Office of Group Benefits
Annual Enrollment 2012
FOR ACTIVE EMPLOYEES & RETIREES WITHOUT MEDICARE1
Welcome
This presentation is a summary of
information and does not purport to present
complete details of all plan options offered
by the Office of Group Benefits. For
complete information on each plan option,
individuals should read plan documents
carefully and also consult other OGB and
plan administrators’ publications.
Welcome
This presentation will cover:
 Ways to Save
 Eligibility
 Overview of Health Plans
 Life Insurance
 Flexible Benefits
Office of Group Benefits
OGB serves state agencies, universities and school boards
Mental Health
Benefits
1%
Administrative
Costs
3.5%
Prescription Drug
Benefits
21.9%
Medical Benefits
71.4%
Life Insurance
2.2%
OGB’s administrative costs are only 3.5% of total costs
(June 30, 2011)
Annual Enrollment Timeline
Annual Enrollment ends
Deadline for employees to submit
health plan enrollment forms to HR
(if changing plans)
Annual Enrollment begins
October 3
November 4
Flexible Benefits Annual Enrollment ends
Deadline for employees to submit
Flexible Benefits forms to HR
(may be earlier for some agencies)
January 1
2012 plan year
begins
Ways to Save
Your Health: Our Premium Priority
7 Ways to Save
1
Choose the right health plan for you
 Out-of-state coverage differs by plan
 Out-of-state dependent? Job transfer? Travel?
 Are your providers in the plan’s network?
 All plans accessible through OGB website www.groupbenefits.org
Stay in your health plan’s provider network
 Avoid balance billing
3
Request generic drugs
 Same active ingredients and big savings
 Preferred drug list at www.CatalystRx.com
2
Your Health: Our Priority
7 Ways to Save
4
Get preventive (wellness) exams
 Prevention
 Early diagnosis
Use Flexible Benefits (active employees)
 Pre-tax deduction saves money
 More take-home pay
6
5
Sign up for Diabetic Sense program (PPO & HMO plans)
 Get test supplies free
 Free glucometer
 Provided by Catalyst Rx through Liberty
 1-888-341-8582
Sign up for Living Well Louisiana program (PPO & HMO plans)
 Access to health coaches 24 hours a day, 7 days a week
 Prescription drug incentive for active LWL participants
 Lower co-pays
1-800-383-0115
7
Prescription Cost Comparison
Brand-Name Drug
insomnia
$ 173.36
migraines
342.63
sumatriptan
66.85
231.48
gabapentin
21.54
prostate hyperplasia
143.47
tamsulosin
42.06
depression
198.93
venlafaxine XR
129.85
anti-viral
268.43
valacyclovir
149.43
pain
260.89
tramadol ER
138.33
258.79
bupriopion XL
61.16
seizures
404.79
lamotrigine
24.26
depression
320.23
fluoxetine
12.39
seizures
422.89
topiramate
31.06
147.35
simvastatin
9.59
147.95
pravastatin
12. 20
140.85
paroxetine
13.68
Ambien
Imitrex
seizures
Neurontin
Flomax
Effexor XR
Valtrex
Ultram ER
Wellbutrin XL
Lamictal
Prozac
Topamax
Zocor
depression
cholesterol
Pravachol
Paxil
Average Cost per Approved Generic Average Cost per
Prescription *
Alternative
Prescription *
cholesterol
depression
zolpidem
* Average costs as of 8-31-11 utilization; subject to change.
$
4.06
Source: Catalyst Rx
Living Well Louisiana
Health Management Program
For PPO and HMO Plans
Free health management program for active employees,
retired employees without Medicare and rehired retirees
without Medicare who are diagnosed with 1 or more of
these 5 ongoing health conditions:
 Diabetes
 Heart disease
 Heart failure
 Asthma
 Chronic obstructive pulmonary disease (COPD)
Living Well Louisiana is not available to individuals who
have Medicare as primary coverage
Living Well Louisiana
Health Management Program
For PPO and HMO Plans
 Once enrolled, you have access to...
