ENROLLMENT INFORMATION FORENROLLMENT INFORMATION FORTHE STATE OF MAINE’STHE STATE OF MAINE’S

FLEXIBLE BENEFITS PLANFLEXIBLE BENEFITS PLANFOR THE PLAN YEAR COMMENCINGFOR THE PLAN YEAR COMMENCING

JANUARY 1 - DECEMBER 31, 2011JANUARY 1 - DECEMBER 31, 2011

05/-1/1005/-1/10

IN ADDITION TO THE PREMIUM PRE-TAX IN ADDITION TO THE PREMIUM PRE-TAX BENEFIT- TWO ADDITIONAL BENEFITS BENEFIT- TWO ADDITIONAL BENEFITS

AVAILABLE EVERY PLAN YEAR –AVAILABLE EVERY PLAN YEAR –

(JANUARY 1(JANUARY 1STST - DECEMBER 31 - DECEMBER 31STST ) ARE: ) ARE:

MEDICAL EXPENSE REIMBURSEMENT ACCOUNT

DEPENDENT CARE REIMBURSEMENT ACCOUNT

ADMINISTERED BY:

H R SUPPORT & CONSULTING SERVICES

FLEX ADMINISTRATION DEPT. 159 WATKINS SHORES RD.

CASCO, ME 04105-4309

207-655-5396 OR Toll Free 1-866-655-5397FAX: 207-655-6636

WHAT’S NEW – IMPORTANT!!!!WHAT’S NEW – IMPORTANT!!!!FOR THE MEDICAL REIMBURSEMENT ACCOUNT---FOR THE MEDICAL REIMBURSEMENT ACCOUNT---

CHANGES TO OVER-THE-COUNTERCHANGES TO OVER-THE-COUNTER(OTC) DRUGS AND MEDICATIONS------(OTC) DRUGS AND MEDICATIONS------

WITH THE PASSING OF THE HEALTH CARE AND EDUCATIONWITH THE PASSING OF THE HEALTH CARE AND EDUCATIONRECONCILIATION ACT OF 2010, EFFECTIVE JANUARY 1, 2011,RECONCILIATION ACT OF 2010, EFFECTIVE JANUARY 1, 2011,(regardless of your plan year), OVER-THE-COUNTER DRUGS &(regardless of your plan year), OVER-THE-COUNTER DRUGS &MEDICATIONS WILL MEDICATIONS WILL ONLY BE REIMBURSABLE IFONLY BE REIMBURSABLE IF THE DRUGS THE DRUGS ARE ARE

PURCHASED WITH A PRESCRIPTIONPURCHASED WITH A PRESCRIPTION. IN MOST INSTANCES,. IN MOST INSTANCES,PARTICIPANTS WILL ALSO BE REQUIRED TO SUBMIT A “LETTER OFPARTICIPANTS WILL ALSO BE REQUIRED TO SUBMIT A “LETTER OFMEDICAL NECESSITY” FROM THEIR DOCTOR.MEDICAL NECESSITY” FROM THEIR DOCTOR.

DO NOT SET ASIDE LARGE AMOUNTS FOR OTC DRUGS &DO NOT SET ASIDE LARGE AMOUNTS FOR OTC DRUGS &MEDICATIONS UNLESS YOU CAN READILY OBTAIN THEMEDICATIONS UNLESS YOU CAN READILY OBTAIN THEREQUIRED REIMBURSEMENT INFORMATION!!!!!REQUIRED REIMBURSEMENT INFORMATION!!!!!

MEDICAL CARE MEDICAL CARE REIMBURSEMENT ACCOUNTS REIMBURSEMENT ACCOUNTS

ALLOWS ELIGIBLE EMPLOYEES TO SET ASIDE PRE-TAX DOLLARS TO PAY FOR OUT OF POCKET MEDICAL EXPENSES FOR THE PARTICIPANT, LEGAL SPOUSE AND ELIGIBLE DEPENDENTS

DEPENDENT /ELDER CARE REIMBURSEMENT ACCOUNTS

TO BE ELIGIBLE TO USE THIS ACCOUNTPARTICIPANT AND SPOUSE MUST:

WORK PART OR FULL TIME ATTEND SCHOOL FULL TIME BE ACTIVELY SEEKING WORK CHILDCARE PROVIDER MUST BE REPORTING

THE INCOMES FOR INCOME TAX PURPOSES

HOW MUCH CAN YOU SAVE?HOW MUCH CAN YOU SAVE?

