Page 41 - Public Citizen 2021-2022
P. 41

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             Dependent Care FSA. This account provides employees with tax free dependent care assistance only when the assistance
             is necessary for the Participant to leave the home to engage in activity directly related to his/her employment. Qualified
             expenses under the Dependent Care FSA include any expenses that you could take as a credit against tax on your income
             tax form for the care of a Qualified Person. Benefits are provided only to the extent of your payroll deduction on the date
             the RFR is processed. The tax laws further limit how much you may contribute to this account.
             Under the law and the terms of the plan, you may defer no more than the lesser of your actual (or, if you are married and
             if less, your spouse's) income for the year or $5000 per year to this Program. A married Participant who files separate tax
             returns is limited to $2500 per year.

             Healthcare Premium (NESP) Reimbursement Account. This account provides reimbursement for premiums you paid for
             employee-owned health insurance policies. Employer-provided insurance plans and coverage offered through the
             Marketplace, (a state or federal plan under the Affordable Care Act), do not qualify. Premiums eligible for reimbursement
             are for a period in which you were a covered Participant under this account.

             HEALTH SAVINGS ACCOUNT (HSA) RULE

             If you elect the Healthcare FSA benefit (General Purpose), you cannot also elect HSA benefits (or otherwise make
             contributions to an HSA) unless you elect the Limited Purpose Healthcare FSA (vision/dental). In addition, when the
             Healthcare FSA includes a grace period and you have a General-Purpose Healthcare FSA (not Limited Purpose), you cannot
             elect HSA benefits or make contributions to an HSA until the first day of the month following the last day of the grace
             period, unless the balance in your Healthcare FSA is $0 as of the last day of that Plan Year.
             If you have a General-Purpose Healthcare FSA (not Limited Purpose) with the Carryover feature, you will need to elect the
             Limited Purpose Healthcare FSA (LPFSA) for the new Plan Year. Expenses with service dates in the new Plan Year can only
             be reimbursed if they are covered under the LPFSA. In any event, you cannot contribute to an HSA in any month in which
             you are eligible for a Healthcare FSA that is not a Limited Purpose Healthcare FSA.
             If your spouse or any dependent is not eligible for an HSA due to other prohibited coverage, they must be excluded from
             coverage under your HSA. You will need to submit a written statement to your employer excluding coverage. You will not
             be able to use your HSA to reimburse medical expense for an excluded spouse or dependent for medical expenses
             incurred during the period of time they are covered by prohibited coverage.

             QUALIFIED RESERVIST DISTRIBUTION
             A Participant who is called to active duty in the US Armed Services and enrolled in the Healthcare FSA may elect to receive
             a Qualified Reservist Distribution of all or a portion of the unused balance in his/her individual Healthcare FSA subject to
             the requirements of Code Section 125(h) and the applicable regulations thereunder. The Employer may limit this
             distribution to the amount you have contributed to the account that has not been used to reimburse you for RFRs
             submitted.
             QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)

             The plan will provide benefits in accordance with a QMCSO and adhere to the terms of any judgment, decree, or court
             order which (1) relates to the provision of child support related to health benefits for a child of a Participant in a group
             health plan; (2) is made pursuant to a state domestic relations law; and (3) which creates or recognizes the right of an
             alternate recipient—or assigns to an alternate recipient the right—to receive benefits under the group health plan under
             which a Participant or other beneficiary is entitled to receive benefits. Participants may obtain, without charge, a copy of
             the plan’s procedures from the Plan Administrator.











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