 Health coaches – 24 hours a day, 7 days a week
 Online health information and resources
 Reduced co-payments to eligible LWL
participants for prescription drugs used to
treat these 5 chronic conditions
When Medicare Part A and/or B become primary,
you are no longer eligible for LWL program
Living Well Louisiana
Health Management Program
For PPO and HMO Plans
 Active participation requires:
 Initial assessment by phone
 Follow-up contacts by phone, mail or email
 Ongoing relationship with LWL health coaches
(contact at least once every 3 months)
If plan member fails to maintain contact with health
coaches, or if Medicare becomes plan member’s
primary health coverage, participant is no longer
eligible to participate in LWL program or receive
reduced co-pay on applicable prescription drugs
Premium Cost-Saving Strategies
Married Couples
If both are state or school employees...
Both eligible?
May save if split coverage
Eligibility
Eligibility – Same for All Plans
Full-Time Employees and Dependents
 Legal spouse
Louisiana does not recognize same-sex marriages regardless of
other states’ laws
 Children up to age 26 – regardless of child’s student,
marital or tax status
No one can be enrolled simultaneously as both an employee and
a dependent in OGB health plans or life insurance
No dependent can be covered by more than one employee
Dependent verification required
Eligibility – Children
• Natural child of you or your legal spouse
• Legally adopted child
• Child placed in home for adoption
• Child in home under legal guardianship
or custody
• Grandchild dependent on you whose
parent is your covered dependent
Dependent Verification
Plan member must provide proof of the
legal relationship of each dependent
within 30 days of date of application for
coverage
Proof: Official documents
Marriage certificate
Birth certificate
Other court records or legal documents
Eligibility Change – Newborns
Effective July 1, 2011, OGB must receive
child’s birth certificate within 6 months of birth
 Birth letter will suffice for first 6 months only –
if received within 30 days of DOB
 OGB will send reminder letter 90 days after
birth date
Over-Age Dependents
Covered child under age 26 who is or
becomes incapable of self-sustaining
employment is eligible to continue
coverage as an overage dependent
 OGB must receive required medical records
before dependent reaches age 26
 Definition of incapacity broadened – now
includes both mental and physical incapacity
Pre-Existing Condition Limitation for
New Hires and Late Applicants
Must complete enrollment form (GB-01) within 30 days
for new dependent … otherwise, pre-existing
condition limitation (PEC) applies
 If diagnosed or treated within 6 months prior to enrollment
date, condition is pre-existing ... no benefits are payable
for that condition in first 12 months of coverage
 PEC limitation does not apply to anyone under age 19
 May be exempt from pre-existing condition limitation if
continuously covered without 63-day break in coverage
prior to enrollment date
Retirement
 Coverage must be in effect prior to
retirement date
 Participation schedule applies to...
 Employees who joined an OGB health
plan on or after January 1, 2002
 Dependents who joined an OGB health
plan on or after July 1, 2002
 Prior OGB health plan coverage as a
spouse qualifies in computing years of
participation
Retiree Participation Schedule
Years of OGB Health Plan
Participation
State Premium
Subsidy %
Less than 10 years
19%
10 years or more, but less than 15 years
38%
15 years or more, but less than 20 years
56%
20 years or more
75%
Schedule not affected when you change OGB health plans
Medicare and OGB Coverage
If you reached age 65 on or after July 1, 2005, AND are
retired AND are eligible for Medicare Part A premium-free,
then…
 You MUST enroll in Medicare Part B to receive OGB
health plan benefits for medical expenses covered by
Medicare Part B
 You must submit Social Security verification to OGB:
 If eligible – submit copy of Medicare card
 If not eligible – submit letter from Social Security
This also applies to your covered spouse
If you are not yet retired, this will apply when you retire
Overview of Health Plans
OGB Health Plans for 2012
PPO
(Statewide)
Administered by
OGB
HMO
(Nationwide)
Administered by
Blue Cross and Blue
Shield of La.
