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Johnson City Schools, TN | Plan Year: January 1, 2008 to December 31, 2008


     
 

WageWorks Contact

  
 

 
   
 

 
     
     
 

Please call your Personnel Office for
all questions concerning this plan.

  
     
     
     

 

 

 

 

WageWorks HealthCare Choice Flexible Spending Account With Debit Card

Maximum Annual Election: $5,000
Minimum Annual Election: $300
Waiting Period: None

Health Care Flexible Spending Account Tax-Free Worksheet Illustration

The Health Care Choice Card
Use your card to pay for eligible products and services. Funds are deducted automatically from your Health Care Choice FSA.

Why Use the Card
• No claims to file; no need to get reimbursed
• Simply swipe your card and select "credit"—no PIN required
• Deducts automatically from your Health Care Choice FSA
• Most convenient way to pay for most eligible health care products and services

When to Use the Card
• Pay for eligible health care products and services received by you or an eligible dependent during your coverage period.
• Pay for products and services on the day you receive them. Regulations prohibit use of the card to pay for eligible expenses received in the past or to be received in the future.
• Your card expires on the expiration date printed on the card or the date you discontinue coverage, whichever comes first.

Where to Use the Card
• Doctor and dentist offices, pharmacies, discount chain and club stores—if their products and services are covered under your plan.
• At most merchants who sell health care products or services and accept either Visa or MasterCard debit cards.

How to Use the Card
• Separate your eligible items from your non-eligible items at the counter when you shop at pharmacies, drugstores, supermarkets or club stores.
• Use your Health Care Choice Card to pay for your eligible items, and another form of payment for the non-eligible items.
• Give your card to the merchant or service provider, or swipe it yourself.
• Select "credit" (No PIN required), and then sign for the transactions.
• Save your receipt or other documentation that describes the items you have paid for. It may be requested by WageWorks or the IRS to verify you used your account to pay for eligible products or services.

Additional Information About Using Your Health Care Choice Card

1. You must activate your card before you use it. Simply call (866) 363-4128 and enter the information requested.

2. Use your card for eligible health care expenses only. See chart for a complete list of eligible expenses. This card can only be used in places where health care products and services are likely to be sold.

3. Do not use your card to pay for past or future services. Tax regulations prohibit you from using this card to pay for services you received before your current coverage period or those you plan to receive in the future.

4. Each time you use your card, you authorize that you are paying for eligible expenses incurred by you or an eligible dependent during your current coverage period and that you have not and will not seek reimbursement for these expenses from any other health plan or source.

5. Save all receipts that describe exactly what you paid for with your card. We may ask you to submit these to show you used your card for eligible health care expenses.

6. Debit or credit? Choose credit. Even though this is not a credit card, choose the credit option. Your card has no PIN.

7. Review your monthly statements. They contain important information about your account, including if you are required to verify any purchases you made with the card.

8. Your plan may require you to reimburse your account in the amount of any card purchase if you cannot show the card was used for eligible health care products and services.

How to order additional cards

1. Log on to www.wageworks.com

2. Enter your user name and password (or click on "First-Time User? Register Now" to complete the simple online registration process)

3. Click on the "Health Care" tab

4. Select "Request Additional Card"

5. Provide first name, last name and Social Security Number of the person who will use the card

• The first additional card is provided free of charge
• There is a charge for the second card
• No more than three cards are available per account (one for you, the employee, and two for use by your eligible dependents)

If You Lose Your Card or if it is Stolen
Contact WageWorks immediately at our toll-free number: (877) 924-3967.

Health Care Pay My Provider
Pay your providers directly from your Health Care Choice FSA.

Why Use Pay My Provider
• No claims to file; no need to get reimbursed
• Works like a bill pay service
• Deducts automatically from your Health Care Choice FSA
• Most convenient way to pay for most recurring eligible health care services

When to Use Pay My Provider
• Regularly scheduled payments for eligible services such as orthodontic or chiropractic care
• When your doctor or dentist bills you for the amount not covered by your health plan
• To pay an invoice for an eligible service you already received and that expense requires only basic proof of service
• When you need to make a payment of $20 or more

How to Use Pay My Provider

1. Log on to www.wageworks.com

2. Click on the "Health Care" tab

3. Click "Request Pay My Provider"

4. Confirm or enter your email address

5. Enter your provider information

6. Enter patient information

7. Enter your payment amount

8. WageWorks will make the requested payment from your account and mail it directly to your provider

9. WageWorks will send you an email each time a requested payment is made

Health Care Pay Me Back
Get reimbursed from your Health Care Choice FSA for eligible products and services you pay for out of pocket.