THE TAX SAVINGS IS DEPENDENT UPON THE TAX SAVINGS IS DEPENDENT UPON THE TOTAL THE TOTAL TAXABLETAXABLE HOUSEHOLD INCOME HOUSEHOLD INCOME FOR ANY GIVEN YEAR.FOR ANY GIVEN YEAR.

FOR THOSE IN A 30% TAX BRACKET, THE FOR THOSE IN A 30% TAX BRACKET, THE TAX SAVINGS WOULD BE $300 ON EVERY TAX SAVINGS WOULD BE $300 ON EVERY $1,000 SET INTO A REIMBURSEMENT $1,000 SET INTO A REIMBURSEMENT ACCOUNT.ACCOUNT.

ARE THERE IRS RULES TO TAKE ARE THERE IRS RULES TO TAKE ADVANTAGE OF THIS PRE-TAX ADVANTAGE OF THIS PRE-TAX BENEFIT? BENEFIT? --- YES--- YES

THERE ARE RULES FOR THE EMPLOYER WHO THERE ARE RULES FOR THE EMPLOYER WHO PROVIDES BENEFITS UNDER A CAFETERIA PLAN;PROVIDES BENEFITS UNDER A CAFETERIA PLAN;

AND AND

THERE ARE RULES FOR THE EMPLOYEE WHO THERE ARE RULES FOR THE EMPLOYEE WHO ELECTS TO PARTICIPATE UNDER THE PLAN(S).ELECTS TO PARTICIPATE UNDER THE PLAN(S).

RULES FOR THE EMPLOYER:RULES FOR THE EMPLOYER:

• • Must select a Plan Year. Usually coincides Must select a Plan Year. Usually coincides with the employer’s health insurance plan with the employer’s health insurance plan year renewal. For the State, the Plan Year is year renewal. For the State, the Plan Year is January 1January 1stst – December 31 – December 31stst of each year. of each year. ______________________________________________________

• • Employer must set a medical account Employer must set a medical account maximum & minimum for the Plan Year and maximum & minimum for the Plan Year and requires that the amount elected by the requires that the amount elected by the participant for any Plan Year be available at participant for any Plan Year be available at the time the expense in incurred, regardlessthe time the expense in incurred, regardless of the deposits taken. of the deposits taken.

MEDICAL MAXIMUM AMOUNT

THE ANNUAL MAXIMUM AMOUNT FOR THE STATE OF MAINE’S MEDICAL REIMBURSEMENT ACCOUNT IS $3,000.00 EACH PLAN YEAR.

THE MINIMUM AMOUNT IS $260.00.

FOR THE MEDICAL ACCOUNTFOR THE MEDICAL ACCOUNT

● ● COBRA applies should a participant COBRA applies should a participant terminate employment during a plan year terminate employment during a plan year and have a positive balance in his/her and have a positive balance in his/her account. account.

● ● Additionally, the employer must allow the Additionally, the employer must allow the former employee to continue to participate at former employee to continue to participate at 102% of the participant’s salary reduction 102% of the participant’s salary reduction amount for the remainder of the Plan Year.amount for the remainder of the Plan Year.

FOR THE DEPENDENT/ELDER CARE FOR THE DEPENDENT/ELDER CARE ACCOUNTACCOUNT

● ● IRS sets the Plan Year amount at $5,000 IRS sets the Plan Year amount at $5,000 perper calendar yearcalendar year - $2,500 if married, filing - $2,500 if married, filing separate returns.separate returns.

● ● The employer The employer DOES NOTDOES NOT upfront the upfront the monies for this account. The participant must monies for this account. The participant must first receive the child care before funds can first receive the child care before funds can be reimbursed.be reimbursed.

