The Health Care Reimbursement Account (HCRA) offers a real advantage for your pocketbook. Many people find this a cost effective way to pay for such items as medical and dental plan deductibles/co-payments, eyeglasses, contact lenses, orthodontics and other health-related expenses that may not be covered by insurance. Even taxpayers who do not itemize can take advantage of this tax break by using the Health Care Reimbursement Account.

Managing Your Account
WageWorks makes it easy for you to track your money with real-time account access and frequent account statements.

Online Account Access
Access your account online anytime to check account activity and claims status. Log onto www.wageworks.com to view your account. A simple registration process is required the first time you visit. Or, you may be able to access this site through your employer’s benefits portal.

Access by Phone
If you do not have Internet access, you can call our automated voice system to check your account status. Call toll free (877) 924-3967 and follow the prompts to check account balance, claims status and account activity. WageWorks Customer Service Representatives are available from 9am to 8pm Eastern Time and from 5am to 5pm Pacific Time.

Monthly Statements
Every month you will receive a statement that contains your account balance, payment history and helpful tips for using your accounts. This statement will be emailed to you if you have entered an email address in your Profile and mailed to you if you have not.

Why Use The Card?
By purchasing eligible health care items with the card, the cost of your purchases is automatically deducted from your Health Care Account. No claims to file. No waiting for reimbursement.

When To Use the Card
Use the card to pay for eligible health care expenses such as co-payments, prescriptions and glasses.

Where To Use the Card
In addition to doctors’ offices and pharmacies, you can use your card to purchase eligible merchandise at discount chain stores, supermarket pharmacies and wholesale clubs.

How To Use Your Card
1. Activate your card by calling (866) 363-4128.
2. Give your card to the service provider or swipe it yourself. If you are using a terminal, choose the credit option. Sign for your purchase.
3. Save the itemized receipt (not the credit card-like receipt) that describes what you paid for. You may be asked to submit this receipt to show you used the card for eligible health care expenses. Watch your monthly statement for details.

Call (877) 924-3967 if you have any questions about using your Health Care Card.

Your WageWorks Dependent Care Account saves you money by allowing you to pay for your eligible dependent care costs with pre-tax dollars. Your election amount will be deducted automatically from your paycheck by your employer and used to fund your account. You have easy access to your account to pay for eligible dependent care expenses using the convenient WageWorks payment options: Pay My Provider or Pay Me Back. (Debit Card does not apply to the Dependent Care Account).

When To Use It
Pay My Provider is the most convenient payment option. You tell us how much to pay your provider and we’ll write and mail a check directly from your account.

How To Use It

• Log onto your account at www.wageworks.com

• Click on Dependent Care tab

• Click on Request Pay My Provider

• Confirm or enter your email address

• Enter your provider information

• Enter dependent information

• Enter your payment amount(s)

• WageWorks will make the requested payment(s) from your account and mail it directly to your provider

Other Things You Need To Know

• Payment will be made in the amount requested or your account balance before the payment date, whichever is lower.

• WageWorks will send you an email if you use up all the money in your account before we can make your requested payment(s).

• An email address is required to use Pay My Provider so we can send you time sensitive payment information.

• As with all use of your Dependent Care Account, save your receipts or other proof of expense with your tax documents.

Pay Me Back

When To Use It
If you like to pay for your dependent care expenses as you normally do and then get reimbursed for your expenses, then Pay Me Back is the option for you.

How To Use It

• Pay for your dependent care as you usually do.

• Complete a Dependent Care Pay Me Back form. There is one form included in this guide. Additional forms are available for download from www.wageworks.com, or you can request one from your benefits representative.

• Provide proof of service for each expense in the form of a photocopy of a receipt, statement or bill from your provider (formal or informal), or your provider’s signature on the form.

• Fax your form and photocopies of your proof of services to the toll free number (877) 353-9236.

• Or mail your form and photocopies of your proof of service to the WageWorks Processing Center.

Other Things You Need To Know

• Remember to send photocopies of your proof of service.

• Save your originals with your tax documents.

What Qualifies

You can use your Dependent Care Account to pay for expenses to care for any eligible dependents:

• Your qualifying child under the age of 13 years

• Your spouse, qualifying child (even if over 13 years) or qualifying relative - who is physically or mentally incapable of self care.

All of the following must be true about the care:

• The care is provided while you work or to enable you to work. If you are married, the care is provided while your spouse also works or to enable your spouse to work or go to school full-time (at least 5 months a year) or while your spouse is incapable of self care.

• The care may be provided by a relative or a non-relative but is not provided by a tax dependent.