CDHP-HSA *
Regional HMO
(Regions 6, 7, 8 & 9)
Fully insured by
Vantage Health Plan
Medical Home HMO
(Nationwide)
(Statewide – must choose
PCP in Region 9)
Administered by
UnitedHealthcare
Fully insured by
Vantage Health Plan
* CDHP-HSA plan is not available to retirees;
other plans are available to all employees and retirees
Key Points
 Can change health plans during Annual
Enrollment
 Compare costs, benefits and restrictions when
choosing a plan
 Active employees and retirees who choose to
keep same plan do not have to fill out a form
 Active employees who want to change plans
must notify your HR office
Key Points
Retirees who want to change plans must…
 Fill out an OGB enrollment form … or
 Write a letter to OGB that includes:




Your plan choice
Your name and address
Your date of birth
Your daytime phone number
Sign form or letter and mail it to ...
OGB Eligibility Division
P.O. Box 66678
Baton Rouge, LA 70896
... or visit any OGB Agency Services office
Plan Member Out-of-Pocket Expenses
In-Network
PPO
HMO
Medical Home HMO
CDHP-HSA
Regional HMO
Coverage
Area
All regions
Nationwide
Statewide ***
PCP must be in Region 9
(northeast LA)
Nationwide
Regions 6, 7, 8 & 9 ***
(Baton Rouge, Alexandria,
Shreveport & Monroe)
Administrator
OGB
Blue Cross
Vantage Health Plan
UnitedHealthcare
Vantage Health Plan
Lifetime
Maximum
Unlimited
Deductible
$500 active
$300 retiree
3-person maximum
None
None
$1,250 employee
$2,500 employee + 1
$3,000 family
None
Out-of-Pocket
Maximum
$1,000 per person **
$1,000 per person
$3,000 per family
No maximum
$2,000 per person
$1,000 per person
$3,000 per family
Hospital
In-Network
10% of
contracted rate*
Pre-certification
required
$100 per day
$300 maximum per
admission
Pre-certification
required
$100 per day
$300 maximum per
admission
Pre-certification required
20% of
contracted rate*
Pre-certification
required
$100 per day
$300 maximum per
admission
Pre-certification required
Doctor Visits
10% of
contracted rate*
No referral required
Co-pay $15 PCP
$25 specialist
No referral required
Co-pay $10 PCP
$25 specialist
Referral required for most
specialists; PCP required
20% of
contracted rate*
(primary care &
specialty care)
Co-pay $15 PCP
$25 specialist
Referral required for most
specialists; PCP required
* Subject to plan year deductible and/or applicable co-insurance
** Active employees and retirees without Medicare
*** Active employees and retirees without Medicare
Plan Member Out-of-Pocket Expenses
In-Network
PPO
HMO
Medical Home HMO
CDHP-HSA
Regional HMO
Referrals
None required
None required
Required for all specialists
except OB/GYN;
1 routine eye exam every year
None required
Required for
most specialists
Maternity
Doctor Visits
10% of
contracted rate *
$90 co-pay
(first visit only)
$10 co-pay
(first visit only)
20% of
contracted rate *
$90 co-pay
(first visit only)
No referral required
MRI or
CAT Scans ***
10% of
contracted rate *
$50 co-pay
$50 co-pay
20% of
contracted rate *
$50 co-pay
Sonograms ***
10% of
contracted rate *
$25 co-pay
$25 co-pay
20% of
contracted rate *
$25 co-pay
Chemotherapy
Radiation Therapy ***
10% of
contracted rate *
$15 co-pay
$25 co-pay per treatment
20% of
contracted rate *
$25 co-pay
Routine
Mammograms **
0% of
contracted rate
$0 co-pay
100% covered
Member pays $0
$0 co-pay
Routine PSAs **
0% of
contracted rate
$0 co-pay
100% covered
Member pays $0
$0 co-pay
Cardiac
Rehabilitation ***
10% of
contracted rate *
Complete within
6 months
$15/$25 co-pay
20% co-insurance
Pre-authorization required
Up to 18 visits in
6-week period
20% of
contracted rate *
$15/$25 co-pay
Emergency Care
$150 deductible
$100 co-pay
