Page 18 - Enrollment Guide

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Healthcare FSA

The healthcare FSA allows you to allocate pretax dollars to pay for
healthcare expenses that are not paid by your healthcare plans. You

are reimbursed for eligible healthcare expenses, and your entire annual
election is available for immediate use.

Eligible expenses are those you incur for healthcare for you, your spouse,
and your eligible dependents, even if they are not enrolled in EnTrans
health plans. Healthcare includes medical, pharmacy, dental, vision and
hearing expenses that you pay for out of your own pocket except for
expenses paid by another insurance plan.

What are Eligible Healthcare FSA Expenses?

Examples of Eligible Expenses
„ Deductibles „ Dental work/orthodontia

„ Copays/coinsurance „ Diabetic supplies
„ Eye exams/glasses „ LASIK surgery

Examples of Ineligible Expenses
„ Certain over-the-counter drugs „ Vitamins

„ Obtained without a prescription „ Dietary supplements
„ Cosmetic surgery „ Expenses reimbursed or paid by
„ Non-medically necessary another health plan or insurance
prescriptions

The maximum contribution amount is $2,550.

Change in FSA Eligible Expenses

As a reminder, under Health Care Reform, certain over the-counter
medications obtained without a prescription are not eligible for
reimbursement from your healthcare FSA.

For a complete listing of eligible expenses, consult IRS publication 502
via the web at www.irs.gov.