What
is a Section 125 Cafeteria Plan?
It is a plan
designed and setup by the Internal Revenue Service to allow participants
to have monies taken out of their paychecks pre-tax for group health
insurance premiums, unreimbursed medical expenses, and child care
expenses.
What
is a POP?
A POP or a Premium
Only Plan is a plan that allows you to have your
medical/dental insurance taken out of your paychecks pre-tax.
What
is an FSA?
A FSA or Flexible
Spending Account is an account that allows you to have money
taken out of your paycheck pre-tax for either unreimbursed medical
expenses, dependent or child care reimbursement or other insurance
premiums that pay for insurance that isn't offered through your work.
What
is a FSA payment period?
A FSA payment period
is any time a deduction is made from your paycheck and put into the
Section 125 account. Normally these payment periods coincide with your
payroll periods.
What
is the maximum that I can claim for the year for Section 125?
For the Medical
Reimbursement of the Section 125 plan it depends on your company's plan
document. You should have been given a copy of the Summary Plan
Description when you became eligible for the plan. As for dependent Care
Reimbursement the IRS annual maximum is $5,000.00 per household.
How
often can I submit claims?
As off We suggest that you
submit only one claim per payroll period.
Can
I claim over the counter items like Tylenol, Vitamins and Nyquil?
No, per the IRS
guidelines, over the counter items may not be claimed as un-reimbursed medical expenses.
What
are considered to be acceptable forms of receipt?
In order to insure
prompt payment we require that the following information be on any form of
receipt:
-
Date the service was rendered. (the most common mistake is that this
is not the date you were billed, it is the date you go to get the
procedure done)
-
Who rendered the service. (i.e. your doctor, dentist, the hospital,
not the insurance carrier)
-
What service was rendered . ( this does not include account balance,
we need to know what procedure was done. i.e. office visit, x-ray, the
specifics)
-
Out of pocket expense. (This does not need to include the amount the
insurance company has to pay)
-
The best form of receipt is "The Explanation of Benefits"
which is provided by your insurance company and gives you a total
break down of your incident.
What
are not acceptable forms of receipt?
Unacceptable forms
of receipts for:
Medical Reimbursement Are:
-
Credit card slips
-
Cancelled checks
-
Previous balances
-
Payment past due
-
Orthodontic statements without an explanation that it is for
Orthodontics
Dependent Care Are:
-
Carbon copies of checks
-
Just the front of a check
-
Just the back of a check
What
happens if I do not have enough expenses during
the year to claim the full amount I set aside for the plan year?
At the end of the
year all money that has not been claimed by the end of the year is forfeited. The summary Plan Description details where the forfeited
amounts go.
What
happens when I terminate employment?
To claim any money
in the Section 125 account after you terminate you can only submit
receipts for services that were done before your date of termination. All
other expenses will not be allowed, unless you elect COBRA.
Can
I carry the balance of my account from one plan year to another?
No, each plan year
starts with a new enrollment period where you will decide how much money
to set aside for that year.
What
is a "grace period"?
A "grace
period" is the amount of time after a plan year ends that you the
participant has to get your claims in to MypaperlessOffice. Keep
in mind that the actual service has to be incurred before the end of the
plan year.
Can
I claim my insurance premiums under the Un-reimbursed Medical Plan?
No you may not.
Can
I claim prescription sunglasses and contact lenses solution?
Yes you can.
Will
I get my check within 5 days of when I send in my claim?
Not necessarily,
your check will leave our office approximately 1-5 working days from your
company's scheduled processing date. (see contact us for your company's
scheduled processing date)
Can
I use a copy of a cancelled check as form of receipt?
For dependent care :
Yes only if you copy both front and back and the front of the check has
the person's social security number or facility's federal id number along
with the dates of service for the check For Medical Reimbursement: No,
under any circumstances
Can
I change my election during the year?
Generally no, but
there is certain events that can take place that will allow you to change
your election. These changes are called "Changes in Family
Status" which the IRS will allow a change to occur in your election
and these includes:
-
Birth or adoption of a child
-
Marriage
-
Divorce
-
Death of your spouse and/or dependent
-
Your spouse or yourself have taken an unpaid leave of absence
-
Switching from part-time to full-time (or vice versa) employment on
your behalf
-
A significant change in my family's health coverage or your spouse's
coverage
-
Termination/commencement of employment
Can
I claim getting my teeth bleached?
No, teeth bleaching
or whitening is classified as a cosmetic procedure.
When
I get my varicose or spider veins stripped can I claim that procedure?
No, stripping of the
veins unless medically necessary, is considered to be a cosmetic
procedure.
I
went to my Optometrist in 1999, but picked up and paid for my glasses in
January of 2000. Can I claim this expense in the 2000 plan year?
No, the IRS
regulations specify that expenses that are reimbursed must have been
incurred during the period for which the participant is actually covered
under the plan for that specified plan year.
I
am taking treatments for infertility, such as prescription fertility drugs
and artificial insemination. Are these claimable?
Yes, But only when
administered by a licensed physician.
Can
I send in just my receipt?
No, we require that
all receipts to be accompanied by a signed claim form (either Medical
Reimbursement or Dependent Care), these claim forms can be found in
several places.
-
Your Human Resources Department
-
This web page under "Forms"
-
By contacting our office.
Is
corrective laser eye surgery like Radial Keratotomy and Lasik claimable?
Yes, this eye surgery has been classified as an eligible expense under
Section 125.
Are
dietary supplements claimable?
Not unless your doctor is willing to write a prescription for them or
submit a letter stating that they are a medical necessity
I
go to a massage therapist can I claim these visits?
Yes, recently massage therapy has been added as an eligible form of
therapy to be reimbursed under Section 125
How
do I get a claim form to submit my receipts?
There are three ways that you can get our claim forms:
- you can
get them from your Human Resources Department
- you can
get them off this website under forms
- you can
contact our office either by phone, email, or fax
Can I submit expense
for Neuro Feedback Therapy for my child's Attention Deficit
Disorder for reimbursement?
You can claim Neuro
Feedback for the treatment of Attention Deficit Disorder.
I
am currently undergoing Birthing Classes, are those expenses claimable under
un-reimbursed medical expenses?
Yes, birthing
classes are eligible, but only expenses for the mother can be claimed.