Greeneville City Schools, TN | Plan Year: January 1, 2006 - December 31, 2006


     
 

WageWorks Contact

 
 

 

 
   
 

 
     
     
 

Please call your Personnel Office for
a
ll questions concerning this plan.

 
     
     
     

 

 

 

 

WageWorks HealthCare Reimbursement Account

Plan Year: January 1, 2006 - December 31, 2006
Medical Reimbursement Plan Maximum: $5,000
Medical Reimbursement Plan Minimum: None
Waiting Period: 1 Year

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 6am 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.

Using the WageWorks Health Care Card

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.

Using The WageWorks Web Site

Register
If you have not already registered to use the WageWorks site, you can register at www.wageworks.com to access your account, schedule payments, download forms and update your personal information.

1. Go to www.wageworks.com and click on First Time User? Register Now.
2. Enter the information requested so we can identify you.
3. Confirm or update the contact information in your Profile.
4. Review the User Agreement and confirm your acceptance.

Download Forms
1. Log onto your account at www.wageworks.com, and choose the Print Forms button.
2. Select Health Care or Dependent Care.
3. Select the form you need.
4. Print or save the form.

Scheduling Payments
Use the WageWorks web site to schedule payments to your health care or dependent care provider. Here’s how:

Pay My Provider—Health Care
1. Log onto your account at www.wageworks.com and choose the Health Care tab.
2. Click Request Pay My Provider.
3. Confirm or enter your email address.
4. Enter your provider information.
5. Enter patient information.
6. Enter your payment amount(s).
7. WageWorks will make the requested payment(s) from your account and mail it directly to your provider.

Pay My Provider—Dependent Care
1. Log onto your account at www.wageworks.com and choose the Dependent Care tab.
2. Click Request Pay My Provider.
3. Confirm or enter your email address.
4. Enter your provider information.
5. Enter dependent care information.
6. Enter your payment amount(s).
7. WageWorks will make the requested payment(s) from your account and mail it directly to your provider.

Health Care Account
Your WageWorks Health Care Account saves you money by allowing you to pay for your eligible health care costs with pre-tax dollars. Your election amount is deducted from your paycheck automatically by your employer. You have easy access to your account to pay for eligible health care expenses not covered by your health plan by using the convenient WageWorks payment options: the WageWorks Health Care Card, Pay My Provider or Pay Me Back.

Over-the-Counter Drugs and Medicine Are Eligible!
If you buy products like Advil®, Band-Aids®, Benedryl®, Claritin® or Tums®, you can now use your Health Care Account to pay for these items thanks to an IRS ruling in September 2003. Check the list of Health Care Expenses to find out which items are covered.

Reimbursement for Over-the-Counter Drugs and Medicine
When you file a Pay Me Back claim, make sure the description you enter on your claim form clearly indicates the type of over-the-counter product you purchased
such as indicated in the list of Health Care Expenses. You must also submit an itemized receipt that indicates what you paid for, the date and the amount.

WageWorks Health Care Card
The WageWorks Health Care Card works like a credit card that you can use to purchase eligible health care services and items at qualified merchants who accept MasterCard®. Unlike a credit card, the cost of the purchases you make with the card is automatically deducted from your Health Care Account.

When To Use It
The WageWorks Card is a “limited-use” card, which means you can use it only at qualified medical offices and merchants to pay for eligible health care expenses. For full details of items that are and are not covered see the list of Health Care Expenses. Your card should be used only for eligible health care you receive while covered under the Health Care Account. You cannot use the card to pay for services you received before you were covered under this account this plan year or to pay for eligible health care you will receive any time in the future. The WageWorks Card is especially convenient for:

• Co-payments at your doctors, dentists and hospitals
• Prescriptions at the pharmacy counter or through a mail-order program
• Prescription eyeglasses, sunglasses or contact lenses
• Surgical and laboratory fees
• Medical supplies

How To Use It
• Give your card to the service provider or swipe it yourself at the point of purchase.
• If you are using a terminal, choose the credit option.
• Sign for your purchase.
• Keep your itemized receipt–the one that describes what you paid for.

