AMERICOMP BENEFITS, INC. FLEXIBLE SPENDING ACCOUNTS NOTEBOOK FOR THE EMPLOYEES OF ATLANTA PUBLIC SCHOOLS Dependent Day Care Accounts & Medical Reimbursement Accounts INTRODUCTION Your company has established a flexible spending account (the Plan ) to allow you to make your own decisions about your benefit needs. The Plan provides you with a way to set aside amounts from your payroll deposits so you can pay for certain health care expenses on a tax-free basis. This booklet explains, in general terms, how your cafeteria plan works. HOW THE REIMBURSEMENT PROGRAM WORKS Here is an overview of how the Dependent Day Care and Medical Reimbursement accounts work. The amount of money you elect to set aside for the plan year will be deposited over the course of the plan year on a per-pay period basis. Refer to your enrollment form for the maximum eligible amount to be set aside for your medical reimbursement account. As you incur expenses, you will pay for the expenses with your own money or use your Flexible Spending Debit Card. After you have incurred the expenses, you can claim reimbursement from your account(s) for any expenses you paid for with your own money. As long as you are making contributions to the Plan, the full annual amount of coverage you have elected (reduced by any prior reimbursements received during the Plan year) will be available for reimbursement at any time during the Plan year for the medical reimbursement account. For the dependent daycare account, only the amount currently deposited in your account will be available (reduced by any prior reimbursements received during the Plan year). All claims must be submitted for reimbursement within ninety- (90) days of the close of the Plan year in order to be considered for payment. If submitted after that date, claims will be denied and any funds in the account will be forfeited to your employer. ELECTING THE RIGHT AMOUNT TO DEPOSIT INTO YOUR PERSONAL ACCOUNT Be cautious when estimating your expenses for the forthcoming plan year because overestimating will result in forfeitures. Every year, during your group s open enrollment, you will be given the opportunity to elect how much money you want to deposit into your account(s) for the upcoming plan year. Although you should take advantage of the maximum tax savings offered by the Plan, overestimating will result in forfeiture. You may wish to consult your individual tax advisor. ELIGIBLE DEPENDENT DAYCARE EXPENSES Daycare expenses are covered for children under age thirteen (13). These expenses must be incurred to allow the custodial parent(s) to remain actively employed. The following is a brief listing of common fees that are and are not eligible under a flexible dependent daycare program: COVERED NON-COVERED Registration Fees Kindergarten Late Pick Up Fees Field Trips Routine Daycare Fees Gymnastic Fees Before & After School Care Piano Lessons Day Camp Fees Overnight Camps As a general rule, all outdoor activities that a daycare center charges extra for, are not considered eligible expenses. The receipts for the daycare center or baby sitter should have their address, social security number/tax identification number, dates services rendered and fees charged. Your spouse is not considered an eligible daycare provider. You can only have people whom you cannot claim an exemption on your taxes for, perform daycare services. Sometimes an employee is paying a mother or mother-in-law to take care of the child(ren). If you have advised the caregiver that you will not report the funds to the IRS so the caregiver will not be taxed on the fees, then you cannot be reimbursed for these expenses under a dependent daycare account plan. Also, remember both custodial parents must be working in order for either spouse to enroll in a dependent daycare program. Daycare expenses incurred while your at home spouse volunteers or does charity work are not covered. The only times an employee with an at home spouse can enroll for dependent daycare benefits is when: 1. Your at home spouse is self-employed on a full-time basis; or 2. Your at home spouse is mentally or physically unable to take care of the child(ren); or 3. Your at home spouse is going to school full-time; or 4. Your at home spouse is job hunting on a full-time basis. ELIGIBLE MEDICAL EXPENSES An eligible medical expense under a flexible spending account plan must satisfy this definition: Amounts paid for the diagnosis, cure, mitigation or prevention of disease, or for treatment affecting any structure or foundation of the body, and for transportation primarily for essential medical care. This also includes insulin and all prescription drugs. A brief listing of covered and non- covered expenses follows on the next page:
Invitro-fertilization & fertility treatments
Smoking-cessation programs & associated
medications (prescription & over the counter)
Weight Loss Programs for specific medical
condition (letter from physician would be
physician for specific medical condition such
as Obesity, Hypertension, Diabetes, etc.
(letter from physician would be required)
Here are Examples of Expenses that are NOT Eligible
Cosmetic Surgery or Services Marriage Counseling
OVER-THE-COUNTER DRUGS AND MEDICINES
Over-the-counter drugs and medicines may now be reimbursable under your Health Care Spending Account. The expenses that may be reimbursed depend on whether the drug or medicine treats a specific medical condition or is used mostly for a person s general good health. Drugs and medicines which are primarily used for a person s general good health (e.g., mouthwash) may only be reimbursed if it is used to treat a specific medical condition and proper documentation from the doctor or dentist is submitted. Most over-the-counter drugs or medicines are eligible; cosmetic, toiletry, or sundry items are Eligible Expenses (Examples)
Pain relievers (aspirin, Tylenol, Advil, Midol, Motrin, Ibuprofen, Bayer, Aleve, Doan s, Excedrin, Anacin, etc.) Cold/sinus medicines (Actifed, Sudafed, Dimetapp, Drixoral, Robitussin, Triaminic, Comtrex, Theraflu etc.) Antacids (Axid AR, Pepcid, Prilosec, Tagamet, Zantac, Tums, Rolaids, Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Gaviscon, Gas-X etc.) Allergy medicine ( Alavert, Benadryl, Chlor-trimeton, Claritin, Tavist, etc.) Cough syrup Laxatives Hemorrhoid medicine Sore muscle medicines (Ben Gay) Nicotine patches and gum Athletes foot medicine Medical ointments (Neosporin, Bacitracin etc.)
