07-D TML Health Reimbursement Acct

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Step 1: When you have a covered child care expense, obtain a bill or receipt. This is your documentation for the expense. . This documentation must include the name of the child/children the care was provided for along with the date the care was provided and the amount charged. If a bill or receipt is not available, your childcare provider can document your expense using the Statement of Certification provided at the bottom of the dependent care reimbursement form. Step 2: Fill out the dependent care reiInbursement claim form. (A copy of the form is included in this booklet.) Be sure to attach proper documentation for the expense to the form. Documentation includes one of the following: · Bill · Receipt · Statement of Certification Step 3: Mail your completed reimbursement claim form and documentation to : TML Intergovernrnental Employee Benefits Pool PO Box 140167 Austin, Texas 78714-0167 Step 4: You will receive a spending account reimbursement check made out to you and mailed to your home address. Claims are paid within 10 working days from the day of receipt. TYPICAL ELIGIBLE MEDICAL OR MEDICAL-RELATED EXPENSES The following, while not intended to be complete, illustrates medical or medical-related expenses, which may be claimed as part of the Flexible Benefits plan. For complete details, please refer to IRS publication 502 - Medical. and Dental Expense. Abortion - Medical expenses associated with a legal abortion are reimbursable. Acupuncture - Medical expenses paid for acupuncture are reimbursable. Air Filter - If prescribed to treat a specific medical condition, this expense is reimbursable. Also see Personal use items. Alcoholism and drug abuse - Medical expenses paid to a treatment center for alcohol or drug abuse are reimbursable. This includes meals and lodging provided by the center during treatment. Alternative medicine - See Naturopathy. Ambulance - Medical expenses paid for ambulance service are reimbursable. Artificial Limb - Medical expenses paid for an artificial limb are reimbursable. Artificial Teeth - See Medical aids. Aspirin - See Over-the-counter. Attendant - See Nurse services. Autoctte - See Wheelchair; Automobile - See Car. Babysitting and child care - These expenses are not reimbursable under a health FSA, even if the care allows a parent to get medical care. Also see Dependent care expenses. Birth control pills - Medical expenses paid for birth control pills prescribed by a doctor are reimbursable. Braille books and magazines - Medical expenses for the cost of Braille books and magazines for use by a visually impaired person that is more than the price for regular books and magazines are reimbursable. Page 11