you have a doctor you can turn to for healthcare advice. You don’t need to visit your PCP first to receive care. And you can see any doctor or specialist that you want without a referral. If you prefer a different PCP, you can easily change it online.
Find a network doctorCheck if your preferred doctors are in the Tandem PPO Network at blueshieldca.com/networkTandemPPO. You’ll find the latest listing of PCPs, specialists, mental health providers, hospitals, dentists, vision care providers, and pharmacies. Tandem includes about 58% of doctors and 93% of hospitals from our broader PPO network.
Introducing
* For a complete description of benefits, limitations, and conditions of coverage of the plans, please see the Evidence of Coverage, which can be found at blueshieldca.com/policies.
Get care when you need it, where you need itYour Tandem plan gives you a variety of ways to access care, including more convenient virtual options. For instance, Teladoc lets you talk to a doctor anytime by phone or video chat, and NurseHelp 24/7SM can provide you with immediate health advice. You can also schedule on-demand doctor house calls with Heal.
Discover all your options at blueshieldca.com/care.
Wellvolution: Your prescription for real healthReach your health goals with Wellvolution – our digital health platform available to you through your Tandem plan. You’ll get access to a variety of health and wellness programs – including popular apps – at no extra cost.
Visit wellvolution.com to learn more.
Discount programs to help you saveBlue Shield offers a wide range of discount programs* to help you save money and get healthier. These include savings on gym memberships, massage therapy, acupuncture and chiropractic services, and more.
Visit blueshieldca.com/hw for details.
* These discount program services are not a covered benefit of Blue Shield health plans and none of the terms or conditions of Blue Shield health plans apply.
The networks of practitioners and facilities in the discount programs are managed by the external program administrators, including any screening and credentialing of providers. Blue Shield does not review the services provided by discount program providers for medical necessity nor efficacy, nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services or products.
Some services offered through the discount program may already be included as part of the Blue Shield health plan covered benefits. Members should access those covered services prior to using the discount program.
Members who are not satisfied with products or services received from the discount program may use Blue Shield’s grievance process described in the Grievance Process section of the Evidence of Coverage or Certificate of Insurance. Blue Shield reserves the right to terminate this program at any time without notice.
Heal is a trademark of Get Heal, Inc.
Healthy Savings is an independent entity that administrates services on behalf of Blue Shield of California.
NurseHelp 24/7 and Wellvolution are service marks or registered trademarks of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities.
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Exciting benefit enhancements coming in 2020:
$0 copay for all Teladoc consults
$0 copay on your first on-demand doctor house call from Heal plus $0 delivery fee on prescriptions after consults
Access to healthier foods at a reduced price through Healthy Savings
Note: These are available to new and renewing Tandem members upon their 2020 effective date or renewal.
Understanding Your Employer’s Section 125 PlanIf there was a program available that could save you money on your taxes and help you proactively plan for out-of-pocket expenses, would you take advantage of it? That’s exactly what a Section 125 Plan does – reduces your tax and increases your spendable income. Under a Section 125 Plan, employers can offer eligible benefits to employees, through payroll deduction, on a pre-tax basis.
This employer-sponsored program is designed to help you save money on important expenses like eligible insurance premiums, health-related expenses, and dependent day care expenses.
See How Much You Could SaveThis example shows what a sample employees’ bi-weekly paycheck could look like when using a Section 125 Plan. The sample is based on 24 pay periods.
Plan Today for Tomorrow’s Expenses
9000 Cameron Parkway • Oklahoma City, OK 73114 800-654-8489 • americanfidelity.com
Without A Section 125 Plan With A Section 125 Plan
$2,000.00 Pay Period Salary $2,000.00 Pay Period Salary
N/A Insurance Premiums and Out-of-Pocket Expenses -$436.15 Insurance Premiums and
Out-of-Pocket Expenses
$2,000.00 Taxable Gross $1,563.85 Taxable Gross
-$400.00 Taxes (Federal & State @ 20%) -$312.77 Taxes (Federal & State @ 20%)
-$153.00 Less Estimated FICA (7.65%) -$119.63 Less Estimated FICA (7.65%)
-$436.15 Insurance and Out-of-Pocket Expenses (After Taxes) N/A Insurance and Out-of-Pocket Expenses
(After Taxes)
$1010.85 Estimated Adjusted Take Home Pay $1,131.45 Estimated Adjusted
Take Home Pay1If you are subject to FICA taxes, there might be a slight reduction in your social security benefit due to the reduction of FICA contributions. Example is for illustrative purposes only. Please consult your tax advisor for actual tax savings.
