Page 14 - T:\HR\Div\Employee Services (Cust_None)\Flipbuilder\Benefits Resource Guide FB Project\

Section 125 plan and flexible spending accounts, cont.

FSA rules and regulations
Below are IRS regulations regarding the Section 125 plan and Flexible
Spending Accounts:

■ Each type of FSA account is separate, the monies cannot be
commingled.
■ Expenses must be incurred during the plan year.
■ For the Health Care FSA, you may roll over up to $500 from one plan
year to the next. Balances more than this allowed roll over amount are
forfeited at the end of the plan year.
■ For the Dependent Care FSA, unused account balances at the end of
the plan year will be forfeited.
■ You have 90 days after the end of the plan year to submit claims for
expenses occurred during the plan year.
■ You must make new elections each plan year during annual open
enrollment to continue your participation.
Using your FSA account and reimbursements
There are a few ways to spend your FSA contribution to pay for eligible
expenses as shown below. If you need to submit a manual claim, claim forms
are on myuhc.com.

■ Using your FSA Mastercard – If you enroll in the FSA, you will receive
an FSA MasterCard to pay for eligible expenses and services. If you do
not use your FSA MasterCard, you may be reimbursed based on the
type of expense (shown below).
■ Dependent care reimbursements – Submit a Dependent Care
Flexible Spending Account Claim Form.
■ Health care reimbursements – For an in-network medical claim,
UnitedHealthcare will automatically process a check reimbursement
from your FSA. You may also provide UnitedHealthcare with banking
information to have reimbursements paid to you via direct deposit.
■ For an out-of-network medical claim, submit a Health Care FSA Claim
Form. Services cannot be reimbursed by any other health care plan or
program, federal, state, or governmental program, workers’
compensation, or any other insurance policy.
■ Pharmacy purchase reimbursement – Submit a Health Care FSA
Claim Form.

Employee Benefits Guide 11