Microsoft word - otc participant communication 5.20.10

Important Information for Your Upcoming
Flexible Spending Account (FSA) Enrollment

As you may have heard, there is new legislation going into effect on January 1, 2011 which impacts healthcare
FSAs. Here’s what’s happening. Certain over-the-counter items will require a prescription* to be considered
an eligible FSA expense. The information below is important for you to know as you begin to think about your
healthcare FSA contribution for this year’s enrollment.
How does this new legislation impact me?
It impacts you two ways:
1. Setting Your Contribution
Because OTC drugs and medicines will require a prescription beginning January 1, 2011, you might want to consider this when deciding on your healthcare FSA contribution. 2. Using Your Account Dollars
• OTC drugs and medicines are eligible for reimbursement without a prescription. • Healthcare debit cards, (e.g., PayFlex Card™) can be used to purchase eligible OTC drugs and medicines. • Over-the-counter (OTC) drugs and medicines will be considered ineligible expenses unless you have a
prescription from your physician. OTC Drugs and Medicines Requiring a Prescription
• Healthcare debit cards, (e.g., PayFlex Card™) cannot be used to purchase OTC drugs and medicines. If a healthcare debit card is used to pay for these items after January 1, 2011, the transaction will be denied at the point-of-sale.
Does this mean all OTC items will be ineligible after January 1, 2011?
No, many OTC items will continue to be considered eligible expenses and will not require a prescription See “Eligible
Healthcare Expenses” within this communication for examples.

*Please note: The documentation required for a prescribed
OTC drug or medicine is still being clarified by the IRS. More
information will be provided as it becomes available.