When to Use Pay Me Back
Some products and services are easier to pay for first, and then get reimbursed. For example:
• When your provider requires you to pay before you receive the product or service. Pay for the service as required, and then file your claim after you have received the service.
• The expense is listed as a "Maybe" in the What’s Covered list, meaning it requires additional information to get approved.
• You receive a bill from your provider after your health plan pays and your portion is less than $20, the minimum Pay My Provider payment amount.

How to Use Pay Me Back
• Pay for your eligible products and services as you usually do and save your detailed receipt.
• Complete a Health Care Pay Me Back form. You can download a form after you log in to www.wageworks.com
• Fax your form and appropriate proof of expense to the number indicated on the form.
• Or, mail your form and photocopies of your proof of expense to the address indicated on the form.
• Check your claims status online anytime by logging on to www.wageworks.com.
• All claims (including resubmissions) must be received no later than your Claim It by date (displayed on your monthly statement) to be eligible for reimbursement.

Who’s Covered by Your Health Care Choice FSA?
You can use your Health Care Choice FSA to pay for health care expenses incurred by the following people (per the new IRS rules effective 01/01/05) even if they are not covered by your employer’s health plan:

• Yourself
• Your spouse
• Your qualifying child*
• Your qualifying relative*

*Special rules allow a dependent to be eligible for this plan even when that dependent does not qualify to be claimed as your tax dependent on your tax return form. For more information, go to www.wageworks.com/forms/hcdependents.pdf and contact your personal tax advisor.

what's covered by your health care choice fsa?

Product/Service

Category

Covered?
 

Acne treatments (over-the-counter)

Medical

Yes

Acupuncture

Medical

Yes

Adoption (medical expenses related to)

Medical

Yes

Adoption Fees

N/A

No

Alcoholism Treatment

Medical

Yes

Allergy and sinus medicine and products (over-the-counter)

Medical

Yes

Allergy Medication (prescription)

Pharmacy

Yes

Allergy Treatments

Medical

Yes

Alternative Dietary Supplements (for treatment of a medical condition)

Medical

Maybe

Alternative Drugs and Medicines (for treatment of a medical condition)

Medical

Maybe

Alternative Healers (for treatment of a medical condition)

Medical

Maybe

Ambulance and Emergency Health Services

Medical

Yes

Anesthesia (for non-cosmetic purposes)

Medical

Yes

Antacid (over-the-counter)

Medical

Yes

Antibiotic Ointment (over-the-counter)

Medical

Yes

Aspirin or Other Pain Reliever (over-the-counter)

Medical

Yes

Asthma Medicines or Treatments (over-the-counter)

Medical

Yes

Bandages and Related Items (over-the-counter)

Medical

Yes

Birth Control (over-the-counter)

Medical

Yes

Birth Control (prescription or other)

Medical

Yes

Blood Pressure Monitor

Medical

Yes

Body Scans

Medical

Yes

Braille Books and magazines (difference in cost only)

Vision

Maybe

Breast Pump (to compensate for a medical condition)

Medical

Maybe

Breastfeeding Classes

N/A

No

Cancer (fixed indemnity, $XX per day) Insurance Premiums

N/A

No

Canker and Cold Sore Treatments (over-the-counter)

Medical

Yes

Chest Rubs (over-the-counter)

Medical

Yes

Child or Newborn Care Instruction

N/A

No

Childbirth Classes

Medical

Yes

Chiropractic Care

Medical

Yes

Chiropractic Office Visit or Treatment

Medical

Yes

Christian Science Practitioners

Medical

Yes

COBRA Premiums

N/A

No

Co-Insurance (dental)

Dental

Yes

Co-Insurance (medical)

Medical

Yes

Co-Insurance (prescription)

Pharmacy

Yes

Co-Insurance (vision)

Vision

Yes

Cold and Flu Medicine (over-the-counter)

Medical

Yes

Cold Cream (over-the-counter)

N/A

No

Compression or Anti-Embolism Socks, Stockings, or Hose

Medical

Yes

Condoms and Spermicides

Medical

Yes

Contact Lenses, Cleaning Solutions, Etc.

