What is a Flexible Spending Account (FSA) plan?

What is a Flexible Spending Account (FSA) plan?
A Cafeteria Plan is a benefit provided by your employer which allows you to contribute a certain amount
of your gross income to a designated account or accounts before taxes are calculated. These accounts are
for insurance premiums and medical or dependent care expenses not covered by your insurance, from
which you can be reimbursed throughout the plan year or claim period as you incur the expenses. A
cafeteria plan allows you to reduce your gross income, thereby reducing the amount you pay in Federal,
Social Security and some State taxes – a savings of between 25% and 40% of every dollar you contribute
to the plan.

How does my net pay increase by participating in a cafeteria plan?
Since your gross income is reduced by the amount you place in a cafeteria plan account, the amount you
pay in taxes is lower. This tax savings results in a higher net income. For example, let’s say your adjusted
monthly salary is $3,000, resulting in a tax deduction of $750/month. Your take-home pay is $2,250. If
your unreimbursed medical and dependent care expenses come to $400/month, then your net is $1,850.
However, if you deposit that $400/month into a cafeteria plan account, then your taxes are reduced by
$100, leaving your net pay $1,950 – or $1,200 more per year!

Does participating in a cafeteria plan reduce my Social Security
benefits when I retire?
Yes. Generally speaking, however, the benefit of the tax savings now more than outweighs the reduction
in Social Security benefit after you retire. Discuss your specific financial situation with a tax consultant.

What is a Flexible Spending Account (FSA)?
An FSA is an account into which your contributions (from pre-tax salary reductions) for medical and/or
dependent care expenses are deposited. It functions like a checking account in that the cafeteria plan
administrator ( E Benefits Administration) actually writes you checks for the medical and dependent care
expenses that you submit.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

How do I benefit from participating in an FSA?
There at least two significant ways to benefit from an FSA. The first is by taking advantage of the tax savings. By
reducing your gross income, you pay less in taxes, take home more pay and have the freedom to choose how your
money is used or invested. The second benefit is the “cash flow” increase built into the medical FSA (not the
dependent care FSA). This means that no matter how much money you have actually contributed to the plan at any
given point, you can still be reimbursed up to your entire annual election. So a major medical expense at the
beginning of the claim period can be reimbursed even though few, if any, deposits have been made into the account
at that time. This applies to the medical FSA only.

Does it save me more money to use a dependent care FSA or to
receive the dependent care credit on my tax return?
In general, the higher your adjusted gross income; the more likely it is that you will benefit more from participating
in the dependent care FSA than from taking the tax credit. Note that the amount you elect to place in your dependent
care account reduces your potential tax credit.

What is the maximum amount of money I can elect annually for an
FSA?
For a medical FSA, the maximum annual election is set by your company up to $2,500 for plan years beginning in
2013,, and can be found in the Summary Plan Description (SPD). For a dependent care FSA, the maximum annual
election is set by the IRS and is as follows:

        Married Filing Jointly or Single Head of Household, $5,000
        Married Filing Separately, $2,500

What is the Plan Year?
The Plan Year is the period specified in the SPD that determines the beginning and ending dates of plan
contributions (salary reductions). Usually 12 months. For more information on your plan year, please refer to your
SPD or contact an E Benefits Administration Member Services Agent.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

What is the Claim Period?
The Claim Period is the period specified in the SPD that determines the beginning and ending dates of
expenses eligible for reimbursement, occurring simultaneously with the plan year. In other words, it is the
period of time that claims can be incurred and reimbursed from current plan contributions. The beginning
date always coincides with the beginning of the plan year, but the end date may not.

What if I am not billed for an expense until after the end of the
claim period?
After the claim period, there is a “Run-Out” period as specified in the SPD for submitting claims incurred
during the claim period. This allows all eligible expenses up to the very last day of the claim period to be
submitted and reimbursed.

Can I change my election after the plan year starts?
You can only change your election if you have a qualifying change of status event. Qualifying events
include:

       A change in the participant’s legal married status
       A change in the participant’s number of dependents
       A change in the work schedule of the participant, the participant’s spouse, or the participant’s
        dependent

What happens if there is money left in my account at the end of the
claim period after all my eligible expenses have been reimbursed?
Unless your company’s plan document states otherwise, any funds remaining after all eligible
reimbursements have been made is forfeit to the cafeteria plan; these funds are used to offset plan losses
and expenses.

