2006-041-RES-Health Reimbursement

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TABLE OF CONTENTS TML INTERGO VERN'MENT AL .............................................................................................................................1 ' INTR 0 D U eTI ON............. ...... ....... ...... ..... .... II ........... .... ........... ............ ......... ft. ........ ...... .............. .......... ........ I.... ....... 4 GENERAL INFORl\1A TION.....................................................................................................................................4 NAME AND TYPE OF PLAN AND FISCAL yEAR............................................................................................................4 ADMINISTRATION OF THE PLAN .... ........ ...... ........ ..... ... ... ... .......... ........ ...... ... ........ ... ............ .... ... ....... ..... .......... ..... .....4 AGENTS FOR SERVICE OF LEGAL PROCESS................................................................................................................. 4 AMENDMENTS TO OR TERMINATION OF THE PLAN .....................................................................................................4 FLEXIBLE BENEFIT PLAN ....................................................................................................................................5 How THE PROGRAM WORKS......................................................................................................................................5 WHAT ARE BEFORE-TAX DOLLARS? .......................................................................................................................... 5 ELIGIBILITy............................................................................................................................... ................................. 5 CHANGES IN ELIGIBILITY... .... .... ............. ................. ................. ........ ....... .................. ...... ....... .............. ........... ..... ..... 5 CHOOSING A DEPOSIT AMOUNT .................................................................................................................................5 RESTRICTIONS ON CHANGING YOUR DEPOSIT AMOUNTS ..........................................................................................6 SEPARATION FROM SERVICE... ............. ....... ............. .............. ........ ...... ............... ......... ................ ........ ........... ........... 6 FORFEITURE OF BENEFITS ........... ......... ...... ............... ...... .... ..... .... .... ......... .............. .... ......... ... .......................... .........7 No TRANSFER BETWEEN ACCOUNTS..........................................................................................................................7 REIMBURSEMENTS .. ......... ....... ... ............. ....... ........ ..... ... ............. ........... ....... ... ................... ....... ............... .... ... .......... 7 FLEXIBLE SPENDING ACCOUNT STATEMENTS ............................................................................................................ 7 ACTIVE DUTY RESERVIST ... .... .... ......... ...... ............... ...... ...................... ....... ........ .... ..... ....................... ..... ...... ........... 7 THE EFFECT OF THE PLAN ON OTHER BENEFITS .......................................................................................8 CLAIMS INFORMATION ....... ..... .... ....... .... ...... ................ ..... ...... .......... .... .... ........... ........... ........... ........ .......... ....... 8 PAYMENT OF CLAIMS ................................................................................................................................................. 8 PREMIUM CONVERSION PLAN ...........................................................................................................................8 UNREIMBURSED HEALTH CARE SPENDING ACCOUNT .............................................................................8 WHAT EXPENSES ARE ELIGIBLE FOR REIMBURSEMENT? ............................................................................................ 8 How TO GET REIMBURSED ........................................................................................................................................ 9 PRIVACY OF YOUR HEALTH INFORl\1A TION .................................................................................................9 DEPENDENT CARE REIMBURSEMENT ACCOUNT ......................................................................................10 WHY You SHOULD BUDGET CAREFULLY ................................................................................................................1 0 How TO GET REIMBURSED ......................................................................................................................................1 0 TYPICAL ELIGmLE MEDICAL OR MEDICAL-RELATED EXPENSES .....................................................11 DEFINITIONS ....................................................................................................................,.....................................21 . CAPITAL EXPENSES .............................................................................................................................................23 OPERATION AND MAINTENANCE .................. ........... ........ ............................. ....................... .............. .............. ........23 IMPROVEMENTS TO PROPERTY RENTED BY A PERSON WITH DISABILITIES............................................................... 23 El\fPLO'YEE ENROLLMENT FORl\1...................................................................................................................24 UNREIMBURSED HEALTH CARE REIMBURSEl\fENT FORl\1....................................................................25 DEPENDENT CARE REIMBURSEMENT FORl\1..............................................................................................26 Page 3