What is Flex?
What is Flex?
Flexible Benefits Plan: What is it?
Your employer may offer expense categories such as the following:
- Health Savings Account (HSA)
- Flexible Spending Account (FSA)
- Dependent Day Care Expenses (DC)
- Unreimbursed Medical, Dental, and Vision Expenses
- Adoption Assistance
- Individual Disability
- Individual Insurance Premiums
- Health Reimbursement Account (HRA)
See your employers Summary Plan Description to find out which options are available to you, the participant.
Pre-Taxed Money? Yes, TAX FREE MONEY!
The voluntary salary reduction amount an employee elects to set aside for FSA expenses is taken BEFORE taxes. This means there are no payroll taxes deducted from this money.
Unlike Health Savings Accounts (HSAs), which are required to be reported on the Form 1040 or Form 1040, there are no reporting requirements for FSAs on your income tax return.
*If you enroll in the Dependent Day Care Expense category for an FSA, the amount elected for Dependent Care will be documented in box 10 of your W-2 form.
How would a Flexible Benefits Plan help me?
Your contributions to your Flex Plan are exempt from taxes, as listed above*, and will never be reported as gross income to you.
You can request reimbursement funds from your Health FSA to pay qualified medical expenses even if you have not yet had the funds deducted from your paycheck.
Questions & Answers
Frequently Asked Questions
ALL Plans beginning January 1st 2023, the maximum contribution amount for an FSA is $3,050.00. (Subject to Plan approval).
Effective 1/1/2020, ALL over the counter (OTC) medications ARE eligible for reimbursement without a doctor’s prescription. Vitamins and Supplements still require a Letter of Medical Necessity OR to be filled as a prescription through the pharmacy.
You can. However, each time you file a claim and receive a reimbursement payment, the reimbursement check stub/direct deposit notification will detail the current deposits, reimbursements, and balance(s) of your account(s). You will also receive a cumulative account balance semi-annually, whether or not you have submitted claims, so that you will be aware of your accumulated account balance. In addition, during the last quarter, you will receive an additional statement to remind you of the existing balance(s) in your account(s). It is important that you "use your balance, or lose it!"
Only Health FSA account balances of $570 or less can be rolled over if your company allows for the roll over provision.
The "Use it or Lose it" Principle:
Flex is established in accordance with Federal IRS regulations that determine how the Plan funds may be used. If you allocate money towards a certain benefit account during the Plan year and fail to use those funds for benefits eligible under that benefit account, you will lose the excess. Excess funds do not revert to FLEXBENE. They go back to the Plan to offset administration costs and/or offset benefit costs in the future. What you don't spend from your allocation, however, will be lost to you personally. Therefore you should be careful and conservative in your estimates!
The answer is “yes”, but only if you experience what is called a change in family status during the year. If you add a person to your family (birth, adoption, or marriage), if your family should decrease in size (death, legal separation or divorce), or if your spouse terminates employment, you may change the amounts by which your salary will be redirected. For specific information about this provision please call the M.A. Services claims center. You may be asked for proof of the change.
- Remember, unless you have a “change in family status,” you will not be able to reduce or increase the amount designated on your enrollment form, nor will you be able to shift amounts from one account to another. This is why we encourage you to plan carefully before you enroll.
- For information regarding The Family Medical Leave Act or COBRA, please see your Summary Plan Description or contact your Human Resources representative.
As a general rule, a desired election change will need to be found consistent with a Change in Status event if the even affects coverage eligibility. Qualifying Events for a Medical FSA change are as follows:
- To Increase Medical FSA election: Marriage, Birth/Adoption of a child, child who gains dependent status
- To Decrease Medical FSA election: Divorce, Child no longer qualifies as a dependent, death of a dependent
- To Increase/Decrease Medical FSA election: If you spouse or dependent starts/ends a job, increases/decreases work hours, gains/loses eligibility from their employer sponsored health insurance for health flexible spending coverage
Flexible Benefits Processing Questions
Doctors, Specialists, and Hospital Visits need the following:
- Patient's Name (who received services?)
- Doctor's Name (who performed services?)
- Date of Service (date the service was performed)
- Service Rendered (what did the doctor do?)
- Insurance Reimbursement (what portion is insurance reimbursing?). This can be found on an Explanation of Benefits from your Insurance Provider if it is not on your doctor's bill. If you decided not to submit for insurance reimbursement, you must send a letter indicating and certifying to that fact.
- Name of Patient (person drug is for)
- Name of Doctor (who prescribed the drug)
- Date Filled (date the pharmacy filled the script)
- Name of Drug (e.g..; Allegra, Vioxx, Concerta)
- Insurance Reimbursement (usually says "Insurance Pays $**.** - You Pay $**.**)
*ALL MEDICALLY NEEDED OVER-THE-COUNTER MEDICATIONS ARE NOW REIMBURSABLE WITHOUT A DOCTOR PRESCRIPTION.*
VITAMINS, SUPPLEMENTS AND HERBAL MEDICINES ARE NOT REIMBURSABLE UNLESS APPROVED FOR A PARTICULAR MEDICAL CONDITION THROUGH AN APPROVED LETTER OF MEDICAL NECESSITY. *
Once you have obtained the documentation for your services rendered, attach them to a Reimbursement Voucher. Be sure to complete all sections of the Voucher and sign and date it. You may then mail the completed Voucher and documentation to us at:
PO Box 587
Pittsford, NY 14534
You can also fax the information to us at 585.248.2488. Be sure to get a confirmation for the fax from the machine you are using to verify submission in case we were unable to receive it. You may submit your claim online at www.flexbene.com. You can also email your claim to email@example.com. Receipts & Documentation are required at the time a reimbursement claim is submitted.
The following are not reimbursable:
- Cosmetic procedures, such as teeth bleaching/whitening or plastic surgery
- Services that your insurance company has pended their final payment decisions (We will gladly pay you the final un-reimbursed residual claim amounts)
- Herbal medicines
- Vitamins and supplements (Requires an approved LMN)
Other items which may help you improve your overall health, such as gym equipment, swimming at the YMCA, and other adaptive equipment are only reimbursable with an approved Letter of Medical Necessity (LMN) from your doctor! This is not the same as a letter of recommendation.
Once we receive your claim we will process a payment for the amount of the receipts that you submit for your Dependent Day Care Expenses. You are only allowed to receive reimbursement up to the current balance in your Dependent Day Care account. We must have a Dependent Day Care Registration Statement on file for the current year for each provider. Also, please make sure that the Dates of Service(s) are on your receipt.
Day care services cannot be reimbursed in advance.
Your NET Take Home is ALWAYS greater with Flexible Benefits!
Using pre-tax dollars to pay medical insurance premiums, copayments and other qualified expenses, puts dollars back in your pocket rather than Uncle Sam’s!
* Check with your Flexible Benefits Specialist or HR Director to determine whether your flex plan qualifies for a state tax exemption.