|
Information provided is
in summary format. Any difference between the summary
provided and actual contract will be settled in favor of the
contract.
|
|
Eligibility |
Eligible full- or
part-time employees |
|
Plan
Benefits |
-
Medical Reimbursement Account
-
Dependent Care Account
|
|
Annual
Benefits Limitation |
Medical
Reimbursement Account: $3,600
Dependent
Care Account: $5,000
|
|
Plan
Year |
January 1st
through December 31st. |
|
Mid-Year
Termination |
In the event that your
employment is terminated, voluntarily or
involuntarily, you may file claims against your
account as long as the incurred dates for your
expenses are prior to your termination date. |
|
Dependent
Care Expenses |
Dependent care
expenses are eligible if they enable you and your
spouse to be gainfully employed. These expenses
can also be reimbursed through the plan if your spouse
is disabled or a full-time student for at least five
months during the year. |
|
Eligible Dependents |
Children under the
age of 13, a disabled spouse or other dependents who
are physically or mentally incapable of self-care. |
|
Eligible Expenses |
Must be tied to the
care of a qualified dependent, excluding tuition,
educational expenses or overnight camps. |
|
Medical
Related Expenses |
(Many) health care
expenses incurred by you and your family not covered
by a health insurance plan, such as deductibles and
copayments. Eligible health care expenses
include, but are not limited to: |
|
Eligible Medical
Expenses |
Ambulance, nursing,
fertility treatment, chiropractic services,
wheelchairs or lifts, oxygen equipment, special beds
or mattresses, diabetic supplies, physical therapy,
Braille or other special books/items, etc. |
|
Eligible Vision Expenses |
Routine eye
examinations, eyeglasses, corrective surgery. |
|
Eligible Dental Expenses |
Routine and preventive
services, X-rays, orthodontia and appliances,
restorative and major services including fillings,
crowns, implants and bridges, dentures, periodontal
services. |
|
Eligible
Hearing Expenses
|
Routine hearing
examinations, hearing aids and repair, and repair of
special telephone equipment for the deaf. |
|
Additional Information |
Click
this link for
additional eligible expense information. |
|
Time
Frame to File Claims
|
You have until
March 31st of the following year to submit expenses
incurred through December 31st of the plan year. |
|
Permitted
Changes to Plan Contributions
|
Qualified change
in family status |
|
FSA
Direct |
Find enrollment tools
here, such as
Medical and Dependent Care Expense Calculators. |