07-D TML Health Reimbursement Acct

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THE EFFECT OF THE PLAN ON OTHER BENEFITS Some of the benefits provided by the Member Plan (e.g., pension benefits, group life insurance benefits) are determined on the basis of your earnings. For the purpose of these benefits, the Plan provided by the Member, will be based on your earnings before any salary reduction contributions to the spending account plans are taken into . account. Under present law, your earnings for the purpose of determining your Social Security benefits and FICA taxes do not include salary reduction contributions under the Member Plan, including salary reduction contributions to these spending account plans. In almost all cases, the value of the FICA, Federal and state income tax savings to you will exceed the reduction in your eventual Social Security benefits. Further information on this subject is available from the Member. CLAIMS INFORMATION Payment of Claims In order to receive reimbursement for an eligible claim for dependent care or unreimbursed health care expenses, you must complete the form supplied to you by your employer. This form may require you to submit additional information pertaining to your claims, such as a signed statement from your physician for health care services received. All payments for claims will be reimbursed within 10 business days of receipt. If claims remain at the end of the Plan Year for which there are no remaining funds in your account to reimburse you, these claims will not be paid, carried over or charged against the balance in your account in any subsequent Plan Year. You will not be reimbursed for these excess claims. All payments for claims will be made directly to you and not any provider of service. PREMIUM CONVERSION PLAN The Premium Conversion Plan allows you to pay for health care contributions, which you pay and are payroll deducted, on a pre-tax basis and reduce your taxable income. Examples are the contributions for dependent medical, dental or vision coverage. Also included are contributions for optional employee life, but not dependent life. It is like getting an instant tax refund every payday. In fact, many employees may even increase their take-home pay just. by participating in this option. Note: A maximum of $50,000 basic and/or optional life can be claimed on a pre-tax basis. Any group life insurance in excess of $50,000 is taxable and must be paid with after tax dollars. Once Enrolled. You Mav Not ChaDl!:e your election to have your dependent contribution taken out of your paycheck pre-tax for the remainder of the flex plan year unless a qualifying event occurs (see page 6). UNREIMBURSED HEALTH CARE SPENDING ACCOUNT The Umeimbursed Health Care Spending account reimburses an employee's pledge amount not to exceed the employer's unreimbursed health care spending amount limit to a maximum of $5,200 per plan year for any health care related expenses that have not been (or will not be) paid or reimbursed through a group or individual health care plan. What Expenses are Eligible for Reimbursement? Only medical expenses that are not covered by your medical insurance and that are allowable by the Internal Revenue Service (IRS) may be reimbursed from your account. Expenses for your dependents are included as long as that person is a dependent as defined by the IRS. Included is an alphabetical list of items that are encountered frequently by persons utilizing flexible spending accounts. Some of these items may be reimbursed, and some may not; a brief note L1dicating which category the item falls into follows each item. Page g