Expenses Requiring Additional Documentation (Examples)
Medicated Shampoo Mouthwash Dietary Supplements Vitamin Supplements Nutritional Supplements
Ineligible Expenses (Examples)
Vitamins for general good health Facial creams Deodorants Toothpaste Bug repellant Sunscreens
Required Documentation: A store receipt showing the place of purchase is required and must include the date of purchase, name of the item and the amount charged. For expenses requiring additional documentation, a letter of medical necessity from your physician or dentist will be required. SMARTFLEX DEBIT CARD We are offering the SmartFlex Debit Card to be used for the dependent day care and medical spending accounts. The SmartFlex Card can be used at any participating merchant that accepts VISA. Examples of participating merchants are Physicians Offices, Hospitals, Dental Offices, Vision Service Locations, Pharmacies, Durable Medical Supply Locations, Home Healthcare Services, any facility where you purchase over the counter drugs, and any dependent day care provider that accepts VISA. To use the SmartFlex Debit Card simply present your card at time of payment to make qualified purchases for medical care goods and services directly from your flex account. You may use your SmartFlex Card for eligible medical, dental and vision expenses up to the maximum amount you have selected for the plan year. You may use your card for eligible dependent day care expenses up to the amount available in your account at that time. If the amount swiped exceeds your available projected annual benefit, the transaction will be declined. The card is swiped as a credit card and no pin number needed. As a member of the Flex Plan, each time you incur an Eligible Expense, these choices are available. You have a choice of using the SmartFlex Card which will automatically take the funds out of your flex account, or you can pay for the eligible expenses and then file a claim to be reimbursed. You can check the balance in your account at any time by going to. Your member ID is your SSN and your password is the last four digits of your SSN. If you use the SmartFlex Card and it is swiped for a single doctor office copay or single prescription copay within the medical plan for your employer the amount will automatically adjudicate in our system. If the amount swiped is for coinsurance, deductible, multiple prescriptions or doctor office copays, or over the counter medicines you are responsible for faxing or mailing us the itemized statement from the provider showing the date(s) and services incurred, name of the provider and the amount of the expense. You may be asked to provide the Explanation of Benefits from your insurance carrier. Do not swipe the card for prior year expenses. If this happens you will be asked to reimburse the funds back to us. We ask that you provide the required documentation within 15 days. If you do not provide it within 30 days of the date of service your SmartFlex Card will be disabled and you will have to submit all claims by fax or mail and wait for reimbursement. If you use the card for dependent day care expenses you are still required by the Internal Revenue Service to provide us with a receipt from the day care provider showing dates of service, amount charged and the name and tax ID or SSN of the provider. You will be provided one card for yourself when you enroll in the flexible spending benefits plan. If additional cards are needed for a spouse or dependent there is a one time $5.00 fee per card that comes out of your flexible spending account. Please complete the Dependent Card Request Form and return to us. CHANGES IN CONTRIBUTIONS You may change the amount of money you are depositing into your accounts during your company s annual open enrollment with those requested changes to be effective on the Plan s renewal date. In addition, you may make a revision if you experience a change in status event as defined by the IRS regulations. Some examples of change in status events are: Marriage; Divorce; Adoption of child(ren) or birth of child(ren); Death of your spouse and/or child(ren); Termination or commencement of your spouse s job; For dependent daycare, if your non-family member daycare provider increases or decreases their fees; and Also, for dependent daycare, your child turning age 13. Remember, you must make your written request for a change based on a change in status within sixty- (60) days of the event date (date of marriage, date of divorce decree, date of birth, etc.) in order for the request to be handled. If submitted after this timeframe, the requested revision will not be able to be made. Also, note the requested change must be consistent with the change in status event. TERMINATION OF CONTRIBUTIONS AND REIMBURSEMENTS Your ability to make contributions to the Plan ends if you retire, become disabled, die, are laid off or terminate employment for any other reason. If you take a leave of absence, you have the option of stopping the deduction while on leave and either double/triple up before taking the leave or when you return (if deductions will be taken during the same plan year). If you terminate employment with your company, you will be able to continue your medical reimbursement account under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), if your company is subject to this federal mandate. Whether or not you continue the medical reimbursement account under COBRA is entirely up to you. Remember, the full annual benefit for the medical reimbursement account has to be made available to you as of the first day of the plan year. If you terminate and have not used your money and you incur an expense after your date of termination off of the Plan, you will be able to continue this benefit under COBRA. Remember, when continuing under COBRA, you are paying with after tax money and you are paying 2% more than the actual premium due to administrative service fees imposed by the COBRA administrator. This will not apply to your dependent daycare account. You can only claim the funds that were deducted from your pay and deposited into your account, prior