Flexible Spending Accounts

Health Care and Dependent Care FSA

Eligibility

Coverage begins at the date of hire for:

• Medical House Staff employees who work at least 20 hours a week and are classified as regular full-time or part-time

How to Enroll

New Hires - if you are eligible, enroll online through Employee Self Service within the initial 31 days following your date of hire.

Existing Employees - Mid-year enrollments can be completed if you have an IRS qualified Family Status Change. Family Status Change enrollments must be completed within 31 days of the event; please see the online Guide to Family Status Change for instructions on how to enroll.

Additionally, you can enroll online through Employee Self Service during the annual open enrollment for the upcoming plan year, typically held in the fall of each year. These elections begin on January 1st of each year.

Note: The IRS requires a new election annually to re-enroll in the Health Care or Dependent Care Flexible Spending Accounts (FSA). Previous year enrollments do not carry forward into a new plan year.

How to Make Changes

With a qualified Family Status Change, you may enroll or make changes within 31 days through Employee Self Service.

You may also make online changes through Employee Self Service to your payroll deduction for the Flexible Spending Accounts during the annual enrollment period, typically held in the fall of each year.

How to Submit Reimbursement Requests

There are two methods available to receive reimbursement for qualified expenses using your Flexible Spending Accounts.

• Submit a Paper Claim: When you have an eligible dependent care expense, you pay the provider directly and then submit the receipt and a FSA Claim Form to Fiserv for reimbursement. For eligible health care expenses, you must first submit the claim to your medical or dental carrier. Once the claim is processed and you receive the Explanation of Benefit (EOB) from your medical or dental carrier, submit a copy of the EOB and a Health Care FSA Claim Form or Dependent Care FSA claim form to Fiserv for reimbursement.
• Use the Debit Card (Benny Card): When you have an eligible expense, simply present the Debit Card (Benny Card) at the time of service for payment. *Please make sure you use the credit feature even though it does say debit card at the time of purchase.
  • If the transaction amount is less than or equal to one of your Emory health plan co-pay amounts, no further action is needed.
  • If your eligible expense is not covered by an Emory health plan and your Debit Card (Benny Card) is declined, you can still receive reimbursement by submitting the appropriate FSA Claim Form to Fiserv .
  • The Debit Card (Benny Card) can be used to purchase certain over-the-counter medications; however, if you cannot use your card, these can be purchased and paid for by you, and then you can submit the receipts to Fiserv for reimbursement.
  • If a match (co-pay or reimbursement amount) is not found when you are using your Debit Card (Benny Card), you can still be reimbursed by submitting the appropriate FSA Claim Form to Fiserv.
• Debit Card (Benny Card) You can use your “Benny” card to make over-the-counter (OTC) purchases at Sam’s Club, Walgreens, Wal-Mart or Drugstore.com. To verify if a store accepts the “Benny” card, call Fiserv Health Services at 866-226-8084.

• When you enroll in the Health Care FSA, you automatically receive a Debit Card (Benny Card).
• For a Dependent Care FSA, you will also automatically receive a Debit Card (Benny Card). However, if you are also enrolled in a Health Care FSA, you may contact Fiserv to have your Dependent Care funds added to your Health Care Debit Card.
• If you are enrolled in the Dependent Care FSA but not in a Health Care FSA, you will also automatically receive a Debit Card (Benny Card).

Note:

• To receive reimbursement under either the Health Care or Dependent Care FSA, all eligible expenses must be incurred while you are covered under the plan(s).
• You may view the status of your Flexible Spending Accounts 24/7 online, by logging in and registering on the FiServ web site. The Group number is 76140147 to register.

Vendor Contacts

Fiserv

866-226-8084

Plan Coverage

Plan Coverage

Health Care Flexible Spending Account

• You can contribute a minimum of $200 and up to $5,000 per year into your Health Care FSA through payroll deduction. These funds can be used to reimburse you for eligible health care expenses. These expenses include; over-the-counter medications as well as prescription drugs for you, your spouse/SSDP, or dependents that are not reimbursed by your health care plan. Over-the-counter drugs do not include vitamin or dietary supplements.
• It is IMPORTANT you estimate your eligible expenses carefully.  For the 2008 plan year, any unused funds remaining in your Health Care Flexible Spending Account on March 15, 2009 are forfeited by you. You can continue to submit reimbursement requests through May 15, 2009 for expenses you incur through March 15, 2009.
  
  To use an online calculator to help you determine your contribution amounts, visit FiServ.

Dependent Care Flexible Spending Account

• You can contribute a minimum of $200 and up to $5,000 per year if you are single or married and filing a joint return, or up to $2,500 per year if you are married and filing taxes separately.
• These funds can be used to reimburse you for eligible dependent care expenses incurred while you are working. Examples of these expenses include fees for licensed day care or adult-care facilities, or wages paid to a housekeeper providing care outside the home.
• Eligible dependents are children under the age of 13, or your spouse or other adult dependents(s) who are incapable of caring for himself or herself.  All dependents must be able to be claimed by you as a dependent on your annual income tax return.
• It is IMPORTANT that you estimate your eligible expenses carefully. For the 2008 plan year, any unused funds remaining in your Dependent Care Flexible Spending Account on December 31, 2008 are forfeited by you. You can continue to submit reimbursement requests through March 15, 2009 for expenses you incur through December 31, 2008.

Note: Health Care and Dependent Care FSA are separate and cannot be combined. In other words, you cannot request reimbursement of unused Health Care FSA dollars to cover dependent day care expenses, and vice-versa.

Qualified and Non-Qualified Expenses

Health Care Flexible Spending Account

Dependent Care Flexible Spending Account

Plan Information Documents

IRS Eligibility Guidelines - Publication #502

Plan Forms

Health Care FSA Claim Form

Dependent Care FSA

Emory University Benefits

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Disclaimer

Emory reserves the right to terminate, suspend, withdraw, amend or modify the Plan in whole or in part at any time. Further, Emory reserves the right to terminate or modify coverage for any group of employees, active or retired and their dependents or a class of dependents at any time.