Vision

Yes

Contraceptives (prescription or over-the-counter)

Medical

Yes

Co-Payment (dental)

Dental

Yes

Co-Payment (medical)

Medical

Yes

Co-Payment (other)

Medical

Yes

Co-Payment (vision)

Vision

Yes

Cord Blood Storage (for unidentified future use)

N/A

No

Corneal Keratotomy

Vision

Yes

Cosmetic Surgery

N/A

No

Cough Drops and Sore Throat Lozenges (over-the-counter)

Medical

Yes

Cough Syrup (over-the-counter)

Medical

Yes

Counseling (for treatment of a medical condition)

Medical

Yes

CPR Classes (adult or child)

N/A

No

Crutches, Canes, or Like Equipment (purchase or rental)

Medical

Yes

Dancing Lessons (for treatment of a medical condition)

Medical

Maybe

Deductible for Dental Plan

Dental

Yes

Deductible for Medical Plan

Medical

Yes

Deductible for Prescription Plan

Pharmacy

Yes

Deductible for Vision Plan

Vision

Yes

Dental

Dental

Yes

Dental Care (for non-cosmetic purposes)

Dental

Yes

Dental Co-Payment

Dental

Yes

Dental Insurance or Plan Premiums

N/A

No

Dental Products (for treatment of a dental condition, not general health)

Dental

Maybe

Dental Reconstruction

Dental

Yes

Dental Veneers

Dental

Maybe

Dentures, Bridges, Etc.

Dental

Yes

Diabetic Monitor

Medical

Yes

Diagnostic Services

Medical

Yes

Dietary Supplements (for treatment of a medical condition)

Medical

Maybe

Drug Addiction Treatments

Medical

Yes

Drugs (experimental or imported)

N/A

No

Drugs (prescription)

Pharmacy

Yes

Dylexia Treatment

Medical

Yes

Ear Drops and Wax Removal (over-the-counter)

N/A

No

Educational Classes or Tuition

N/A

No

Electrolysis

N/A

No

Emergency Kits (over-the-counter)

N/A

No

Exercise Equipment (for treatment of a medical condition)

Medical

Maybe

Eye Examinations

Vision

Yes

Eye-Related Equipment/Materials

Vision

Yes

Eye Surgery or Treatment to Correct Vision

Vision

Yes

Eyeglasses (over-the-counter)

Vision

Yes

Eyeglasses (prescription)

Vision

Yes

Face Lifts

N/A

No

Fertility Monitor (over-the-counter)

Medical

Yes

Fertility Treatment (for employee, spouse, dependent)

Medical

Yes

Fertility Treatment (for non-dependent surrogate)

N/A

No

First Aid Kits (over-the-counter)

N/A

No

Fitness Programs

N/A

No

Flu Shots

Medical

Yes

Funeral Expenses

N/A

No

Gastrointestinal Medication (over-the-counter)

Medical

Yes

Guide Dog (dog, training, care)

Vision

Yes

Hair Regrowth Products

N/A

No

Hair Removal

N/A

No

Hair Transplant

N/A

No

Hair Treatments

N/A

No

Hand Lotion (over-the-counter)

N/A

No

Health Club Dues

N/A

No

Health Insurance or Plan Premiums

N/A

No

Health Savings Account (HAS) contributions

N/A

No

Hearing Aids and Batteries

Medical

Yes

Herbal or Homeopathic Medicines (over-the-counter)

N/A

No

Hospital (fixed indemnity, $XX per day) Insurance Premiums

N/A

No

Hospital Fees

Medical

Yes

Hospital Services

Medical

Yes

Household Help

N/A

No

Illegal Operations or Substances

N/A

No

Immunizations

Medical

Yes

Infertility Treatment (for employee, spouse or dependent)