RULES FOR THE PARTICIPANT:RULES FOR THE PARTICIPANT:

● ● The employee must elect to participate The employee must elect to participate each Plan Year each Plan Year beforebefore the plan year begins the plan year begins during the State’s enrollment period.during the State’s enrollment period.

● ● Once the decision to participate or not to Once the decision to participate or not to participate has been made, the employee is participate has been made, the employee is locked into the decision for the full 12-month locked into the decision for the full 12-month Plan Year UNLESS he/she experiences a Plan Year UNLESS he/she experiences a qualifying status change.qualifying status change.

WHAT IS AN ALLOWABLE QUALIFYINGWHAT IS AN ALLOWABLE QUALIFYINGSTATUS CHANGE?STATUS CHANGE?

*BIRTH /DEATH /MARRIAGE /DIVORCE;*BIRTH /DEATH /MARRIAGE /DIVORCE;*CHANGE IN OR TERMINATION OF EMPLOYEE OR*CHANGE IN OR TERMINATION OF EMPLOYEE OR SPOUSE’S EMPLOYMENT THAT AFFECTSSPOUSE’S EMPLOYMENT THAT AFFECTS ELIGIBILITY;ELIGIBILITY;ANY CHANGE AN EMPLOYEE WISHES TO MAKEANY CHANGE AN EMPLOYEE WISHES TO MAKEMUST BE MADE WITHIN 30-DAYS OF THEMUST BE MADE WITHIN 30-DAYS OF THEQUALIFYING EVENT QUALIFYING EVENT ANDAND THE REQUESTED THE REQUESTEDCHANGE MUST COINCIDE WITH THE EVENT.CHANGE MUST COINCIDE WITH THE EVENT.ALL CHANGES MUST ORIGINATE WITH YOURALL CHANGES MUST ORIGINATE WITH YOURBENEFITS REPRESENTATIVE.BENEFITS REPRESENTATIVE.

WHAT KINDS OF MEDICAL EXPENSES WHAT KINDS OF MEDICAL EXPENSES ARE REIMBURSEABLE?ARE REIMBURSEABLE?

PLEASE REFER TO THE “ALLOWABLE PLEASE REFER TO THE “ALLOWABLE MEDICAL EXPENSES” LISTED ON PAGE 1 MEDICAL EXPENSES” LISTED ON PAGE 1 OF THE REIMBURSEMENT REQUEST FORM.OF THE REIMBURSEMENT REQUEST FORM.

COMMON REIMBURSEABLE EXPENSES COMMON REIMBURSEABLE EXPENSES INCLUDE SUCH THINGS AS CO-PAYS, INCLUDE SUCH THINGS AS CO-PAYS, DEDUCTIBLES, EYE EXAMS, DENTAL DEDUCTIBLES, EYE EXAMS, DENTAL WORK, AND PRESCRIPTION CO-PAYS. WORK, AND PRESCRIPTION CO-PAYS.

WHAT KINDS OF EXPENSES ARE NOT WHAT KINDS OF EXPENSES ARE NOT ALLOWED?ALLOWED?

● ● EXPENSES FOR WELLNESS, SUCH AS GYM EXPENSES FOR WELLNESS, SUCH AS GYM MEMBERSHIP OR THOSE THAT ARE COSMETIC IN MEMBERSHIP OR THOSE THAT ARE COSMETIC IN NATURE, SUCH AS TEETH WHITENING ARE NOT NATURE, SUCH AS TEETH WHITENING ARE NOT ALLOWABLE. ALSO, VITAMINS/SUPPLEMENTS ARE ALLOWABLE. ALSO, VITAMINS/SUPPLEMENTS ARE GENERALLY NOT ALLOWED.GENERALLY NOT ALLOWED.

● ● EXPENSES MUST BE TO TREAT, CURE OR MITIGATE AN EXPENSES MUST BE TO TREAT, CURE OR MITIGATE AN EXISTING MEDICAL CONDITION AS PER IRS EXISTING MEDICAL CONDITION AS PER IRS REGULATIONS.REGULATIONS.

