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\HEALTH CARE EXPENSES

The following is a summary of common expenses that may be eligible for reimbursement through a Health Flexible Spending Account. The information that follows is compiled from publications issued by the Internal Revenue service. The information below is meant to serve as a guide only and is subject to the interpretation of the law by the Internal Revenue Service, that of other government agencies, and changes to the law. All expenses must be incurred during the plan year in which contributions are made and while actively enrolled as defined by your employer in the Health Flexible Spending Account in order to be reimbursable.

	Acupuncture Performed by a licensed practitioner	Optometrist services within scope of license
	Services rendered by a treatment center for Alcoholism/Drug	Orthodontia for non cosmetic reasons
	Dependency	Oxygen
	Artificial Limbs	Physical Exams that are non employment related
	Artificial Teeth	Physical therapy
	Birth control pills and devices prescribed by a physician	Psychiatric care
	Braille books and magazines	Psychoanalysis
	Breast Reduction when physician substantiates medical necessity	Psychologist services
	Car controls and other special equipment for the handicapped	Schools special schooling to relieve handicap
	Chair - The cost of a reclining chair prescribed by a	Smoking-cessation programs and prescribed drugs to
	physician to alleviate a heart, back or other condition	alleviate nicotine withdrawal
	Chiropractors Services within scope of license	Sterilization
	Christian Science practitioners	Surgery including experimental
	Contact Lenses and solutions	Syringes, needles, and injections
	Crutches Purchase or rental	Telephone special equipment for hearing impaired
	Deductibles and co-payment AND balance not paid by	Television audio display equipment for hearing impaired
	insurance	Therapy physical or occupational therapy
	Dental fees and X-rays, fillings, braces, extraction, etc.	Transplants
	Eyeglasses, lenses, frames, exams	Transportation primarily for and essential to medical care as defined
	Eye surgery to correct vision, such as Radial Keratomy and	below:
	Photorefractive Keratectomy	*	bus, taxi, train, or plane fare or ambulance service
	Fertility treatment including in-vitro fertilization	*	car expenses, such as gasoline and oil;
	Founder’s Monthly lump-sum fee to a retirement home	*	parking fees and tolls;
	(covers portion specifically for medical care)	*	transportation expenses for a parent who must accompany a
	Guide dog purchased by the visually or hearing impaired		child who needs medical care;
	Halfway house care to help individual adjust from life in	*	transportation expenses for a nurse or other person who can
	mental hospital to community living		give injections, medications, or other treatment required by a
	Health care equipment not for general use articles for		patient who is traveling to get medical care and is unable to
	Furniture, household items, or appliances		travel alone;and
	Hearing aids and Hearing Aid Batteries	*	transportation expenses to see a mentally ill dependent if the
	Hospitalization, Including private room coverage		visits are recommended as part of treatment
	Hypnosis for treatment of illness	Instead of actual expenses it is acceptable to use a flat rate
	Insulin Medication	provided by the IRS for each mile a car is used for medical
	Learning disability tutoring by licensed school or therapist	purposes.
	for child with severe learning disability	Vaccinations and immunizations
	Lifetime care advance payment to private institution for	Vitamins and mineral supplements, only available by prescription
	care of mentally or physically handicapped patient	and prescribed by a physician to treat a specific medical condition
	Medicines & Drugs	Wheelchairs

DEPENDENT CARE EXPENSES

The following is a summary of the types of expenses that may be eligible for reimbursement through a Dependent Care Flexible Spending Account. The information that follows is compiled from publications of the Internal Revenue Service. The information below is meant to serve as a guide only and is subject to the interpretation of the law by the Internal Revenue Service, that of other government agencies, and changes to the law. Dependent care FSAs essentially operate in the same way as health FSAs, except for one important exception: The entire year’s contribution is not immediately available in a Dependent Care FSA. All expenses must be incurred during the plan year in which contributions are made and while actively enrolled as defined by your employer in the Dependent Care Flexible Spending Account in order to be reimbursable.

Eligible Dependent: An eligible dependent is defined as any person who can be claimed by an employee as a dependent for federal tax purposes (under Section 151 (c ) of the tax code) and who:

•is under age 13; or

•requires full-time care because of physical or mental incapacity (for example, a disabled spouse or parent); or

•is the spouse of the employee and is physically or mentally incapable of care for himself or herself.

Expenses for care provided outside a taxpayer’s home may be claimed only for dependents under age 13 or other dependents who regularly spend at least eight hours per day in the taxpayer’s home. Also, expenses incurred during a plan year after a child attains age 13 are not reimbursable.

You may not claim dependent care expenses which exceed the lesser of: The fixed dollar maximum of your plan; your earned income; or (if you are married) your spouse's earned income. If your spouse is either a full-time student or is incapable of self-care, your spouse will be deemed to have qualifying earnings for each month he or she is a full-time student or incapacitated. The amount of deemed earnings will be: $200 a month, if you provide care for one Qualifying Individual, or, $400 a month, if you provide care for more than one Qualifying Individual.

Qualified care provider: Payments for dependent care services provided by dependents of either the taxpayer or the taxpayer’s spouse, or to a child of the taxpayer who is under age 19, do not qualify.

Expenses incurred for care at a child care center are qualified only if the center:

•provides care for more than six individuals (other than those who reside at the facility);

•receives a fee, grant or payment for providing these services to any individual; and

•complies with all applicable state an local laws.

Qualified expenses: A qualified expense must enable the employee (and spouse, if married) to be gainfully employed or to look for gainful employment. Qualified expenses only include the cost of services for the dependent’s well-being and safety

Schooling - Educational expenses incurred for a child below kindergarten level qualify as eligible expenses.

Camps and baby-sitting: Summer day camp expenses qualify as eligible expenses, but overnight camp expenses do not. Generally, evening baby-sitting would not qualify as an eligible expense unless a single parent or both married parents work in the evening.

Transportation, entertainment and food: The cost of transportation, entertainment, food or clothing cannot be reimbursed unless such items are incidental and cannot be separated from the cost of the care provided. This means that the cost of getting a child or other qualifying dependent from home to a care provider, or from school to a care provider is not a qualified expense. Public transportation fares (e.g., travel by bus, subway or taxi) do not qualify as an expense nor are any costs associated with operating a private car. This rule applies to providers as well as dependents; that is, transportation costs associated with bringing a care provider to an employee’s home are not qualified expenses.

Household expenses: Expenses paid for household services qualify if they: (1) pertain to services provided in the employee’s home that are “ordinary and usual” and “necessary to the maintenance of the household” (such as a maid, housekeeper or cook); and (2) are attributable at least in part to the care of the qualifying individual. The services of a gardener or chauffeur, for example, would not qualify as eligible expenses.

Payroll taxes: Payment of payroll taxes by an employee in connection with compensation paid to a service provider is a qualified expense. These taxes include Social Security (FICA)/Medicare tax, federal unemployment tax (FUTA) or similar state payroll taxes.

REV 11/2005