What is Flex?

What is Flex?

Flexible Benefits Plan: What is it?

A Flex Plan functions much like a personal expense account. You set aside money from each pay check PRE-TAX to pay for eligible expenses. This reduces the amount you pay in FICA, Medicare, other payroll taxes, and increases your take home pay!

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

First you should determine what your typical medical, dental, vision and qualifying dependent care out-of-pocket expenses may be for the upcoming year, for yourself, your spouse and your eligible dependents. You can do this with the aid of a Flex Confidential Survey Form, which is available from enrollment specialists, or your HR Department. The expenses might include any eligible out-of-pocket healthcare expenses you anticipate (such as routine medical examinations, co-pays, contact lenses prescription eye glasses, dental expenses) and dependent child care (daycare) or elder care expenses, the deductible of a Medical Plan or Dental Plan and your share of expenses under Major Medical. A list of qualifying expenses is included under the Forms section. The second point to consider is how much you can afford to redirect from your take-home pay. You should be sure you can meet all of your fixed living expenses without the amount of your salary redirection, until you are able to collect reimbursement from your Flex Account.

The maximum dollar amount that each employee may contribute to the Flexible Benefits Program is determined by your employer and is indicated in your Summary Plan Description. Your Flexible Benefits Enrollment Form will indicate the per pay period dollars which will be contributed to each of the accounts (Medical, Dependent Care, Adoption Assistance, etc.). The total amount cannot be more than the annual maximum specified by the Plan, for each account.

NO! Money will be credited to your account(s) on each payday in equal installments (If you should go out on an unpaid leave of absence or Family Medical Leave, please contact your Human Resource Department for your Company’s specific guidelines). You should also know that once you decide on a salary reduction amount you cannot change or cancel it until the next Plan year, unless there has been a change in family status.

Anyone you claim as a legal dependent on your federal income tax return is an eligible dependent for medical and dependent care expense purposes. For purposes of your medical flexible spending account, any dependent that chooses to be covered to age 26 on your plan may be covered AS LONG AS he/she does not have coverage through another employer. This is regardless of his/her marital status or living arrangements. Divorced and separated parents please refer to the IRS Code Section 152(e) - Dependent Child of Divorced or Separated Parents or Parents Who Live Apart - For more information.

Reimbursable dependent care expenses are generally defined as those that are eligible for a tax credit on your federal tax return. If you are married your spouse must be employed (unless disabled or attending school full-time), and the dependent care expense must be for the specific purpose of allowing both you and your spouse to work (attend full-time classes or care for him/herself in the case of disability). The amount of reimbursable expenses cannot exceed the lesser of either your earnings or those of your spouse. The overall maximum dependent care deduction is $5,000 per year. If you are married and file a separate income tax return, the annual maximum is $2,500. In the event of a disabled spouse or full-time student, the dependent care deduction is limited to $200 per month for one (1) child or dependent and $400 per month for more than one (1) child or dependent. Dependent care expenses can be for the care of any legal dependent under the age of 13 or any other dependent who is physically or mentally incapable of self-care. Eligible charges include those for baby-sitters, companions and day-care centers that meet local regulations. Additionally, housekeepers and summer day camps may be eligible for reimbursement under the dependent care provisions. Dependent care expenses paid to your legal dependent are not eligible for reimbursement. Also, payments made to your child under age 19, even if no longer a dependent, are not eligible for reimbursement.

YES, only if your taxable wages are less than the Social Security wage base (or are reduced below the base) for several years. The Social Security wage base is, generally speaking, the amount of wages up to which Social Security taxes are withheld. Social Security benefits are based on an average of your wages and the number of years you work. The maximum benefit available will result only If your taxable wages have met or exceeded the wage base for most of the years you worked. Therefore, if your salary is reduced below the wage base, or your salary has been below it for most of your working career, your Social Security Supplement feature is available for you to insure against that potential loss. Please discuss this with your enrollment personnel, or the FLEXBENE claim center.

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 $610 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.

Prescriptions:

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 or click on Submit a Claim and you can submit everything online. If completing a paper claim form 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:

FLEXBENE
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 info@flexbene.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!

Flex accounts allow you to reduce your taxes – The higher your tax bracket, the greater your savings when using a Flex Plan! See our example, using a tax base of 28%, calculation below:

Find out how much you can save! Use our Savings Calculator below to calculate your savings!

Calculate Your Savings Here

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.

What is Flex?

What is Flex?

Flexible Benefits Plan: What is it?

Pre-Taxed Money? Yes, TAX FREE MONEY!

How would a Flexible Benefits Plan help me?

Questions & Answers

Frequently Asked Questions

Flexible Benefits Processing Questions

Your NET Take Home is ALWAYS greater with Flexible Benefits!

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CONTACT US

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