Other Things You Need To Know

• Be sure to keep your receipts and other records each time you use the card. In most cases WageWorks receives enough information about your purchase when you pay with the card to confirm that it was for an eligible expense. Occasionally, we require more information to verify a payment. Your monthly statement will show you if more information is required.

• You will be required to reimburse your account for any use of the card for ineligible expenses. If you cannot show the card was used to pay for eligible health care expenses, then you will be required to reimburse your Health Care Account for the amount of the purchase. Your monthly statement will notify you of any payments due. If you fail to reimburse your account when requested, you may be subject to any of the following: (1) the amount due will be deducted from your next Pay Me Back reimbursement check, (2) your card privileges may be revoked and (3) other collection efforts may be taken in accordance with your employer’s policies.

• Save your receipts with your tax documents just as you should for other uses of your Health Care Account.

• The card cannot be used to get cash value. Keep the card safe like a credit card. All purchases will be charged against the account balance.

Pay My Provider
You tell us how much to pay your provider and we will write and mail a check directly from your account.

When To Use It
Pay My Provider is your most convenient payment option if you have:
• Regularly scheduled payments for eligible expenses such as orthodontic care or physical therapy
• Balance billing, which is when your provider bills your health plan and then bills you for the amount your insurance doesn’t cover
• Invoices you receive after the date of service for eligible expenses that require only basic proof of service.

See Proof of Service definitions for more information.

How To Use It
• Log onto your account at www.wageworks.com
• Click on Health Care tab
• Click on Request Pay My Provider
• Confirm or enter your email address
• Enter your provider information
• Enter patient 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
• An email address is required to use Pay My Provider so we can send you time-sensitive payment information.
• WageWorks will send you an email if you use up all the money in your account before we can make your requested payment(s).
• As with all use of your Health Care Account, save your receipts or other proof of expense with your tax documents.

Pay Me Back
Sometimes you will want to pay for your health care expenses yourself and have WageWorks pay you back with money from your Health Care Account.

When To Use It
Some expenses are easier to pay for first and then get reimbursed. For example:
• You must pay in advance. Pay for the service as required and then file your claim once you have received the service.
• Your provider does not accept credit cards.
• You purchase over-the-counter drugs and medications.
• The expense is listed as a Maybe in the Health Care Expense list and requires additional information to get approved.
• You receive a bill from your provider after your insurance pays and your portion is less than $20, the minimum Pay My Provider payment amount.

How To Use It
• Pay for your eligible health care expense as you usually do and save your receipt.
• Complete a Health 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.
• Fax your form and photocopies of your proof of services to (877)353-9236.
• Or mail your form and photocopies of your proof of service to:
WageWorks.

Other Things You Need To Know
• Remember to send us a photocopy of the proof, not your original. Keep your originals with your tax documents for the year.
• Check the proof of service definitions and the list of Health Care Expenses to find which type of proof of service you need to provide.

Whose Expenses Are Eligible?
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, if you are legally married and file a joint tax return
• Your child, grandchild or any other child who you claim as a tax dependent regardless of age
• Your older child, elderly parent, domestic partner or any other person who you claim as a tax dependent

Proof of Service Definitions

Basic Proof applies to the most common types of expenses, such as office visits, prescription and pharmacy items, over-the-counter drugs and medicine, balances not covered by your health plan, recurring expenses for ongoing treatment. For these types of expenses, you can provide doctor’s receipts, pharmacy forms, an itemized receipt, a provider’s bill or an explanation of benefits from your health plan provider.

Basic + Letter Proof is required for expenses that aren’t as straightforward as those listed above. In addition to a receipt, you must provide a signed letter from your doctor. The letter must include your diagnosis, indicate that the expense is for a medically prescribed service, and state the specific reason for the expense.

Basic + Letter + Cost Proof is for very specific expenses such as Braille books. In addition to the cost of the special item, you must also provide proof of the cost of the standard, unmodified item. Only the difference in cost between the standard item and the modified item is eligible to be paid through your Health Care Account.

