Regular full-time and part-time employees scheduled to work at least 16 hours per week are eligible to enroll in a Medical Expense and/or Dependent Care Reimbursement Fund. These programs allow employees to direct pre-tax dollars into a fund to reimburse the employee for expenses incurred for medical and/or dependent care. The tax savings realized will vary among employees, dependent upon income level, tax bracket and filing status. IRS regulations require that money directed into the account each year must be used for expenses incurred that year. Since employees have the advantage of putting pre-tax dollars into the account, the IRS requires that employees bear some risk in planning. As a result, any money left in the account at the end of the year is forfeited.
Enrollment into either of these funds is only allowed due to the following:
For your convenience you may download and print the following flexible spending account forms. You may also obtain these forms and additional information in Human Resources.
As of January 1, 2007 Meritain is the plan administrator for both the medical and ependent care reimbursment accounts. The Customer Service number is 866-448-1696 and is located on the back of your Benny card. In addition, by enrolling on-line at www.mybenny.com you will be able to access information on your account, claims and balances.
Election Form - Complete this form to enroll in the 2009 Medical Expense and/or Dependent Care Reimbursement Accounts.
Disclosure Authorization Form - Complete this form along with the Election Form to enroll in the 2009 Medical Expense and/or Dependent Care Reimbursement Accounts.
Change Form - Complete this form to make allowed changes to an existing flexible spending account.
Health Care Account Reimbursement Request Form - Complete this form when requesting reimbursement for your health care. The form and all receipts must be mailed directly to Meritain, NOT your Human Resources office.
Dependent Care Account Reimbursement Request Form - Complete this form when requesting a reimbursement for your dependent. The form and all receipts must be mailed directly to Meritain, NOT your Human Resources office.
Summary Plan Description - Summary Plan Description for Flexible Benefits Plan
2008/2009 Flex Participant Manual - Participant Manual for 2008 & 2009.