In order to prevent the loss of funds, it is important to plan carefully so that your annual election matches
your actual expenses as closely as possible. Of course, it is impossible to project with 100% accuracy, so
you may come up short or have a little money left at the end of the claim period.

However, it is important to realize that loss of funds does not necessarily indicate a loss out-of-pocket. In
most cases, even when participants claim less than their election, they still save money by participating in

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

the plan. For example, if your calculated annual tax savings is $1,200 (based on a $4,800 election) and
you only use $4,600, you’ve still saved money – in this example, $1,000.

How do I find out the balance of my medical and dependent care
FSAs?
Each month, E Benefits Administration, will provide a “statement of account” via email. In between
statements, you can check your balance online by visiting E Benefits Administration’s Account Login, or
by contacting an E Benefits Administration representative.

What happens if I leave my place of employment while participating
in an FSA?
Expenses incurred during the plan year prior to termination can be submitted for reimbursement for a
period specified by the employer in the Plan Document (usually up to 30, 60 or 90 days after termination).

Who is considered a dependent?
For medical accounts, the general rule is that if you can claim an individual as a dependent on your tax
return, then you can claim them under the Cafeteria Plan.

For dependent care accounts, only children under the age of thirteen or adults or children over the age of
thirteen who are incapable of self-care are considered dependents. In addition, the dependent must reside
with the participant for the majority of the year in order to be eligible for coverage under the dependent
care FSA.

Please note: to be eligible for a Dependent Care FSA, a participant must be employed and, if married, the
participant’s spouse must also be employed. A change in employment status for either the participant or
the participant’s spouse may result in a change in or loss of eligibility.

For more information, see the IRS.gov Dependent Rules.

What expenses are eligible for reimbursement from an
FSA?

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

Amounts paid to a daycare provider either in or out of the home are eligible, as long as the provider is not
a dependent or relative under the age of 19. Pre-school tuition is reimbursable, but tuition and expenses
from grade K-12 schooling are not.

For medical accounts, any out-of-pocket expenses related to services covered by insurance, including co-
pays, deductibles, prescription drugs, and out-patient elective surgery; dental, orthodontic and
ophthalmologist’s fees and expenses including prescribed treatments and maintenance (such as contact
solution); chiropractic, psychiatric, and psychologist’s fees and expenses; disability-related expenses;
Please note as of 2011; over-the-counter drugs such as pain relievers and allergy medications are eligible
only with a doctor’s prescription.

In general, any treatment for a specific medical condition is reimbursable; cosmetic or preventative
expenses are not. For example, teeth-whitening and multi-vitamins are not eligible, but prescription
sunglasses are.

Insurance premiums are not eligible for reimbursement under the Medical FSA.

How do I get reimbursed for my expenses?
Using a Claim Form, you may submit your claim and supporting documentation to E Benefits
Administration by mail, fax or electronic submission. Please visit the Contact Us page for more
information.

How often will my claims be reimbursed?
Your company’s claims will be reimbursed on regularly scheduled processing days. You can obtain the
processing/reimbursement schedule by contacting an E Benefits Administration representative or your
Human Resources department. E Benefits Administration has a submission deadline of noon (12pm EST)
on the day prior to your company’s processing date. In other words, any claims received by noon (12pm
MST) the day before the processing date will be reimbursed (if eligible) on that date.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

Can I be reimbursed for a service that has been provided although I
have not yet paid the bill?
The operative date for claim reimbursement is the service date, not the date the expense is paid. You may
submit expenses billed to you before you remit payment, but you may only submit the expense once. You
may not submit the expense again after it has been paid.

How are orthodontic expenses reimbursed?
Orthodontic expenses are eligible to be reimbursed in the same way as any other medical expense.
However, because such treatments generally cover an extended period of time, you have the option of
scheduling monthly reimbursements rather than payment up front. In addition, if your current election
does not cover the total expense of the treatment(s), it can be reimbursed over multiple plan years as long
as the treatment dates occur during those years.

How do I track my account(s) online?
To login to your account, go to the E Benefits Administration Account Login page. There you will be
prompted to register for an Online Account. Once you are logged in, you can change your Username and
Password and change or edit your personal information. You can also check your account balance(s) and
verify the status of any claims you submitted.