IMPORTANT RE: REIMBURSEMENT FOR IMPORTANT RE: REIMBURSEMENT FOR ORTHODONTICSORTHODONTICS

**********************************************************************BECAUSE THIS PROCESS IS NOTBECAUSE THIS PROCESS IS NOT

GENERALLY COMPLETED DURING YOURGENERALLY COMPLETED DURING YOUR

12-MONTH PLAN YEAR, THERE ARE SPECIAL12-MONTH PLAN YEAR, THERE ARE SPECIAL

RULES FOR REIMBURSEMENT OF ONGOINGRULES FOR REIMBURSEMENT OF ONGOING

ORTHODONTICS. ORTHODONTICS.

PLEASE READ THE SPECIAL COMMUNICATION PLEASE READ THE SPECIAL COMMUNICATION “Using the medical reimbursement account for “Using the medical reimbursement account for orthodontics” found at orthodontics” found at www.maine.go/behwww.maine.go/beh . .

HOW TO DETERMINE HOW MUCH HOW TO DETERMINE HOW MUCH MONEY TO PUT INTO YOUR MEDICAL MONEY TO PUT INTO YOUR MEDICAL

REIMBURSEMENT ACCOUNT.REIMBURSEMENT ACCOUNT.

THE BEST WAY IS TO REVIEW YOUR THE BEST WAY IS TO REVIEW YOUR CHECKBOOK AND SEE WHAT YOU HAVE CHECKBOOK AND SEE WHAT YOU HAVE SPENT OVER THE PAST 12-MONTHS IN OUT-SPENT OVER THE PAST 12-MONTHS IN OUT-OF-POCKET MEDICAL EXPENSES. (Jan. 1OF-POCKET MEDICAL EXPENSES. (Jan. 1stst – – Dec. 31Dec. 31stst ) )

THIS WILL GIVE YOU A STARTING POINT.THIS WILL GIVE YOU A STARTING POINT.

MAKE A LIST OF KNOWN EXPENSES FOR MAKE A LIST OF KNOWN EXPENSES FOR YOU AND QUALIFYING DEPENDENTS FOR YOU AND QUALIFYING DEPENDENTS FOR SUCH THINGS AS MAINTENANCE SUCH THINGS AS MAINTENANCE PRESCRIPTIONS.PRESCRIPTIONS.

LIST OTHER MEDICAL EXPENSES YOU ARE LIST OTHER MEDICAL EXPENSES YOU ARE COMFORTABLY SURE YOU WILL HAVE TO COMFORTABLY SURE YOU WILL HAVE TO PAY OUT-OF-POCKET OVER THE UPCOMING PAY OUT-OF-POCKET OVER THE UPCOMING 12-MONTH PLAN YEAR JANUARY 112-MONTH PLAN YEAR JANUARY 1STST – – DECEMBER 31DECEMBER 31STST, 2011. , 2011.

IF YOU’RE NEW TO THE BENEFIT, IT’S IF YOU’RE NEW TO THE BENEFIT, IT’S ALWAYS WISE TO GO A LITTLE LESS THAN ALWAYS WISE TO GO A LITTLE LESS THAN ANTICIPATED TO AVOID PUTTING TOO ANTICIPATED TO AVOID PUTTING TOO MUCH INTO THE ACCOUNT.MUCH INTO THE ACCOUNT.

FOR THE DEPENDENT CARE ACCOUNT IT’S FOR THE DEPENDENT CARE ACCOUNT IT’S EASY. SIMPLY DETERMINE WHAT YOU EASY. SIMPLY DETERMINE WHAT YOU CURRENTLY PAY FOR CHILD CARE FOR CURRENTLY PAY FOR CHILD CARE FOR THE 12-MONTH PLAN YEAR PERIOD.THE 12-MONTH PLAN YEAR PERIOD.

HOW DO YOU GET REIMBURSED HOW DO YOU GET REIMBURSED AFTER ENROLLING IN THE PLAN?AFTER ENROLLING IN THE PLAN?