Medical

Yes

Insulin, Testing Materials and Supplies

Medical

Yes

Insurance or Health Plan Premiums

N/A

No

Lab (medical)

Medical

Yes

Laboratory Fees

Medical

Yes

Lactose Intolerance (over-the-counter)

Medical

Yes

Lamaze Classes

Medical

Yes

Laser Eye Surgery

Vision

Yes

Lasik

Vision

Yes

Late Payment Fees Charged by Health Care Provider

N/A

No

Laxatives (over-the-counter)

Medical

Yes

Learning Disability Treatments

Medical

Yes

Lice Treatment (over-the-counter)

Medical

Yes

Listening Therapy

Medical

Yes

Lodging (essential to receive medical care)

Medical

Maybe

Long-Term Care Premiums (up to IRS tax-free limit, $490 in 2004)

N/A

No

Long-Term Care Services

Medical

No

Long-Term Disability Insurance Premiums

N/A

No

Magnetic Therapy (over-the-counter)

N/A

No

Marriage Counseling

N/A

No

Massage Therapy (for treatment of a medical condition)

Medical

Maybe

Mastectomy-Related Special Bras

Medical

Yes

Maternity Clothes

N/A

No

Medical Abortion

Medical

Yes

Medical Co-Insurance

Medical

Yes

Medical Co-Payment

Medical

Yes

Medical Equipment (for treatment of medical condition) and Repairs

Medical

Yes

Medical Insurance or Plan Premiums

N/A

No

Medical Literature, Books, Pamphlets or Audio

N/A

No

Medical Monitoring and Testing Devices

Medical

Yes

Medical Records Charges

Medical

Yes

Medical Savings Account (MSA) Contributions

N/A

No

Medical Supplies (for treatment of a medical condition)

Medical

Maybe

Medicare Premiums, Medicare Supplement, and Medicare Alternative Insurance or Plan Premiums

N/A

No

Medicines (over-the-counter)

Medical

Yes

Medicines (prescription)

Pharmacy

Yes

Mileage ($.15 per documented mile for travel to/from eligible health care)

Medical

Yes

Modified Equipment (difference in cost only)

Medical

Maybe

Monitors and Test Kits (over-the-counter)

Medical

Yes

Motion and Nausea

Medical

Yes

Nasal Sprays

Medical

Yes

Nasal Strips (over-the-counter)

N/A

No

No-Show Fees Charged by Health Care Provider

N/A

No

Non-Prescription Drugs and Medicines (for non-cosmetic purposes)

Medical

Yes

Norplant Insertion or Removal

Medical

Yes

Nursing Services (wages and taxes)

Medical

Yes

Nutrition Supplements (for treatment of a medical condition)

Medical

Maybe

OB/GYN Fees

Medical

Yes

Occlusal Guards to Prevent Teeth Grinding

Dental

Yes

Occupational Therapy (related to a medical condition or disability)

Medical

Yes

Office Visits (medical)

Medical

Yes

Office Visits (chiropractic)

Medical

Yes

Office Visits (dental)

Dental

Yes

Office Visits (psych/therapy)

Medical

Yes

Office Visits (vision)

Vision

Yes

Operations (for non-cosmetic purposes)

Medical

Yes

Optometrist/ Ophthalmologist Fees

Vision

Yes

Oral Care (over-the-counter)

N/A

No

Organ Transplants (recipient and donor)

Medical

Yes

Ortho Keratotomy

Vision

Yes

Orthodontia

Dental

Yes

Orthodontia (braces and retainers)

Dental

Yes

Over-the-Counter (eligible medical)

Medical

Yes

Over-the-Counter Acne Treatments

Medical

Yes

Over-the-Counter Allergy and Sinus Medicine

Medical

Yes

Over-the-Counter Antacid

Medical

Yes

Over-the-Counter Antibiotic Ointment

Medical

Yes

Over-the-Counter Aspirin or Other Pain Reliever

Medical

Yes

Over-the-Counter Asthma Medicines or Treatments

Medical

Yes

Over-the-Counter Bandages and Related Items

Medical

Yes

Over-the-Counter Canker and Cold Sore Treatments

Medical

Yes

Over-the-Counter Chest Rubs

Medical

Yes

Over-the-Counter Cold and Flu Medicine

Medical

Yes

Over-the-Counter Cold and Flu Prevention

Medical

Yes

Over-the-Counter Cold Cream

N/A

No

Over-the-Counter Cough Drops and Sore Throat Lozenges

Medical

Yes

Over-the-Counter Cough Syrup

Medical

Yes

Over-the-Counter Health Care Products (eligible)