Expense

 

Eligible

Proof of Service*

Best Way to Pay

Acupuncture

 

Yes

Basic   

Card or Pay Me Back

Acne treatments (including over-the-counter)

 

Yes

Basic

Pay Me Back

Adoption (medical expenses related to)

 

Yes

Basic

Pay My Provider

Adoption fees

 

No

 

 

Alcoholism treatment

 

Yes

Basic

Pay My Provider

Allergy products (including over-the-counter)

 

Yes

Basic

Pay Me Back

Allergy & sinus medicine  
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Allergy treatments (including over-the-counter)

 

Yes

Basic

Pay Me Back

Alternative dietary substitutes

 

No

 

 

Alternative drugs and medicines

 

Maybe

Basic + Letter

Pay Me Back

Alternative healers

 

Maybe

Basic + Letter

Pay Me Back

Ambulance

 

Yes

Basic

Any

Antacid (including over-the-counter)

 

Yes

Basic

Pay Me Back

Antibiotic ointment (including over-the counter)

 

Yes

Basic

Pay Me Back

Aspirin (over-the-counter)

 

Yes

 

Basic

Pay Me Back

Asthma medicines or treatments
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Bandages and related items

 

Yes

Basic

Pay Me Back

Birth control
(by prescription or over-the-counter)

 

Yes

Basic

Pay Me Back

Body scans and other diagnostic services
(even if not prescribed)

 

Yes

Basic

Card or Pay Me Back

Braille books and magazines
(difference in cost only)

 

Maybe

Basic+Letter+Cost

Pay Me Back

Canker & cold sore treatments
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Chest rubs (including over-the-counter)

Yes

Basic

Pay Me Back

 

Child or newborn care instruction

 

No

 

 

Childbirth classes

 

Yes

Basic

Any

Chiropractic treatment

 

Yes

Basic

Any

Chiropractor (office visit)

 

Yes

Basic

Any

Christian Science practitioners

 

Yes

Basic

Pay My Provider

Co-insurance (medical, dental or vision)

 

Yes

Basic

Pay My Provider

Cold & flu prevention

 

No

 

 

Cold & flu medicine
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Cold cream

 

No

 

 

Condoms and spermicides

 

Yes

Basic

Pay Me Back

Contact lenses, cleaning solutions, etc.

 

Yes

Basic

Pay Me Back

Contraceptives (over-the-counter)

 

Yes

Basic

Pay Me Back

Co-payments (medical, dental or vision)

 

Yes

Basic

Card or Pay Me Back

Cord blood storage (for future treatment of a birth defect or known medical condition)

 

Maybe

 

Basic + Letter

Pay Me Back

Cord blood storage
(for unidentified future use)

 

No

 

 

Cosmetic surgery

 

No

 

 

Cough drops & sore throat lozenges
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Cough syrup (including over-the-counter)

 

Yes

Basic

Pay Me Back

Counseling
(for treatment of a medical condition)

 

Yes

Basic

Pay My Provider

Counseling (healthcare related)

 

Yes

Basic

Pay My Provider

Crutches (purchase or rental)

Yes

Basic

Card or Pay Me Back

 

Dancing lessons
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Deductibles (medical, dental or vision)

 

Yes

Basic

Pay My Provider

Dental products
(excluding general health items)

 

Maybe

Basic + Letter

Pay Me Back

Dental treatments

 

Yes

Basic

Pay My Provider

Dental veneers

 

Maybe

Basic + Letter

Pay Me Back

Diagnostic services

 

Yes

Basic

Pay My Provider

Dietary supplements
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Drug addiction treatment

 

Yes

Basic

Pay My Provider

Drugs (prescription)

 

Yes

Basic

Card

Dyslexia treatment

 

Yes

Basic

Pay My Provider

Ear drops & wax removal

 

No

 

 

Electrolysis

 

No

 

 

Exercise equipment
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Eye examinations

 