$100 co-pay
20% of
contracted rate*
$100 co-pay
* Subject to plan year deductible and/or co-insurance * * Age and time restrictions may apply
*** Prior authorization may be required
Plan Member Out-of-Pocket Expenses
Out-of-Network Providers
PPO
Louisiana
resident
30% of
fee schedule *
Out-of-state
resident
10% of
fee schedule *
HMO
$1,000 deductible per
person; $3,000
maximum per family
30% of reasonable
and customary
charge *
Same as Louisiana
resident *
Medical Home HMO
CDHP-HSA**
Regional HMO
Emergencies
covered worldwide;
all other services
require prior plan
approval
30% of
fee
schedule *
30% of Vantage
allowable after
separate $1,000
deductible *
Same as Louisiana
resident
Same as Louisiana
resident *
Same as Louisiana
resident *
* Plan member owes deductible, co-pay, co-insurance and balance of billed charges
** No out-of-pocket maximum for non-network providers
Mental Health & Substance Abuse Treatment Benefit
PPO
ValueOptions
HMO
ValueOptions
Medical Home
HMO
Vantage
Health Plan
2
Member pays
10% of
contracted rate 1
$100 co-payment;
$300 maximum
per admission
$100 co-payment
per day; $300
maximum
per admission
Member pays
20% of
contracted rate 1
$100 co-payment;
$300 maximum
per admission
Outpatient
Member pays
10% of
contracted rate 1
$25 office visit
co-payment
100% after
$25 co-payment
per office visit 2
Member pays
20% of
contracted rate 1
$25 office visit
co-payment 2
Inpatient
1
2
Subject to plan year deductible and/or co-insurance
Pre-authorization required
CDHP-HSA
OptumHealth
Regional HMO
Vantage
Health Plan
Prescription Drug Benefit
PPO and HMO (Administered by Catalyst Rx)
Prescription Drug Benefit In-Network
Generic drug & brand-name drug with no generic available:
 Plan member pays 50% of cost
 Maximum $50 per 31-day fill
 After $1,200 per person per plan year, plan member pays
Plan
co-pay of $15 for brand-name drug, $0 for generic drug
Member Outof-Pocket
Expense
Brand-name drug with FDA-approved generic available:
 Plan member pays cost difference between brand-name
drug and generic, plus 50% of brand-name drug cost
 Cost not applied to $1,200 out-of-pocket maximum
Formulary
Mail Order
Program
Open *
Same as above
* OGB’s open formulary means EVERY FDA-approved prescription drug
is covered by PPO and HMO health plans
Prescription Drug Benefit
Regional HMO (Administered by VHP’s Catalyst Rx)
Prescription Drug Benefit In-Network
Plan
Member
Out-ofPocket
Expense
Generic drug & brand-name drug with no generic available:
 Plan member pays 50% of cost
 Maximum $50 per 30-day fill
 After $1,200 per person per plan year, plan member pays
co-pay of $15 for brand-name drug, $0 for generic drug
Brand-name drug with FDA-approved generic available:
 Plan member pays cost difference between brand-name
drug and generic, plus 50% of brand-name drug cost
 Cost not applied to $1,200 out-of-pocket maximum
Formulary Closed with exceptions *
30-day supply – 1 co-pay
Mail Order 60-day supply – 2 co-pays
Program
90-day supply – 3 co-pays
* Prescription drugs not on Vantage’s formulary list may be available at higher out-of-pocket cost
Prescription Drug Benefit
Medical Home HMO (Administered by VHP’s Catalyst Rx)
Prescription Drug Benefit In-Network
Per 30-day fill
Plan Member  Generic drugs – $5 co-pay
Out-of-Pocket  Preferred brand drugs – $30 co-pay
Expense
 Non-preferred brand drugs – $50 co-pay
 Specialty drugs – 20% co-insurance
Formulary
Closed with exceptions *
Mail Order
Program
30-day supply – 1 co-pay
60-day supply – 2 co-pays
90-day supply – 3 co-pays
* Vantage Health Plan’s open formulary means prescription drugs not on the
