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Flexible Spending Accounts (FSA) are employer-sponsored benefits that allow you
to set aside a portion of your salary, before taxes, to pay for qualified health care
and dependent care (day care) expenses. Because that portion of your income is
not taxed, you end up with more money in your pocket. 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 in-
curred. You do not have to be enrolled in your company insurance plan to be eli-
gible to participate in a FSA.
You can enroll even if you receive insur-
ance coverage through your spouse’s em-
ployer.
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 products that alleviate or treat injuries or illness. Over-the-counter
medicines or products that merely benefit your general health are not reimbursable with-
out a letter of medical necessity. Examples of products that require a physician’s pre-
scription or letter of medical necessity include: pain relievers, cough medicine, allergy
medicine, vitamins, minerals, 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 Depend-
ent Care Spending Account. There are two requirements for eligible dependent care ex-
penses 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 Cred-
it for one child. If you are married and file
a separate return, the maximum election is
$2,500.
The DCA is not pre-funded; you will only
receive reimbursement for dependent care
expenses up to the amount contributed to
date. [Reference the DCA Expense 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 low-
ers your taxable income. That means you also in-
crease 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 ex-
penses for deductibles, eyeglasses, and dental visits
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 un-
der 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 phys-
ically or mentally unable to care for himself or her-
self.
✓ 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) re-
quire a physician’s prescription or OTC Prescription form to qualify as
an eligible medical expense under a Health Care Spending Account.
This provision impacts how we pay for these qualified expenses.
CareFlex Benefits Card—Pharmacies and drug stores that are cer-
tified as a 90% merchant (over 90% of sales are for qualified health care expenses) will con-
tinue 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 Inventory Information Approval System (IIAS) may accept health benefit cards
to purchase OTC medicines provided that a physician’s prescription is presented to the phar-
macist, the pharmacist dispenses the drug in accordance with applicable law, an RX number
is assigned, the pharmacist retains certain records and the records are accessible by the em-
ployer’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 ben-
efit card and will have to pay with another form of payment and submit a claim to receive
reimbursement from your account. Submitted claims must include a completed claim form,
an itemized receipt and a physician’s prescription or completed OTC Prescription form. An ad-
equate 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 prescription 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
purposes (reference the FSA Expense Guide for more information) are reim-
bursable without a prescription under a Health Care Spending Account.
Health benefit cards can be used to pay for eligible OTC products at mer-
chants 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 in-
clude a completed Reimbursement Request form and an itemized receipt. An
adequate itemized 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, circle 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 vita-
mins 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 Medical Necessity form with your claim does not guarantee that the ex-
pense 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 elec-
tion amount is available on
the card on the first day of
the plan year to pay eligi-
ble expenses.
The card swipe process
works like any MasterCard® transaction, but will only
work to transfer funds for properly coded transactions.
Transactions at merchants not providing authorized ser-
vices will be denied. Transactions that exceed your annu-
al election amount will also be denied. The CareFlex Ben-
efits 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,
discount 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. Remember to save your
itemized receipts! At times documentation is requested
to verify purchases. 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 ensure 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
overpayment. 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 CareFlex Benefits Card, or pay out of pocket
and request reimbursement 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 receipts 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 Spending 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 daycare provider. A change in status allows a participant to increase or decrease
an election 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 qual-
ifies, requesting additional documentation if necessary.
The IRS allows pre-tax contributions as long as benefits do not favor highly compensated
employees. Testing will be completed following the open enrollment period to verify ben-
efits do not disproportionately favor highly compensated employees. Participants 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 expenses 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 deter-
mine time frames for submitting claims after the end of the plan year or after you termi-
nate 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 down-
loaded from the CareFlex
website
www.careflex.com.
We make it easy to access and use your funds. There
are two ways to pay for eligible expenses:
1. Use Your CareFlex Benefits Card—This is the sim-
plest way to pay for eligible expenses! Pay using
your CareFlex Benefits Card and keep your item-
ized 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 state-
ments as documentation.
▪ Then, log on to your online account to file for re-
imbursement. 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
request form with documentation to CareFlex.
Appropriate documentation for Health Care expenses
includes: a prescription label, an itemized receipt
(must include the provider name, date and descrip-
tion of expense), an itemized statement (must in-
clude the provider name/address, patient name, date
of service, description of service, and patient respon-
sibility), or a medical insurance Explanation of Bene-
fits (EOB). NOTE: Cancelled checks, credit card
receipts and/or non-itemized receipts are not
acceptable proof of services.
The same rules apply for Dependent Care expenses.
However, the Reimbursement Request Form can act
as a receipt from the provider when the provider
completes, signs, and dates the form. If there is not
a provider signature, you must submit a detailed pro-
vider invoice or statement. [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 submitted to Care-
Flex. Participants are responsible for notifying Care-
Flex if a change is made to the dependent care pro-
vider.
CareFlex sends email notifications to participants who
have provided their email address. For online claims,
a notification will be sent once you file a claim notify-
ing 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
account 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 Flex-
ible Spending Account. Your benefit card is activated upon its initial use for eligible ex-
penses. 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.
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