Medical

Yes

Over-the-Counter Health Care Products (non-eligible)

N/A

No

Over-the-Counter Medication

Medical

Yes

Over-the-Counter Products for Dental Ailments

Dental

Yes

Over-the-Counter Products for General Dental Care

N/A

No

Over-the-Counter Vision Products

Vision

Yes

Ovulation Monitor (over-the-counter)

Medical

Yes

Oxygen

Medical

Yes

Pain Reliever (over-the-counter)

Medical

Yes

Personal Use Items (toothbrush, toothpaste, etc.)

N/A

No

Physical Exams

Medical

Yes

Physical Therapy

Medical

Yes

Pregnancy Tests (over-the-counter)

Medical

Yes

Prescription Co-Insurance

Pharmacy

Yes

Prescription Co-Payment

Pharmacy

Yes

Prescription Drugs (for non-cosmetic purposes)

Pharmacy

Yes

Prescription Drugs for cosmetic purposes

N/A

No

Prescription Drugs for Hair Regrowth

N/A

No

Prescription Insurance or Plan Premiums

N/A

No

Propecia (for treatment of a medical condition)

Medical

Maybe

Prosthesis

Medical

Yes

Psych/Therapy

Medical

Yes

Psychiatric Care

Medical

Yes

Psychoanalysis

Medical

Yes

Psychologist Fees

Medical

Yes

Radial keratotomy (RK)

Vision

Yes

Reading Glasses (over-the-counter)

Vision

Yes

Reconstructive Surgery (following accident or medical procedure or condition)

Medical

Maybe

Removal of Benign Mole, Cyst or Tumor

Medical

Yes

Retin-A (for non-cosmetic purposes)

Medical

Maybe

Rogaine or Other Hair Regrowth Medications (even is prescribed)

N/A

No

Rx (prescription)

Pharmacy

Yes

Smoking Cessation (programs/counseling)

Medical

Yes

Smoking Cessation Drugs (prescription)

Medical

Yes

Smoking Cessation Gum or Patches (over-the-counter)

Medical

Yes

Special Equipment

Medical

Maybe

Special Foods (gluten-free, salt-free or other for treatment of medical condition)

Medical

Maybe

Special School (for mental and physical disabilities)

Medical

Maybe

Speech Therapy

Medical

Yes

Sterilization

Medical

Yes

Student Health Fees (for dental services)

Dental

Yes

Student Health Fees (for medical services)

Medical

Yes

Student Health Fees (for prescriptions)

Pharmacy

Yes

Student Health Fees (for vision services)

Vision

Yes

Sunglasses (over-the-counter)

N/A

No

Sunglasses (prescription)

Vision

Yes

Sunscreen (over-the-counter)

N/A

No

Supplies (for treatment of a medical condition)

Medical

Maybe

Surgery (for non-cosmetic purposes)

Medical

Yes

Swimming Lessons (for treatment of a medical condition)

Medical

Maybe

Teeth Bleaching or Whitening

N/A

No

Teeth Grinding Prevention Devices

Dental

Yes

Therapy (for treatment of a medical condition)

Medical

Yes

Toothpaste, toothbrush, floss, etc.

N/A

No

Transgender Treatments/Surgery

N/A

No

Transportation, Parking and Relative Travel Expenses (essential to receive medical care)

Medical

Maybe

Tubal Ligation

Medical

Yes

Tuition or Educational Classes

N/A

No

UV Protection Clothing

N/A

No

Vaccinations

Medical

Yes

Varicose Vein Removal Surgery

Medical

Yes

Vasectomy

Medical

Yes

Viagra and Similar Prescription Medications

Pharmacy

Yes

Vision

Vision

Yes

Vision Co-Insurance

Vision

Yes

Vision Co-Payment

Vision

Yes

Vision Insurance or Plan Premiums

N/A