Vantage formulary list may be available at higher out-of-pocket expense
Prescription Drug Benefit
CDHP-HSA (Administered by UHC’s PrescriptionSolutions)
Prescription Drug Benefit In-Network
Per 31-day fill
 Generic drugs – $10 co-pay
Plan
 Preferred brand drugs – $25 co-pay
Member Out-  Non-preferred brand drugs – $50 co-pay
of-Pocket  Specialty drugs – $50 co-pay
Expense
Prescription drugs subject to deductible except
maintenance drugs
Formulary
Mail Order
Program
Open
Same as above for 90-day supply
Maintenance drugs not subject to deductible
(See myuhc.com for list of maintenance drugs)
Life Insurance
Life Insurance
Prudential Insurance Co. of America
 Group term life insurance policy
 State pays half of premium for employees and retirees
 Employee pays full premium for dependent life insurance
 25% reduction in coverage and appropriate reduction in
premiums on July 1 after plan member reaches age 65
and age 70
Life Insurance
Basic Plan
Option I
Option II
Employee
$5,000
$5,000
Spouse
$1,000
$2,000
Each Child
$ 500
$1,000
Employee
Schedule in
Premiums
Helpful Information Book
Premiums for Dependent Life
Employee
Pays
$0.88/mo
$1.76/mo
Life Insurance
Basic Plus Supplemental Plan
Option I
Option II
Employee
Schedule to maximum of $50,000
(amount based on employee’s
annual salary)
Same
Same
Spouse
$2,000
$4,000
Each Child
$1,000
$2,000
Employee Premiums
Schedule in Helpful Information Book
Premiums for Dependent Life
Employee Pays
$1.76/mo
$3.52/mo
Life Insurance
 Accidental Death and Dismemberment (AD&D)
benefits available to all active and retired employees
covered under Basic or Basic Plus plan
 Retirees over age 70 not eligible for AD&D
ALL inquiries and changes in life insurance must
be made through your agency’s HR office
Sources of Information
 OGB website with links to all health plans…..
www.groupbenefits.org
 OGB (PPO)…..1-800-272-8451
 Blue Cross and Blue Shield of La. (HMO)….. 1-800-392-4089
 Vantage Health Plan (Medical Home & Regional HMO)…..1-888-823-1910
 UnitedHealthcare (CDHP-HSA)…..1-866-336-9374
 Catalyst Rx…..1-866-358-9530
 Living Well Louisiana Program…..1-800-383-0115
 Diabetic Sense Program…..1-888-341-8582
 ValueOptions…..1-866-492-7143
 DataPath Administrative Services….1-877-685-0655
Flexible Benefits
2012 Plan Year
January 1, 2012 – December 31, 2012
Flexible Benefits Options – Why Enroll?
Easy to
participate
Reduce
taxes
Flexible
Benefits
Plan
Increase
spendable
income
Flexible Benefits – More Take-Home Pay
Premium Conversion
Option
(no fee)
Set aside eligible payroll deductions for health care premiums
Eligible premium deductions automatically continue in Premium
Conversion from year to year unless you request to drop out during
Annual Enrollment
Health Savings Account Set aside money from paycheck for out-of-pocket medical expenses
(no fee)
General-Purpose
(Health Care) FSA
($36/plan year)
Limited-Purpose
(Dental & Vision) FSA
($36/plan year)
Dependent Care FSA
($36/plan year)
MUST RE-ENROLL EACH YEAR during Annual Enrollment
Must participate in OGB Consumer Driven Health Plan (CDHP)
Set aside $600 - $5,000 (per plan year) from your paycheck for
eligible out-of- pocket medical expenses
MUST RE-ENROLL EACH YEAR during Annual Enrollment
Set aside $600 - $5,000 (per plan year) from your paycheck
for eligible out-of-pocket dental and vision expenses only
MUST RE-ENROLL EACH YEAR during Annual Enrollment
Set aside money from your paycheck for dependent care expenses
while you work
MUST RE-ENROLL EACH YEAR during Annual Enrollment
Premium Conversion
More Take-Home Pay – Example
Premium Conversion Option
Category
Participant
Non-Participant
Monthly Taxable Salary