Eligible Healthcare Expenses

Following is a condensed listing of eligible healthcare expenses. For a more complete listing, visit the participant portal.
Please note this listing is subject to change at any time and without notice due to new legislation.
Effective January 1, 2011, the list of items that will require a prescription includes, but is not limited to acne medicine; allergy
medicine; cough, cold & flu medicine; eye drops; indigestion medicine; laxatives; nasal sprays, drops; ointment for cuts, burns, Items that will remain eligible without a prescription include, but are not limited to band aids, birth control, braces & supports, contact lens solutions & supplies, elastic bandages & wraps, first aid supplies, and reading glasses. Acupuncture
Guide dog or other animal used to assist
Health institute
Schools and education, special (for
Bandages, band-aids, wraps and splints
mentally impaired or physically disabled Insulin, syringes
Birth control pills (Norplant, ovulation Laboratory fees
Chiropractor professional fees
Surgical fees (for legal operations not cosmetic in nature) Cold medicine (see notice above)
Therapy, physical or speech
Meals (only as part of inpatient hospital
Dental treatment (includes exams, x-
rays, fillings, root canals, gum disease Treatment for learning disability caused Nursing home (if necessary for medical
care and only the portion for medical
Drugs (prescription drugs, insulin; see Over-the-counter Drugs/Medicines; Operations (legal operations that are not
Eye surgery (includes cataract, LASIK,
Weight-loss program (only if medically
Pain reliever (for arthritis pain,
Fertility treatments (ovulation predictor
or joint pain, e.g., aspirin, ibuprofen; supplements) (see notice above)
X-ray fees 
What is a Healthcare FSA?
A Healthcare FSA is a Flexible Spending Account that My HealthHub Resources: Education & Planning Tools
allows you to set aside money for eligible healthcare Savings calculator to help you estimate your healthcare Digital library designed to help you understand an FSA This account reimburses you for out-of-pocket medical, Educational materials & forms to better assist you with dental, prescription and vision services, such as deductibles, co-pays, coinsurance and over-the-counter (OTC) items. Starting January 1, 2011, certain OTC medicines and drugs will be considered ineligible unless What you need to know about an FSA
you have a written prescription from your doctor. You may only determine your contribution in an FSA during open enrollment or when you first Quick Tip: View a listing of eligible expenses
Login to > My HealthHub Resources > Planning
Once you establish your plan year contribution, y only change it if you experience a change An FSA is a smart way to save!
in status. This may include a change in one of the following conditions: An FSA can help reduce your taxes and increase your take-home pay—giving you extra dollars for the things you Legal marital status (marriage, divorce, legal separation, annulment or death of a spouse) Number of tax dependents (birth, adoption or With a salary of $20,000 and an annual contribution of $1,500 for could increase your take-home pay by $405! Employment status that affects eligibility With a salary of $40,000, an annual contribution of $2,000 for Dependent satisfying or ceasing to satisfy could increase your take-home pay by $540! coverage requirements (reaching limiting age, gain/loss of student status, marriage) With a salary of $60,000, an annual contribution of $3,000 for could increase your take-home pay by $810! * To apply for a change, you must complete a change-in-election form through your employer’s Human Resources/Benefits department within 30 Getting started is easy!
Start by estimating the amount that you will incur for If your employer offers a ―grace period‖, you wil eligible healthcare expenses during the plan year. Then be allowed an additional 2 ½ months after the end review your expenses from the prior plan year and use our of your plan year to use your FSA dollars. For planning tools available at to determine example, if your plan year ends on December 31, your contribution. The amount that will be deducted from your employer will allow expenses to be incurred your paycheck each pay period can be determined by dividing your annual contribution by the number of pay Any claims that were incurred during the plan year periods (e.g. 12, 24 or 26), in your plan year. must be submitted for reimbursement by the end of your run out period. This date is established by Quick Tip: Find out how much you can save
your employer and is generally 90 or 120 days Login to > My HealthHub Resources > Any amount left in your healthcare FSA at the end Getting reimbursed
Access account information you
For quick and easy reimbursement, simply submit your need on My Dashboard
healthcare expenses online at Your Login to to view a snapshot of your reimbursement will be deducted from your FSA and will be provided by check or direct deposit into your checking or savings account. If your employer offers the PayFlex Card™, you can use this to pay for eligible expenses and the amount will be automatically deducted from your FSA without having to submit a claim. If you paid out-of- Quick Tip: View your claim history and payments
pocket, remember to keep your receipt for your purchase Login to > Financial Center > Select Account to submit along with the claim form for reimbursement. Shop online with your FSA!
Quick Tip: Enroll in direct deposit
Access our Consumer Center to buy items such as Login to > Financial Center > Enroll in Direct Deposit glasses, contacts, and eligible over-the-counter items using your PayFlex Card™ (if offered by your employer) or any other major credit card. If an item is not identified Reimbursement Methods
as ―FSA eligible‖ you will need to use a form of payment other than your PayFlex Card™. If using your own credit Online:
card, make sure to keep the receipt you receive from your purchase and submit along with a claim form for Healthcare expense tips
Healthcare expenses must be for services received after Quick Tip: Download a claim form
the effective date of your FSA election and during the Login to > My HealthHub Resources > Each individual, allowed to use your healthcare FSA contribution generally includes your Remember to save your receipts & Explanation of Benefits
spouse, your child younger than age 19 OR, under age 24 and a full-time student OR any age and is permanently and totally disabled Stay informed with eNotify
whom you are entitled to claim as dependent on If you are enrolled in eNotify, you will receive an email your federal tax return. In addition, your child from confirming that your claim has under the age of 27 may also be allowed to use your FSA dollars, if this feature is part of your Quick Tip: Sign up for eNotify to receive important e-mail
All expenses must be for services received, not notifications
for services to be provided in the future. In Login to > Settings > Change Email reimbursed and must not be reimbursable by Questions?
Contact Customer Service at 800.284.4885, 7am-7pm, Monday – Friday and Saturday 9am-2pm CT. deduction on your annual income-tax return.


New Jersey Department of Human Services State Upper Limit (SUL) List as of August 12, 2011 Pharmacy reimbursement for legend and non-legend drugs is based on the lowest of the Average Wholesale Price (AWP) less 17.5 percent; the Federal Upper Limit (FUL); the State Upper Limit (SUL), each with a dispensing fee of $3.73 to $3.99; or the pharmacy’s usual and customary charge C

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