• Your care provider must conform to state and local laws (including being licensed, if required) and be able to provide you with his/her Social Security or Tax ID number. You will need this to request a payment or file a claim.

Dependent Care Services

Frequently Asked Questions

Where can I get more Pay Me Back Forms?

You can download forms from www.wageworks.com, request one from your employee benefits manager or contact WageWorks Customer Service at (877) 924-3967.

Can I change or cancel my plan once I have enrolled?

You may be eligible to change or cancel your enrollment after experiencing a qualified change (such as getting married or having a child) only if and as permitted by your employer’s plan.

How long will it take to receive reimbursement for my claims?

You can expect to receive a reimbursement check for approved Pay Me Back claims within about one week.

What if my claim is denied?

You will be notified via mail or e-mail within a week if your claim is denied and if additional information is needed to approve your claim. You can also view your claim status online at anytime.

How do I request a second Health Care Card?

You will receive a card with your name on it for your own use after you enroll. You may request a second card for use by one of your dependents (it will have their name on it). Both cards will automatically draw from funds in your Health Care Account. To request a second card, log into your account at www.wageworks.com and click on the Health Care tab. Select "Request a Second Card" and provide your dependent’s first and last names and social security number, or send an email to help@wageworks.com. If you do not have Internet access, call WageWorks Customer Service at (877) 924-3967 Monday through Friday, 8am to 8pm Eastern Standard Time.

What if I lose my Health Care Card?

If you lose your card, or if it’s stolen, report it to WageWorks immediately by calling toll-free (877) 924-3967.

How do I know my personal information is kept secure and private?

WageWorks is committed to keeping your personal information safe by enforcing rigorous security and privacy procedures including SSL encryption on our web site. WageWorks’ web site has been certified by the Trust Privacy Program, and we are compliant with all current HIPAA regulations. WageWorks’ full Privacy Policy is available online at www.wageworks.com.

What if I have additional questions?

If you can’t find the answer to your question in this guide, browse the Help section of our web site at www.wageworks.com, send us an email at help@wageworks.com or call us at (877) 924-3967 (877-WageWorks). Our customer service representatives are here to assist you from 8am to 8pm Eastern Standard Time.

The Rules

The following rules are dictated by federal regulations. These apply when you participate in the Health Care Account or Dependent Care Account, employer-

sponsored plans that allow you to pay for eligible health care or dependent expenses on a pre-tax basis.

1. By enrolling, you authorize your employer to deduct your election amount from  your paycheck on a pre-tax basis.

2. Your account can be used to pay for eligible expenses incurred while you are  enrolled during the plan year. Expenses are considered incurred on the day of   service for health care or on the day your dependent receives care for dependent  care, not when you are billed or pay. Your account cannot be used to pay for   expenses incurred before or after you are covered under this plan, or that will be  incurred in the future.

3. You cannot take a deduction or tax credit on your tax return for any health care or  dependent care expenses paid for through your accounts.

4. You are responsible for maintaining documentation (receipts, etc.) to verify your   expenses (the nature of each expense, the amount, and the date incurred). Keep  these with your other important tax papers for the calendar year. You may be  requested to provide these per your monthly statement.

5. After the plan year ends, you will have a 90-day run-out period to get reimbursed  through the Pay Me Back feature for eligible expenses incurred while you were covered under in this plan during the plan year. (See extended grace period).

6. Be sure to incur eligible expenses totaling your election amount while you are  covered under in this plan during the plan year. Any balance remaining in your account after the 90-day run-out period cannot be rolled over or paid out to you   and will be forfeited. (See extended grace period).

7. If you want to participate in the plan during the next plan year, you will need to

re-enroll during the next open enrollment period. We’re not allowed to keep you enrolled or automatically re-enroll you.

8. You may be eligible to change or cancel your enrollment after experiencing a qualified change, only if and as permitted by your employer’s plan.

9. Participation in this plan reduces your taxable income and may affect other compensation-based benefits such as life, disability and Social Security.

10. Consult a tax advisor if you have any questions regarding your personal situation.

11. You cannot use your dependent care account balance to pay for health expenses and vice versa.

1. Your Health Care Account can be used to pay for only medically necessary and eligible health care expenses that are not covered by or reimbursed through

insurance, a health plan or any other source.

2. When you use your WageWorks Card, you are certifying that the expenses paid for with the card are medically necessary and not covered by or reimbursable through any other source.

1. Your Dependent Care Account can be used to pay for only work-related and eligible dependent care expenses that are not covered by any other source.

2. You will need to provide the Social Security or Tax ID number of your dependent care provider to request payments or get reimbursed from your Dependent Care Account.