Yes

Basic

Pay My Provider

Eye related equipment/materials

 

Yes

Basic

Pay Me Back

Eyeglasses (over-the-counter)

 

Yes

Basic

Pay Me Back

Eyeglasses (prescription)

 

Yes

Basic

Card or Pay Me Back

Face lifts

 

No

 

 

Fertility monitor (over-the-counter)

 

Yes

Basic

Pay Me Back

Fertility treatment
(for employee, spouse or dependent)

 

Yes

Basic

Pay My Provider

Fertility treatment
(for non-dependent surrogate)

 

No

 

 

Fitness programs

 

No

 

 

Flu shots

 

Yes

Basic

Pay My Provider

Funeral expenses

 

No

 

 

Gastrointestinal medication
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Guide dog (dog, training, care)

 

Yes

Basic

Pay My Provider

Hair removal

 

No

 

 

Hair transplant

 

No

 

 

Hand lotion

 

No

 

 

Health club dues

 

No

 

 

Hearing aids and batteries

 

Yes

Basic

Pay Me Back

Herbal medicines

 

No

 

 

Herbal treatments (non-prescription)

 

No

 

 

Homeopathic medicines

 

No

 

 

Hospital services

 

Yes

Basic

Pay My Provider

Household help

 

No

 

 

Illegal operations

 

No

 

 

Illegal substances

 

No

 

 

Immunizations

 

Yes

Basic

Pay My Provider

Infertility treatment
(for employee, spouse or dependent)

 

Yes

Basic

Pay My Provider

Insulin

 

Yes

Basic

Card or Pay Me Back

Insulin testing materials and equipment

 

Yes

Basic

Pay Me Back

Insurance premiums

 

No

 

 

Insurance premiums
(employee portion or other)

 

No

 

 

Laboratory fees

 

Yes

Basic

Pay My Provider

Lactose treatment
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Lamaze classes

 

Yes

Basic

Pay My Provider

Laser eye surgery

 

Yes

Basic

Card or Pay Me Back

Lasik

 

Yes

Basic

Card or Pay Me Back

Laxatives (including over-the-counter)

 

Yes

Basic

Pay Me Back

Learning disability treatments

 

Yes

Basic

Pay My Provider

Lice treatment (including over-the-counter)

 

Yes

Basic

Pay Me Back

Lodging (essential to receive medical care)

 

Maybe

Basic + Letter

Pay Me Back

Long-term care services

 

No

 

 

Magnetic therapy

 

No

 

 

Marriage counseling

 

No

 

 

Massage therapy
(for treatment of a medical condition)

 

 

Maybe

Basic + Letter

Pay Me Back

Mastectomy-related special bras

 

Yes

Basic

Card or Pay Me Back

Maternity clothes

 

No

 

 

Medical abortion

 

Yes

Basic

Card or Pay Me Back

Medical equipment
(for treatment of medical condition) and repairs

 

Yes

Basic

Pay My Provider

Medical monitoring and testing devices

 

Yes

Basic

Pay Me Back

Medical records charges

 

Yes

Basic

Pay My Provider

Medical savings accounts

 

No

 

 

Medical supplies
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Medicines (over-the-counter)

 

Yes

Basic

Pay Me Back

Medicines (prescription)

 

Yes

Basic

Card or Pay Me Back

Modified equipment

Maybe

Basic+Letter+Cost

Pay Me Back

 

Monitors & test kits

 

Yes

Basic

Pay Me Back

Motion & nausea (including over-the-counter)

 

Yes

Basic

Pay Me Back

Nasal sprays (including over-the-counter)

 

Yes

Basic

Pay Me Back

Nasal strips

 

No

 

 

Non-prescription drugs and medicines

 

Yes

Basic

Pay Me Back

Norplant insertion or removal

 

Yes

Basic

Pay My Provider

Nursing services (wages and taxes)

 

Yes

Basic

Pay My Provider

Nutritional supplements
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

OB/GYN fees

 

Yes

Basic

Pay My Provider

Occlusal guards to prevent teeth grinding

 

