Miami University

Flexible Spending Account Forms Direct Deposit Authorization Form Employee Reimbursement Request Form Benny Card Expense Substantiation Form Change of Status Request Form Frequently Asked Questions Grace Period Flex Spending Informational Video Healthcare Eligible Expenses Eligible Dependent Care Expenses Limited FSA (if you also have a HSA)

CHARD, SNYDER & ASSOCIATES 3510 Irwin Simpson Rd Mason, OH 45040 (513) 459-9997 (800) 982-7715 E-mail: flex@chard-snyder.com Visit the website for details: www.chard-snyder.com

Medical Flexible Spending Account (FSA)

The Healthcare Flexible Spending Account allows for certain out-of-pocket healthcare expenses to be paid for on a pre-tax basis. Participant elections are payroll deducted and placed in a special account for reimbursements to be issued as claims are incurred. Participants are able to receive their full election amounts anytime during the plan year.

There is no income tax reporting required when participating in this account. The payroll deductions are free of federal and state taxes and do not even appear on a W-2 as reported income. The maximum annual election is $3000.

Reimbursements are received by faxing, emailing or mailing claims and supporting documentation to Chard Snyder. Supporting documentation may be a receipt, a bill, an explanation of benefits summary (EOB) and/or any documentation that provides the date of service, the type of service and the amount. After the claim has been reviewed and the expense approved, payment is then issued to the participant via direct deposit or a check. Claims are processed daily and payments are issued at least once per week. Expenses can also be paid using a Benny™ Prepaid Benefit Debit Card.

Reimbursements are only issued for eligible expenses incurred by the participant, their spouse/same-sex domestic partner or their eligible dependents. Any funds remaining in the account at the end of the plan year and after the corresponding 2 ½ month grace period are forfeited.

Dependent Care Flexible Spending Account (FSA)

The Dependent Care Flexible Spending Account allows for certain out-of-pocket daycare expenses to be paid on a pre-tax basis. Participant elections are payroll deducted and placed in a special account for reimbursements to be issued as claims are incurred. Participants may receive reimbursements up to the total amount contributed through payroll deductions, but not more than their current account balance. Participants cannot change their individual elections unless they experience a qualifying event: birth, death, marriage, divorce, loss of spouse coverage, or dependent child no longer eligible.

Payroll deductions from this account are free of federal and state taxes. Employees who participate in the Dependent Care FSA will see their pre-tax deductions represented in box 10 of their W-2. In addition, participants will be prompted to supply information about their daycare provider (name, address and tax ID number) on Form 2441 or Schedule 2 of their income tax return. Please consult a tax professional for questions regarding income tax preparation.

Reimbursements are received by faxing, emailing or mailing claim forms and supporting documentation to Chard Snyder.

Reimbursements are only issued for eligible expenses incurred by participants' dependents. Any funds remaining in the account at the end of the plan year and after the corresponding 2 ½ month grace period are forfeited.

Participant elections for the Dependent Care FSA are also limited by IRS requirements.