$3,000
$3,000
Pre-Tax Premium
(Employee + spouse) *
- $420
-
Taxable Income
$2,580
$3,000
Federal Taxes (25%)
- $645
- $750
After-Tax Premium
-
$0
- $420
Spendable Income
$1,935
$1,830
$0
* Employee + spouse is health plan premium for employee and spouse
$105 monthly savings x 12 months = $1,260 yearly savings
Premium Conversion (Free Participation)
Eligible Payroll Deductions
 OGB health plan premium

OGB life insurance premium (Prudential)
 Employee portion only

Some miscellaneous/statewide insurance premiums

Cancer insurance deduction*
 Dental insurance deduction
 Hospital indemnity insurance deduction
 Intensive care insurance deduction
 Vision insurance deduction
* Policy cannot have a cash value or a return-of-premium rider
Health Savings Account (HSA)
OGB Health Savings Account (HSA)
 You cannot participate in OGB HSA option if you have:
• General-Purpose (Health Care) FSA – or your spouse
has General-Purpose (Health Care) FSA
• Medical coverage under a non-CDHP
• TRICARE or TRICARE for Life coverage
• Used any VA benefits within previous 3 months
• Medicare Part A or Part B coverage
 You must participate in OGB Consumer Driven Health
Plan (CDHP) to participate in Health Savings Account
(HSA) option
Health Savings Account (HSA)
You can use your HSA to pay these eligible
expenses:
 Office visits (including deductibles and co-insurance)
 Chiropractic services
 Prescription drugs
 Over-the-counter medications with a prescription
 Dental expenses
 Eye glasses, contact lenses and solutions
 Eye surgery (including Lasik)
 Lab fees
 COBRA, Medicare and qualified long-term care premiums
Health Savings Account (HSA)
 State will make initial $100 deposit in your HSA
 State will match your additional HSA contributions,
dollar-for-dollar, up to $400 – if made through an IRS
Section 125 cafeteria plan via payroll deduction
 Reimbursement limited to current account balance
 Total contribution limits for calendar year:
 $3,100 (individual coverage)
 $6,250 (employee plus 1 or family coverage)
 Can add $1,000 more if you are over age 55
Health Savings Account (HSA) –
Contribution Amount Changes
Requested changes in your contribution amount
during the plan year will take effect as follows:
 A change request received on or before the 15th of the
month will be effective on the 1st of the next month
 A change request received after the 15th of the month
will be effective on the 1st of the following month
Health Savings Account (HSA)
IRS “use-or-lose” rule does not apply
Funds can roll over from one plan year to the next
Money in your HSA grows tax-free
If you change health plans or jobs, or you retire, HSA is
yours to keep
From age 65 on, you can use your HSA dollars for any
health care or non-health care expense with no penalty
Decrease your taxable income
 Use tax-deferred dollars to pay health care costs for
family household members NOT on your health plan
UnitedHealthcare Consumer Driven
Health Plan (CDHP) with HSA Option
 UnitedHealthcare Consumer Driven Health Plan
(CDHP) with Health Savings Account (HSA) option
 CDHP premium must be paid through an IRS Section 125
cafeteria plan (i.e. OGB’s Premium Conversion option)
 Health Savings Account (HSA) eligibility
 Current participants in General-Purpose (Health Care) FSA must
have $0 balance on or before…
December 31 to be HSA-eligible on January 1; or
March 15 to be HSA-eligible on April 1
Flexible Spending Arrangements (FSAs)
FSA Participation
Employees can participate in these Flexible
Spending Arrangements:
 General-Purpose (Health Care) FSA
 Limited-Purpose (Dental & Vision) FSA
 Dependent Care FSA
Even if they are...