Yes

Basic

Pay My Provider

Office visits (medical, dental or vision)

 

Yes

Basic

Card or Pay Me Back

Operations (excluding cosmetic)

 

Yes

Basic

Pay My Provider

Optometrist / ophthalmologist fees

 

Yes

Basic

Pay My Provider

Oral care (over-the-counter)

 

No

 

 

Organ transplants (recipient and donor)

 

Yes

Basic

Pay My Provider

Orthokeratotomy

 

Yes

Basic

Pay My Provider

Orthodontia

 

Yes

Basic

Pay My Provider

Over-the-counter medication

 

Yes

Basic

Pay Me Back

Ovulation monitor (over-the-counter)

 

Yes

Basic

Pay Me Back

Oxygen

 

Yes

Basic

Card or Pay Me Back

Pain reliever (including over-the-counter)

 

Yes

Basic

Pay Me Back

Personal use items (toothbrush, toothpaste, etc.)

 

No

 

 

Physical exams

 

Yes

Basic

Pay My Provider

Physical therapy

 

Yes

Basic

Pay My Provider

Pregnancy tests (over-the-counter)

Yes

Basic

Pay Me Back

 

Premiums (health plan or insurance)

 

No

 

 

Prescription drugs

 

Yes

Basic

Card or Pay Me Back

Prosthesis

 

Yes

Basic

Pay My Provider

Psychiatric care

 

Yes

Basic

Pay My Provider

Psychoanalysis

 

Yes

Basic

Pay My Provider

Psychologist fees

 

Yes

Basic

Pay My Provider

Radial keratotomy (RK)

 

Yes

Basic

Card or Pay Me Back

Reading glasses (over-the-counter)

 

Yes

Basic

Pay Me Back

Reconstructive surgery
(following mastectomy or other)

 

Maybe

Basic + Letter

Pay Me Back

Removal of benign mole, cyst or tumor

 

Yes

Basic

Pay My Provider

Retin-A (excluding cosmetic uses)

 

Maybe

Basic + Letter

Pay Me Back

Rogaine®

 

No

 

 

Smoking cessation (programs / counseling)

 

Yes

Basic

Pay My Provider

Smoking cessation drugs (prescription)

 

Yes

Basic

Card or Pay Me Back

Smoking cessation gum or patches
(including over-the-counter)

 

Yes

Basic

Pay Me Back

Special equipment

 

Maybe

Basic+Letter+Cost

Pay Me Back

Special foods
(e.g., gluten-free or salt free diet)

 

Maybe

Basic+Letter+Cost

Pay Me Back

Speech therapy

 

Yes

Basic

Pay My Provider

 

Sterilization

 

Yes

Basic

Pay My Provider

Student health fees (for medical services)

 

Yes

Basic

Card or Pay Me Back

Sunglasses (over-the-counter)

 

No

 

 

Sunglasses (prescription)

 

Yes

Basic

Card or Pay Me Back

Sunscreen

 

No

 

 

Supplies
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Surgery (cosmetic)

 

No

 

 

Surgery (excluding cosmetic)

 

Yes

Basic

Pay My Provider

Surgical abortion

Yes

 

Basic

Card or Pay Me Back

Swimming lessons
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Teeth bleaching or whitening

 

No

 

 

Therapy (for treatment of a medical condition)

 

Yes

Basic

Pay My Provider

Toothpaste, toothbrush, floss

 

No

 

 

Transgender treatments / surgery

 

No

 

 

Transportation, parking and related travel expenses (essential to receive medical care)

 

Maybe

Basic + Letter

Pay Me Back

Tubal ligation

 

Yes

Basic

Pay My Provider

UV protection clothing

 

No

 

 

Vaccinations

 

Yes

Basic

Pay My Provider

Varicose veins surgery

 

Yes

Basic

Pay My Provider

Vasectomy

 

Yes

Basic

Pay My Provider

Viagra® (prescription)

 

Yes

Basic

Card or Pay Me Back

Vitamins (over-the-counter)

 

No

 

 

Vitamins (prescription)

 

Yes

Basic

Card or Pay Me Back

Weight loss counseling

 

Maybe

Basic + Letter

Pay Me Back

Weight loss program
(to improve or maintain general health)

 

No

 

 

Weight loss program and / or drugs
(for treatment of a medical condition)

 

Maybe

Basic + Letter

Pay Me Back

Weight loss foods

 

No

 

 

Wheelchair and repairs

 

Yes

Basic

Pay My Provider

X-ray fees

Yes

Basic

Pay My Provider

 

See Proof of Service definitions for more information.