Please note: when updating your personal information it is important to provide your e-mail address for
the fastest and most efficient communication. Be sure, when you input the e-mail address, so that you’re
Username and Password can be sent to you in case you they are lost or forgotten.

What is a Flex Card and how does it work?
A Flex Card is a stored value card that reflects the balance of your medical and/or dependent care
reimbursement account or flexible spending account. Since there are no transaction fees or pin numbers,
the card should be swiped through the provider location scanner using the “credit/credit card” option.
When the Flex Card is swiped, the funds are immediately and directly withdrawn from your account.

How do I benefit from using a Flex Card?
Using a Flex Card eliminates the time spent waiting on reimbursement checks. This allows you to bypass
the inconvenience of restricted cash flow arising from the “lag time” between the expense and the
reimbursement. However, you may be asked to document your expense after using the card.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

Will I still need to keep my receipts?
Yes. According to IRS regulations, each Flex Card transaction needs to be verified for eligibility in the
same way that paper claims are. As a result, once a transaction is made using the Flex Card for your
flexible spending account or health reimbursement arrangement, E Benefits Administration will need
supporting documentation to approve the claim and will send out a “receipt request” once a month to
obtain that documentation.

Will I be asked to document all the expenses I use my card for?
Not necessarily. Due to recent legislative changes by the IRS, not all Flex Card transactions will require
documentation if properly “coded” in the new Inventory Information Approval System (IIAS). With the
IIAS in place, provider locations with “non-medical” Merchant Category Codes (MCCs) will be able to
“auto-check” the item in question for eligibility under a reimbursement plan. Items marked under the
IIAS as eligible will be accepted on the Flex Card and ineligible items will be denied. This new system
will eliminate both the hassle of submitting claims or documentation for eligible items and the
inconvenience of having to repay the reimbursement plan for improperly swiped ineligible items.

What is a “receipt request” and what do I do with it?
A receipt request is a notice that supporting documentation is needed for verification of transactions that
have occurred. This notice lists “initial receipt requests”, “second receipt requests”, and “ineligible
expenses” (items not approved or not documented). Automatically approved transactions will not be
included on that notice. When you receive a receipt request, gather all supporting documentation for each
transaction listed and submit it. DO NOT use a traditional (paper) claim form for a Flex Card transaction.
Using a paper claim form for a Flex Card transaction may result in the expense being tagged as a
duplicate (ineligible) claim.

Where can the Flex Card be used?
The Flex Card can be used at any properly coded provider location (including pharmacy and daycare) that
accepts the provider logo on your Flex Card (MasterCard)

What if the provider location doesn’t accept my card?
If you are unable to use the Flex Card, simply pay the expense and submit it for reimbursement on a paper
claim form.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058

When will I receive my Flex Card?
You will receive your Flex Card approximately 10-12 business days from the date that E Benefits
Administration receives your enrollment information. Expenses incurred prior to receipt of the card (after
the date of enrollment) can be submitted for reimbursement as a paper claim.

How long is my Flex Card valid?
Generally, your Flex Card will be valid for three years from the month that you receive it, unless you
terminate your participation in the plan or all cards are re-issued for your plan. Approaching the
expiration date, a new card will automatically be ordered and sent to you.

Can I order additional Flex Cards?
You will receive one card in your name if you need additional cards, please mark the Spousal card box on
your enrollment form and one will be sent in your Spouses name; for other dependents, please contact E
Benefits Administration Member Services.

What happens if I use my Flex Card for an ineligible expense?
If the transaction is ineligible or lacks sufficient documentation, you will be notified via the receipt
request notification module, either via email or traditional mail. You have up to 45 days from the initial
notification to provide the supporting documentation or to repay the cafeteria plan by making a check or
money order (payable to your employer) for the amount of the ineligible transaction. At the end of that
period (45 days from the initial notification), if the expense has not been approved or repaid, your Flex
Card will be deactivated. You will need to repay your Employer Plan or provide documentation for your
card to be reactivated.

www.ebenefitsadministration.com | PO Box 357, Kuna, ID. 83634| PH: 208-391-2567 |Fax: 888-876-1058