Coverage Period
The period of time during which you are enrolled for the Health Care Account or

Dependent Care Account during the plan year. You can use your Health Care Account to pay for eligible expenses incurred during your coverage period.

Dependent Care Account
An employer-sponsored plan that allows you to set aside pre-tax income from your paycheck to pay for eligible dependent care expenses incurred while you are enrolled during the plan year.

Eligible Expense
A health care or dependent care expense that you can pay for using your Health Care Account or Dependent Care Account. See the list of Health Care and Dependent Care Expenses.

Health Care Account
An employer-sponsored plan that allows you to set aside pre-tax income from your paycheck to pay for eligible health care expenses incurred while you are enrolled during the plan year.

Medically Necessary
For the diagnosis, cure, mitigation, treatment, or prevention of disease and/or for transportation primarily for and essential to receiving medical, dental or vision care.

Participant
A person enrolled for a Health Care Account or Dependent Care Account.

Plan Year
The period of time during which your employer offers the Health Care Account or

Dependent Care Account. You can use your Health Care Account or Dependent Care Account to pay for eligible expenses incurred during your coverage period during the plan year. Check online at www.wageworks.com or with your employer for your plan year start and end dates.

Proof Of Service For Dependent Care
A provider’s signature on your claim form, a receipt, or other record of a dependent care expense from a third party that specifies the type of care provided, the date care was provided, and the cost.

Proof Of Service For Health Care
A written record documenting your health care expense that describes the service you received or the item you purchased, the date of service and the amount. A credit card-like receipt that shows only the cost is not sufficient proof of service.

Provider (Dependent Care)
A person or business who provides dependent care services. Can include daycare centers, preschools, and senior daycare.

Provider (Health Care)
A person or business providing health-related services or materials. Can include doctors, optometrists, pharmacists, dentists, orthodontists, and medical suppliers.

1. Use Pay Me Back for any type of eligible expense.

2. Pay for your expenses any way you like and then get reimbursed for them directly from your Health Care Account. Do not file a claim for any expenses paid for with the WageWorks Card or Pay My Provider. (Remember, expenses do not have to be paid in order to qualify for reimbursement; they just have to be incurred.)

3. After you have received the service or made your purchase, complete and submit a Pay Me Back form with the appropriate required proof.

4. You can view the status of your claim online within 24 hours after we receive it.

5. Reimbursement checks are mailed daily for APPROVED claims. You can expect your check to be mailed to you within 5 days after we receive it (provided you have an available balance in your account).

6. Your Health Care Account balance will be automatically adjusted to reflect all payments made using Pay Me Back, Pay My Provider and your WageWorks Card.

PROOF OF SERVICE for health care claims:
You will need to provide proof of service for each expense listed on the Pay Me Back form. Your proof should be appropriate for the type of expense:

• Pharmacy receipt for prescriptions and other pharmacy purchases

• Doctor’s office receipt for office visit

• Explanation of Benefits (EOB) from your insurance or health plan, for covered medical and dental expenses

• Bill or invoice from doctor or dentist for expenses not covered by your insurance or health plan

• Payment contract, monthly payment coupon or statement from your orthodontist

• Receipt from your optometrist or other medical service provider

Note: Some expenses may require you to submit a letter or written statement from your doctor stating (1) the diagnosis and (2) the need for the expense and, if applicable, the difference in cost between (3) standard, unmodified item and (4) special or modified item. For a list of these expenses, go to www.wageworks.com or see your WageWorks Health Care and Dependent Care Guide.

ELIGIBLE DEPENDENTS:
You can use your Health Care Account to pay for health care expenses incurred by any of the following people (even if they are not covered by your employer’s health coverage):

• You

• Your spouse

• Your qualifying child

• Your qualifying relative

1. Pay for your expenses as usual and then get reimbursed (with pre-tax dollars) directly from your Dependent Care Account.

2. You will need to complete and submit a Pay Me Back form with the appropriate required proof.

3. You can view the status of your claim online within 24 hours after we receive it.

4. Reimbursement checks are mailed twice a week for APPROVED claims. You can expect your check to be mailed to you within 5 days after we receive it (provided you have an available balance in your account).

5. Your account is funded strictly through your payroll deductions. Your available balance at any time is the total of all amounts deducted from your paycheck (as reported to us by your employer) less any payments made to date.

6. There is no limit to the amount of claims you can file against your account at any time. However, payments will be limited to your available balance.

7. Once you have used your available balance, no additional benefits will be paid until your available balance again exceeds $0 (as your payroll deductions are reported by your employer).

8. All unpaid claims will be held to await available funds from your payroll deductions. Each time a payroll deduction is reported by your employer, any unpaid claims will be paid up to the amount of your new available balance.