 

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WageWorks Dependent Care Reimbursement Account

Plan Year: January 1, 2006 - December 31, 2006
Dependent Care Reimbursement Plan Maximum: $5,000

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).

Pay My Provider

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 your cancelled check (front and back) or 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 (877)353-9236.
• Or mail your form and photocopies of your proof of service to:
WageWorks.

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 child, grandchild or any other child under the age of 13
• Your older child, spouse, elderly parent or any other person who is physically or mentally incapable of self care

All of the following must be true about this person:
• The person lives in your home at least eight hours on each day you pay for care
• You (and your spouse, if you are married) pay over half the cost of maintaining a household for the person
• You claim the person as a tax dependent, or you would be eligible to except:
(a) the person’s income prevents you from doing so or
(b) the person is claimed by his non-custodial parent due to written decree

And, 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 Expenses

Child Care Expenses

Eligible?

 

After school programs

Yes

Babysitting (someone else’s home)

Yes

Babysitting (your home)

Yes

Before school programs

Yes

Child care

Yes

Dance lessons

No

Educational services (other than pre-school)

No

Kindergarten

No

Language classes

No

Nursery school

Yes

Piano lessons

No

Preschool

Yes

Private school tuition (for kindergarten and up)

No

Sick child care

Yes

Sleep-away camp

No

Summer day camp

Yes

Transportation to and from eligible care

Yes

Tutoring

No

 

 

Elder Care Expenses

Eligible?

 

Adult day care center

Yes

Day nursing care

No

Elder care (in your home)

Yes

Elder care (outside your home)

Yes

Medical care

No

Nursing home care

No

Senior day care

Yes

Transportation to and from eligible care

 

Yes

Frequently Asked Questions

Where can I get more Pay Me Back Forms?
Included with this guide is one Health Care Pay Me Back form and one Dependent Care Pay Me Back form. If you need additional forms, you can download them from www.wageworks.com, request one from your company 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 email 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, 9am to 8pm Eastern Time and from 6am to 5pm Pacific 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 TRUSTe 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 9am to 8pm Eastern Time and from 6am to 5pm Pacific 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.

Rules for Both Accounts
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.

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.

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.

Rules for Your Health Care Account
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.

Rules for Your Dependent Care Account
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.

Definitions

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.

See Proof of Service definitions for more information.

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.

GUIDELINES:
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 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).
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:
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 (if you are legally married and file a joint tax return)
• Your child, grandchild or any other child who you claim as a tax dependent (regardless of age)
• Your older child, elderly parent, domestic partner or any other person who you claim as a tax dependent
• Your older child, elderly parent, domestic partner or any other person who you would be eligible to claim as a tax dependent except the person’s income prevents you from doing so

GUIDELINES:
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.

PROOF OF SERVICE:
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)

ELIGIBLE DEPENDENTS:
You can use your Dependent Care Account to pay for expenses to care for any eligible dependents:
• Your child, grandchild or any other child under the age of 13
• Your older child, spouse, elderly parent or any other person who is physically or mentally incapable of self care

All of the following must be true about this person:
• The person lives in your home at least eight hours on each day you pay for his care
• You (and your spouse, if you are married) pay over half the cost of maintaining a household for the person
• You claim the person as a tax dependent, or you would be eligible to except: (a) the person’s income prevents you from doing so or (b) the person is claimed by his non-custodial parent due to written decree

And 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

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 Corporation 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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