to termination. However, the claims can be incurred after your date of termination but must be incurred during the plan year and the expenses must be incurred because you become actively employed or are actively looking for employment. FILING A CLAIM To file a claim for reimbursement of eligible expenses, submit a completed claim form to AmeriComp Benefits for each participant you are requesting reimbursement on at the address below along with a receipt for each expense, including the following information: Name of the claimant (person receiving services); Nature of services or supplies incurred or purchased; Name and address of the provider of service. If it is a daycare provider, we will also need their tax identification number; Amount of charges (itemized); Date each service incurred; When submitting medical reimbursement claims for all services besides your prescription copays and office visit copays, we will need a copy of your insurance carrier s Explanation of Benefits (E.O.B.) before we can process these items. Your claims should either be mailed or faxed to our office. If you mail them, do not fax them and vice versa. AmeriComp Benefits, Inc. Post Office Box 4319 Columbus, Georgia 31914 Fax Number: (706) 327-1160 Phone Number: (706) 327-6511 or (800) 868-0196 IF YOUR CLAIM(S) IS/ARE DENIED If disagreements arise, we hope they will be resolved quickly and informally. However, if that is not possible, procedures have been developed so that you can appeal the decision. If a claim if denied, either totally or partially, you will receive a written notice as to that effect along with the reason(s) for the denial. If you disagree with a claim denial, you may make a written request to the Plan Administrator for a review of the claim. The request must be made within sixty- (60) days of the denial date. Within sixty- (60) days after a written request for a review is received, you will receive a written notice of the final decision or of the reason(s) for the delay in reaching a final decision if special circumstances require an extension of time. In any event, a final decision will be reached, and you will be notified within one hundred twenty- (120) days after your written request for review is received. GENERAL INFORMATION Discrimination Rules Your company is obligated by federal law to ensure that the Plan does not discriminate in favor of highly compensated or key employees. Specific discrimination tests must be applied to the Plan. If the Plan fails to satisfy the tests, highly compensated employees may be required to have their participation in the Plan limited. Your company will notify any highly compensated employees who may be affected by these tests. If the Plan Changes or Ends/Terminates Your company reserves the right to amend, suspend or terminate the Plan, in whole or in part, at any time for whatever reason it finds appropriate, including but not limited to financial losses or a merger with or acquisition of or by another corporation. This means the Plan may be discontinued in its entirety, modified to provide different levels of benefits, modified to provide a different distribution of cost sharing between your company, its employees and retirees, or amended in any other way. If such a termination or any material amendment occurs, you will be promptly notified. Plan Records The Plan and all of its records are maintained and a copy is on file at your company s main office. Effect of Employment Eligibility to participate in this Plan has no effect on your employment status with your company. Furthermore, your participation in the Plan does not constitute a commitment from your company to continue your employment. Your Rights Under ERISA As a participant in the Plan, you are entitled to certain rights and protections under the Employer Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to: 1. Examine, without charge, at the Plan Administrator s office and at other specified locations, such as worksites, all Plan documents, including insurance contracts and copies of all documents filed by the Plan with the U.S. Department of Labor, such as detailed annual reports and Plan descriptions; 2. Obtain copies of all Plan documents and other Plan information upon written request to the Plan Administrator. The administrator may make a reasonable charge for the copies. 3. Receive a summary of the Plan s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report. In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the Plan. The people who operate your Plan, called fiduciaries of the Plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. If your claim for benefits is denied in whole or in part, you must receive a written explanation of the reason(s) for the denial. You have the right to have the Plan review and reconsider your claim. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the Plan and do not receive them within thirty- (30) days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to one hundred dollars ($100.00) a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that the Plan fiduciaries misuse the Plan s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous. If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about rights under ERISA, you should contact the nearest Area Office of the U.S. Labor-Management Services Administration, Department of Labor.
Management of Acute Pain After An Emergency Department Visit: Acetaminophen (Tylenol) 1,0000 mg every 6 hours as needed Acetaminophen (Tylenol) 1,0000 mg every 6 hours AND Ibuprofen (Advil) 600 mg every 6 hours as needed for breakthrough pain Acetaminophen (Tylenol) 1,000 mg every 6 hours AND Ibuprofen (Advil) 600 mg every 6 hours AND Narcotics as needed for breakth
CURRENT POSITIONS Chief, Department of Psychiatry, China Medical University and Hospital, Taichung, Taiwan Director, Institute of Clinical Medical Science, China Medical University Medical College, Taichung, Taiwan Professor, Institute of Clinical Medical Science, China Medical University Medical College, Taichung, Taiwan Adjunct Professor, Institute of Behavioral Medicine, College of