With a Section 125 Plan Without a Section 125 Plan
Gross Bi-Weekly Income $2,000.00 Gross Bi-Weekly Income $2,000.00
Insurance Premiums- Medical insurance
- Dental insurance- Vision
- Cancer insurance- Accident insurance
- Health Flexible Spending Acct
-$250.00-$30.00-$25.00-$20.00-$15.00-$50.00
Less Tax- Federal & State at 20%
- FICA at 7.65%-$400.00-$153.00
Taxable Bi-Weekly Income $1,610.00 Bi-Weekly Income Before Benefits $1,447.00
Less Tax- Federal & State at 20%
- FICA at 7.65%- $322.00- $123.17
Insurance Premiums- Medical insurance
- Dental insurance- Vision
- Cancer insurance- Accident insurance
- Health Flexible Spending Acct
-$250.00-$30.00-$25.00-$20.00-$15.00-$50.00
Net Bi-Weekly Salary $1,164.83 Net Bi-Weekly Salary $1,057.00
S P E C I A L I Z I N G I N S U P P L E M E N T A L B E N E F I T S F O R Y O U R I N D U S T R Y
Health Flexible Spending AccountsHow It WorksA Health Flexible Spending Account (Health FSA) may be used to pay for common medical expenses throughout the year. You determine how much money you may spend on eligible medical expenses and then set that amount aside pre-tax in a Health FSA. Throughout the year, when you purchase those items, you may reimburse yourself from the account.
Eligible and Ineligible ExpensesYou may use your Health FSA to pay for a wide variety of common medical expenses for you, your spouse, and your eligible tax dependents. The Internal Revenue Service (IRS) determines which expenses are eligible for reimbursement. The following are common types of eligible and ineligible expenses.
Examples of Eligible Expenses:• Medical expenses, including medical bills to cover
deductibles and copayments
• Prescriptions drugs and over-the-counter medicines prescribed by your doctor
• Vision expenses, including eye exams, glasses, contact lenses, Lasik surgery
• Dental expenses, including dental exams, fillings, and orthodontia expenses1
• Transportation expenses relative to medical care, including mileage at the IRS allowable rate
Examples of Ineligible Expenses:• Cosmetic procedures
• Toothbrushes
• Insurance premiums
• Vitamins for general wellness
• Any expenses reimbursed under other health plans
SB-15062-1016
Visit with your American Fidelity Assurance Company account manager to learn more.
“Use or Lose”It is important that you carefully choose your election amount each year. Under IRS regulations, if you don’t use your full election amount during the required timeframe, any remaining funds are forfeited. Check with your employer to see if your plan offers a Runoff Period, Carryover Provision, and/or Grace Period.
• Runoff Period - A period after the plan year ends when you are able to submit claims that you incurred during the previous plan year but have not yet submitted.
• Carryover Provision - You are able to carry over up to $500 of unused contributions from one plan year to the next, which may be used to reimburse eligible medical expenses incurred anytime during the next plan year.
• Grace Period - An additional two and a half months following the end of the plan year in which you are allowed to incur Health FSA claims and still receive reimbursements.
Dependent Day Care Flexible Spending AccountHow It WorksA Dependent Day Care Flexible Spending Account (Dependent Day Care FSA) is used to reimburse yourself, with tax-free funds, for eligible dependent care expenses incurred while you are working. Your contribution is withheld from your paycheck before tax, which in turn reduces your overall tax. You may allocate up to $5,000 pre-tax per calendar year for reimbursement of dependent care expenses if you are married or $2,500 if filing separate tax returns.
Who May ParticipateAny employee who meets certain eligibility requirements and who has a qualifying dependent may participate in a Dependent Day Care FSA. If you are considering participating, you should be aware that you may be able to take a federal and/or state tax credit instead of participating in the Dependent Day Care FSA. Consult your tax advisor to review your options.
San Marcos Branch Office1 Civic Center Dr. #360San Marcos, CA 920691-866-523-1857 · 760-798-7515americanfidelity.com
American Fidelity Contact Information Local Office: American Fidelity Assurance PRIMARY CONTACT NUMBER 36310 Inland Valley Drive #100 For district and individuals to ask Wildomar, CA 92595 questions about AFA products Phone: (800) 365-9180 and services. Fax: (951) 600-0202 Reps: Vinci Schiro, ext. 219 Thomas Harris, ext. 373 [email protected] [email protected] Bryan Kraft, ext. 405 Nathan McCrary, ext. 397 [email protected] [email protected]
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