Flexible Spending

Accounts

ProBusiness, A Division of ADP National Accounts

It Pays to Participate!

FSAFSA

®

A Division of ADP National Accounts

®

What Are Flexible Spending Accounts? What Are Flexible Spending Accounts? And Why Should I Participate?And Why Should I Participate?

Flexible Spending Accounts (FSA) allow you to set aside pre-tax dollars to pay for certain health and dependent care expenses.

Flexible Spending Accounts (FSA) are a “tax free” benefit through the IRS

Flexible Spending Accounts (FSA) are a great way to reduce your taxable income

®

TaxTax Savings Example Savings Example

Without FSA With FSA

Gross Monthly Salary $3,000 $3,000

Pre-tax Contribution to Reimbursement Account - 0 - - $ 300

Taxable Salary $3,000 $2,700

Less: FICA & Federal Tax* $1,050 $ 945

Take Home Pay $1,950 $1,755

After Tax Expenses - $ 300 - 0 -

Net Take Home Pay $1,650 $1,755

Increase in Monthly Spendable Income N/A $ 105

Increase in Annual Spendable Income N/A $ 1260

* State tax savings are available in most states but are excluded from this example.

Your tax savings may vary based on your tax bracket and income.

®

Your Flexible Spending Account ComponentsYour Flexible Spending Account Components

Health Care Spending AccountUn-reimbursed or uncovered eligible health care expenses (copayments, Rx, dental/vision, deductibles)

Dependent Care Spending Account Eligible dependent care including child care, disabled spouse & incapacitated parent expenses

Premium Payment PlanPay for your share of employer-sponsored insurance premiums

®

How Do Flexible Spending Accounts Work?How Do Flexible Spending Accounts Work?

Calculate and decide on your plan year election Complete an enrollment form authorizing deduction on a pre-tax

basis from each paycheck. Your contributions will be placed into your account throughout the plan year

As you incur* expenses, submit and the necessary receipts anda claim form to ProBusiness

ProBusiness will reimburse you for your expenses

* Incurred means a Plan Participant has been provided services that gives rise to an expense, not when the Plan Participant is formally billed, charged for, or pays for the services.

®

Planning is Important!Planning is Important!

Be conservative when establishing your plan contributions

Target 80% of your estimated expenses

Only services incurred during the plan year are eligible

You have a grace period to submit claims after the plan year is over

®

Changing Your Flexible Spending Account Changing Your Flexible Spending Account ElectionElection

Once enrolled and your period of coverage begins, your election is irrevocable except in these instances:

During open enrollment

You experience a qualified family status change

®

What Are Qualified Status Changes?What Are Qualified Status Changes?

Marital status change

Number of dependents

Employment status

Dependent satisfies or ceases to satisfy the requirements for unmarried dependents

Residence

Adoption Assistance

Health CareReimbursement

Account

®

A Division of ADP National Accounts

®

Health Care Expense EligibilityHealth Care Expense Eligibility

Orthodontia treatment

Rx co-payments

Acupuncture

Chiropractic

Contraceptive Prescriptions

Psychiatrist/Counseling

Durable Medical Equipment

Over the Counter (OTC) Drugs or Medicines used for medical care

Deductibles

Co-insurance

PPO, HMO or EPOco-payments

Dental expenses

Eye glasses, contact lenses

Contact solutions, cleaners

Diabetic supplies

®

Ineligible Health Care ExpensesIneligible Health Care Expenses

Cosmetic Treatments

Cosmetic Prescriptions

Teeth Bleaching

Health Club Memberships

Herbs and Vitamins

Dietary Supplements

Union Dues or Insurance Premiums

* This is only a partial list of health care expenses that are not eligible for reimbursement from your Health Care Reimbursement Account.

®

Health Care Spending Account ClaimsHealth Care Spending Account Claims

To receive reimbursement, your documentation must include:

Date of service

Diagnosis or description of Service

Dollars outstanding after insurance or other payment (money you owe)

Dependent CareReimbursement

Account

®

A Division of ADP National Accounts

®

Can I Use The Can I Use The Dependent Care Account?Dependent Care Account?

YES, as long as...

You & your spouse are gainfully employed or looking for work

OR

You are a single, working parentOR

Your spouse is a full-time student for at least 5 months during the calendar year

®

Eligible Dependent Care ExpensesEligible Dependent Care Expenses

Care through kindergarten

If the provider cannot separate the cost of care from the cost of schooling, the entire amount is reimbursable.

If the provider separates the cost of care from the cost of schooling, only the cost of care is reimbursable.

®

Eligible Dependent Care ExpensesEligible Dependent Care Expenses

Care before & after normal school hours

Beginning with 1st grade, it is mandatory that the cost of care and the cost of schooling be separated. Only the cost of care is reimbursable. Care before & after normal school hours qualifies.

Day camps

Au pair or nanny expenses(including their associated payroll taxes)

Day care for a disabled spouse or dependent parent that lives with you

ReimbursementProcess

®

A Division of ADP National AccountsA Division of ADP National Accounts

®

Reimbursement ProcessReimbursement Process

Submit a Claim Form:

For Health Care: include Explanation Of Benefits statements, co-payment receipts, “super bills” that include description of service, date(s) of service and out of pocket costs (copies are recommended)

For Dependent Care: include receipts for expenses or have the care provider sign the claim form. The provider’s tax ID number or social security number must be provided on the claim form.

®

Don’t Forget . . .Don’t Forget . . .

If you are submitting a paper claim . . .

To sign the claim form

To indicate the $ amount being requested

Supporting claim documentation – the IRS does not allow: cancelled checks

credit card receipts

balance-due statements

®

Paper Claim Reimbursement ProcessPaper Claim Reimbursement Process

Fax your signed reimbursement form & documentation to us @ 800-269-5231

Reimbursements will occur according to the reimbursement schedule in your welcome packet

Questions? Visit our Web Site: www.probusiness.com

E-Mail us at: bsa@probusiness.com

Call us: 1-800-269-0020

®

Enroll Using the World Wide Web!Enroll Using the World Wide Web!

Access the ProBusiness’ Web site from work or home at www.probusiness.com

Refer to the step-by-step on-line instructions

Once enrolled you will receive: Confirmation your data was received

A welcome kit with a confirmation statement and reimbursement schedule following open enrollment

Enroll in your

Flexible Spending Account Plans today!

It Pays to Participate!

FSAFSA

®

A Division of ADP National Accounts