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Hussmann Corporation









FSA Administrator

We partner with UnitedHealthcare (UHC) to administer our FSA
program. If you participate in the FSA program, you’ll receive a debit
card from UHC.


Using Your FSA Funds

If you sign up for the healthcare FSA or the limited FSA, you’ll
receive a debit card from UHC. It works like a bank debit card except
it is connected to your FSA. Once the card is activated, you can use it
to pay for many eligible expenses after you receive services or at the
time of purchase. Be sure to save all receipts. For a complete list of How FSA Works
eligible expenses, please go to www.myuhc.com. „ During enrollment, you elect to
set aside a certain amount of your
As a reminder, you cannot use the debit card to pay for over-the- compensation in an FSA. Depending
counter medications. You must pay for them and then ile an FSA on your medical election, you can
claim for reimbursement; the claim must be accompanied by a enroll in either the Healthcare FSA or
the limited FSA; and independently of
doctor’s prescription (such eligible over-the-counter medications that decision, you can also enroll in
include, for example, pain relievers, cold medicines, antacids, and the Dependent Care FSA. You must

allergy medication). enroll each year to participate, even if
you participated in the prior year.
You will not receive a debit card for use with the dependent care „ The amount you decide to contribute
FSA. With this account, you pay for eligible expenses out of your for the year will be deducted from
pocket, then fax, mail, or submit online a reimbursement request your paycheck in equal installments
along with a receipt for the expense to UHC. UHC then processes throughout 2016, on a before-tax

your request and promptly reimburses you through direct deposit or basis. Your contribution level will
by check. remain in effect throughout 2016
unless you have a qualiied status
change.
You can draw on the total amount of your annual contributions to
the healthcare FSA and the limited FSA at any time during the year, „ Use the tax-free money you set aside
regardless of how much has been deducted from your pay to date. to pay or reimburse yourself for

With the dependent care FSA, however, you can only make claims for eligible expenses incurred after the
FSA is established. Note over-the-
as much as you have contributed to the account to date. If you ile a counter medications are eligible for
claim for more than your account balance, you will be reimbursed as reimbursement through an FSA only if
your contributed funds become available in the account. they are prescribed by a doctor.









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