9. Your Dependent Care Account balance is automatically adjusted to reflect all payments made using Pay Me Back and Pay My Provider.

10. If you are using the Pay My Provider feature, you are not eligible to get reimbursed through Pay Me Back until all of your Pay My Provider payments have been made or cancelled.

You will need to provide proof of service for each expense listed on your Pay Me Back form. Submit one of the following for each expense:

• Signature of your provider on this form

• Photocopy of your cancelled check (front and back)

• Photocopy of a receipt

• Statement or bill from your provider (formal or informal)

You can use your Dependent Care Account to pay for expenses to care for any eligible dependents:

• Your qualifying child under the age of 13 years

• Your spouse, qualifying child (even if over 13 years) or qualifying relative - who is physically or mentally incapable of self care.

All of the following must be true about the care:

• The care is provided while you are working or enables you to work (and, if you are married, while your spouse is working or going to school full-time at least 5 months a year or incapable of self care)

• The care may be provided by a relative or a non-relative but is not provided by a tax dependent

• Your care provider must conform to state and local laws (including being licensed, if required) and be able to provide you with his/her Social Security or Tax ID number

You now have more time to spend the money in your account!
On May 18, 2005, the Internal Revenue Service changed the FSA rules to allow your employer to offer a grace period at the end of the plan year. This two-and-a-half month grace period provides you with more time to incur expenses against the plan. This means you can continue to spend your current account funds during the new grace period after the end of our plan year. A run-out period will follow the new grace period, giving you time to file claims for those expenses incurred during this plan year and/or during the new grace period.

The grace period applies only if you are covered on the last day of the plan year. Your coverage will be extended automatically; there’s nothing you need to do to take advantage of the new grace period, except file Pay Me Back claims or request Pay My Provider payments for those expenses incurred during the grace period.

Example: If you are covered on the last day of the plan year, your coverage will automatically be extended to include the grace period. Any eligible products and services you receive during the new grace period are eligible for reimbursement from the current plan year account.

Does the grace period apply if I started participating after the start of the plan year?
Yes. The grace period automatically applies if you are covered on the last day of the plan year, no matter what day you started coverage. So, if you enrolled as a new hire during the middle of the plan year, the grace period will apply as long as you are still covered on the last day of the plan year. If your coverage ends prior to the end of the plan year, you do not qualify for the grace period; all of your eligible expenses need to be incurred during your actual coverage period.

If I re-enroll for the next plan year and then submit a claim for a doctor’s appointment I have during the grace period, how do I know if that claim will be paid out of this plan year’s account or the new plan year account?
Any Pay Me Back claims or Pay My Provider payments that cover expenses incurred during the new grace period will be paid out of this plan year’s year account first and then, when that account balance is exhausted, your new plan year account.

Once the new plan year begins, be sure to file this plan year’s claims before your new plan year claims to get the most out of this plan year’s account!
If you file claims for products and services you receive during the grace period, you may exhaust this plan year’s account balance with claims you intended to pay from your new plan year account and then have nothing left to cover the claims you incurred during this plan year that you were holding.

Once a payment is made from an account, there will be no way of getting those funds paid out of another plan year account.
Example: You file a claim for $50 for a service you receive during the new grace period. This plan year’s account has a balance of $20 and your new plan year account has a balance of $1,200.

You will receive a payment of $50 ($20 paid out of this plan year’s account and $30 paid out of your new plan year account). All future claims will be paid from your new plan year account (provided they are incurred during your new plan year coverage period).

How long do I have to file claims against my account?
Now that the grace period extends the amount of time you have to use this plan year’s account, we are extending the period you have to file claims to the claims deadline indicated above. All claims for expenses incurred during the current plan year or during the grace period that you want paid from the current plan year’s account must be received (not just postmarked) by WageWorks on or before that claims deadline.

Please remember as required by law, any money in your Health Care or Dependent Care Account not used by the end of the plan year, will be forfeited. Therefore, it is in your best interest to be conservative when estimating your contribution, but keep in mind that your tax savings may more than make up for any extra dollars you leave in your account at the end of the year. If you are in doubt about an expense, please contact WageWorks for assistance.

Also, in line with Internal Revenue Service guidelines, you can change your election if you have a qualifying status change during the plan year. This includes change in legal marital status, change in number of tax dependents, termination or commencement of employment, dependent satisfies or ceases to satisfy dependent eligibility requirements, or a judgment, decree or order. However, the adjustment in your election must be relevant to the change in status and the requested election change has to be in line and consistent with the event. All requests must be submitted to WageWorks for approval.

There is a run off period with the reimbursement accounts. You will have 90 days following the end of the plan year to file for services rendered during the plan year.

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