COMPLETE THE “REIMBURSEMENT COMPLETE THE “REIMBURSEMENT REQUEST FORM” (ONE IS PROVIDED WITH REQUEST FORM” (ONE IS PROVIDED WITH YOUR MATERIALS).YOUR MATERIALS).

SUBMIT IT WITH YOUR RECEIPT(S) OR BILL SUBMIT IT WITH YOUR RECEIPT(S) OR BILL WHICH CONTAINS: THE NAME OF THE WHICH CONTAINS: THE NAME OF THE PROVIDER, THE PROVIDER, THE DATE OF SERVICEDATE OF SERVICE, THE , THE DOLLAR AMOUNT OWED/PAID AND A DOLLAR AMOUNT OWED/PAID AND A DESCRIPTION OF THE SERVICE.DESCRIPTION OF THE SERVICE.

!!! IMPORTANT !!!!!! IMPORTANT !!!YOU YOU CANNOT SUBMIT A CANCELLEDCANNOT SUBMIT A CANCELLED CHECK OR CREDIT CARD RECEIPT AS CHECK OR CREDIT CARD RECEIPT AS

A RECEIPTA RECEIPT. IT IS AGAINST IRS . IT IS AGAINST IRS REGULATIONS.REGULATIONS.

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YOU MAY FAX OR MAIL YOUR FORM AND YOU MAY FAX OR MAIL YOUR FORM AND RECEIPTS TO THE ADDRESS ON THE FORM.RECEIPTS TO THE ADDRESS ON THE FORM.

CHECKS ARE MAILED THURSDAY OF EACH CHECKS ARE MAILED THURSDAY OF EACH WEEK TO YOUR HOME ADDRESS.WEEK TO YOUR HOME ADDRESS.

IT IS IMPORTANT THAT YOU IT IS IMPORTANT THAT YOU REVIEWREVIEW ALLALL THE COMMUNICATION MATERIALS THE COMMUNICATION MATERIALS BEFOREBEFORE

ENROLLING – ENROLLING – ESPECIALLY THE MAJOR ESPECIALLY THE MAJOR CHANGE TO OVER-THE-COUNTER DRUGS CHANGE TO OVER-THE-COUNTER DRUGS

AND MEDICATIONSAND MEDICATIONS!!!!!!SHOULD YOU HAVE ANY QUESTIONS, CONTACT SHOULD YOU HAVE ANY QUESTIONS, CONTACT

YOUR BENEFITS REPRESENTATIVE AT THE YOUR BENEFITS REPRESENTATIVE AT THE OFFICE OF EMPLOYEE HEALTH & BENEFITSOFFICE OF EMPLOYEE HEALTH & BENEFITS

OR, IF YOU PREFER, OR, IF YOU PREFER,

CONTACT H R SUPPORT DIRECTLY CONTACT H R SUPPORT DIRECTLY AT 1-866-655-5397.AT 1-866-655-5397.

DON’T FORGET !!!DON’T FORGET !!!

ALL ENROLLMENT FORMS MUST BE ALL ENROLLMENT FORMS MUST BE SIGNEDSIGNED, , DATEDDATED AND AND

RETURNED TORETURNED TO::

THE STATE OF MAINE THE STATE OF MAINE

OFFICE OF EMPLOYEE HEALTH AND BENEFITSOFFICE OF EMPLOYEE HEALTH AND BENEFITS

114 STATE HOUSE STATION114 STATE HOUSE STATION

AUGUSTA, ME 04333-0114AUGUSTA, ME 04333-0114

FORMS MAY ALSO BE FAXED TO: FORMS MAY ALSO BE FAXED TO: 287-6796 (Keep a (Keep a

copy for your files).copy for your files).

ALL FROMS MUST BE RECEIVED NO LATER THANALL FROMS MUST BE RECEIVED NO LATER THAN

5 P.M. ON FRIDAY, DECEMBER 18, 2010.5 P.M. ON FRIDAY, DECEMBER 18, 2010.

QUESTIONS