 Not enrolled in Premium Conversion option
 Not enrolled in an OGB health plan
Eligibility and Enrollment Rules
General-Purpose FSA and Limited-Purpose FSA
• Must be active, full-time employee (as defined by
employer) in a participating payroll system
• Must be continuously employed as active, full-time
employee for at least 12 consecutive months from
January 1, 2011, through December 31, 2011
• Can enroll during Annual Enrollment or after you
experience an IRS qualifying event
• Must re-enroll each year to continue participation
General-Purpose FSA
General-Purpose Flexible Spending Arrangement
 Minimum amount $600; maximum amount $5,000
 Can be used for medical expenses – for you, your
spouse and your eligible dependents
 Health coverage-related expenses – deductibles and
co-pays
 Medications – both prescription drugs and prescribed
over-the-counter drugs
GPFSA – Yearly Savings (Example)
Category
Participant
Non-Participant
Monthly Taxable Salary
Monthly Deduction
General-Purpose FSA
Monthly Administrative Fee
General-Purpose FSA
Monthly Taxable Income
Taxes (20%)
After-Tax (Out-of-Pocket)
Health Care Expenses
$2,000.00
$2,000.00
- $150.00
-
0.00
-
-
0.00
0.00
- $150.00
SPENDABLE INCOME
$1,477.60
$1,450.00
$3.00
$1,847.00
$369.40
-
$2,000.00
$400.00
$27.60 Monthly Savings x 12 = $331.20 Yearly Savings
Limited-Purpose FSA
Limited-Purpose (Dental & Vision) Flexible
Spending Arrangement
• Minimum amount $600; maximum amount $5,000
• Can be used only for dental and vision medical expenses
• Can be used in conjunction with a Health Savings Account
• Cannot participate in both General-Purpose (Health Care)
Flexible Spending Arrangement (GPFSA) and Limited-Purpose
Flexible Spending Arrangement (LPFSA)
Reminder – Dependent Coverage Rule
Reimbursement of eligible out-of-pocket
medical expenses for children up to age 27
through:
General-Purpose (Health Care) FSA
or
Limited-Purpose (Dental & Vision) FSA
Dependent Care FSA
• For eligible dependent care expenses while you work
• Signing up for DCFSA Recurring Expense Service
reduces submissions of DCFSA claims
• Reimbursement limited to current amount in account
• Must re-enroll each year to continue participation
• Minimum annual amount is $600
• Must file an IRS Form 2441
DCFSA – Remaining Balance
 After termination of employment, employee
can use remaining balance in Dependent
Care FSA while looking for work
Claim reimbursement request must be
submitted by April 29
Dependent Care FSA – Contributions
Parental/Tax
Status
Single Parent or
Married Filing
Separately
Maximum
Amount
Allowed Dependents
Child age 12 or younger
$2,500
Older dependent
incapable of self-care
Child age 12 or younger
Single Head of
Household
$5,000
Older dependent
incapable of self-care
Child age 12 or younger
Married Filing Jointly
$5,000
Older dependent
incapable of self-care
Spouse incapable of self-care
Note: DCFSA is good for employees who earn $25,000 or above
Easy Participation … FSA Card
mySource FSA card can be used to pay providers
who accept MasterCard for eligible expenses…
 General-Purpose (Health Care) FSA
 Limited-Purpose (Dental and Vision) FSA
 Dependent Care FSA
• Full amount of General-Purpose (Health Care) FSA funds
available immediately (interest-free loan)
• Full amount of Limited-Purpose (Dental and Vision) FSA
funds available immediately (interest-free loan)
• Dependent Care FSA funds available upon deposit
Easy Participation … FSA Card
 Fax receipts within 2 weeks upon
request
 No receipts needed for:
 Hospitals
 Physician providers
 Dental providers
 Vision providers
 Doctors’ prescriptions and receipts
needed for reimbursement of
FSA-eligible over-the-counter drugs
and medicines at:
 Albertsons
 CVS Pharmacy
 Kroger
 Sam’s Club
 Sav-A-Center
 SuperFresh
 Target
 Walgreens
 Walmart
 Winn-Dixie
 drugstore.com
 IPS
Grace Period and Run-Out Period
 Grace Period
January 1, 2013 – March 15, 2013
Can incur eligible expenses during this period
to be paid with money remaining in FSA from
the immediately preceding plan year
 Run-Out Period
March 16, 2013 – April 29, 2013
Must receive claims from the immediately
preceding plan year for reimbursement
Flexible Benefits – Key Facts
 No fee for Premium Conversion option or Health
Savings Account option
 Administrative fee ($36 per account per year) – applies to:
 General-Purpose (Health Care) FSA
 Limited-Purpose (Dental and Vision) FSA
 Dependent Care FSA
 “Use or lose” rule applies to all FSAs – but not to HSA
 Flexible Benefits elections locked in for plan year –
except in case of qualifying event as defined by IRS
Flexible Benefits
Annual Enrollment Period
October 3 – November 4, 2011
May vary by agency –
check with your agency’s HR office
DataPath Administrative Services
Phone (toll-free):
1-877-685-0655
E-mail:
info@idpas.com
Fax:
1-888-472-6777
Website:
www.myrsc.com
Questions?