1-2-3!Using your Benny® Prepaid MasterCard® Card

is as easy as

It’s so easy for Guardian Flexible Spending Account (FSA) members to pay for eligible health care

expenses. Just use your dedicated Benny Prepaid MasterCard Card (Benny Card) – it deducts

money directly from your FSA account. No need to pay with cash up front!

What could be more convenient than using your Benny Card to pay for Flexible

Spending Account (FSA)-eligible health care expenses? Using your Benny Card at:

• Drugstore.com • Sam’s Club

• Walgreens • Wal-Mart

By shopping at one of these merchants, your FSA-eligible items are automatically

verified at the time of purchase. (Your receipt will identify the FSA-eligible items

with an “H” or “F”). You won’t need to provide receipts to verify the eligibility of

most purchases!

I F Y O U H A V E A N Y Q U E S T I O N S A B O U T Y O U R B E N N Y C A R D , C A L L T H E N U M B E R O N T H E B A C K O F Y O U R C A R D .

Step 1 Activate and sign your Benny Card(s)• After you receive your card(s) in the mail, call the number on the card sticker

to activate it.

• Wait 48 hours after activation to use your card. (Your full-year FSA health care

amount is available upon activation.)

Step 2 Use your Benny Prepaid MasterCard CardYour Benny Card can be used to pay for eligible expenses only for you and

your dependents at pharmacies, your doctor’s office and vision centers.

(Refer to your lists of eligible and ineligible medical care and over-the-counter

medical care expenses.)

• At the merchant, separate your eligible items from non-eligible items.

• Present your Benny Card for payment for eligible items.

• If there are sufficient funds in your account, the card swipe transaction will

be approved and the amount of the FSA-eligible purchases is deducted from

your account balance.

• If your expenses are more than your FSA balance, the card swipe

transaction will be declined and the clerk will ask for another form of

payment. (You may be able to use your Benny Card for the exact amount

left in your account and use another form of payment for the difference –

check with the merchant.)

Step 3 Check your balances• You can check your FSA balance by calling the phone number or logging

onto the website on the back of your card.

• Checking your balances will help you know whether you have sufficient

funds in your account to cover your expenses before you make a purchase.

Using your card is as easy as 1-2-3!

For even greater convenience use yourBenny Card at one of these merchants

You may be contacted by your plan administrator to submit certain receipts to verifyexpenses in order to comply with IRS guidelines. Make sure to save your receipts!

Follow-up letters requesting itemized receipts may be sent to you in the followinginstances:

1. When benefit plan data is not available and when the card is used to pay a coinsurance bill from a provider (for amounts not covered by insurance)

2. When the employee or dependents are not covered by the employer plan

3. When over-the-counter items are purchased from merchants other than our partners (ie. Walgreens, Drugstore.com, Sam’s Club, Wal-Mart)

4. When ineligible items are purchased with FSA-eligible items in a pharmacy,medical, dental or vision location.

REMINDER – SAVE ALL ITEMIZED RECEIPTS

INELIGIBLE FLEXIBLE SPENDING ACCOUNT (FSA) EXPENSES

F O R Q U E S T I O N S R E G A R D I N G M E D I C A L C A R E R E I M B U R S E M E N T S T H R O U G H Y O U R F S A , C O N T A C T F L E X P L A N C U S T O M E R S E R V I C E A T 1 - 8 6 6 - 3 5 9 - 4 5 4 2 .This listing does not represent all allowable or non-allowable charges.

Medical Care ExpensesELIGIBLE FLEXIBLE SPENDING ACCOUNT (FSA) EXPENSES

Medical monitoring and testing devices (if prescribed by physician for a particular ailment)

Medicines

Occlusal guards (to prevent teeth grinding)

Operations (legal operations which treat a specific ailment)

Optometrist

Orthodontia (unless for cosmetic purposes)

Osteopath

Oxygen

Periodontal fees

Physical exams (except for employment-related physicals)

Physical therapy (for specified medical purpose)

Pregnancy tests/kits

Prescription sunglasses

Private hospital room

Psychiatric care

Psychoanalysis

Psychologist

Radial keratotomy

Surgery

Telephone for the deaf

Transplants

Transportation for seminar on medical condition &cost of seminar on medical condition

Vaccinations

X-rays

Adoption - Medical Expense (incurred beforeadoption is finalized)

Alcoholism treatment

Ambulance

Artificial limbs

Artificial teeth

Braille books and magazines (differencebetween regular material and Braille material)

Car controls for handicapped

Chiropractic services

Christian science practitioners (payments formedical care)

Coinsurance amounts and deductibles

Contact lenses and solution

Crutches

Dental treatment

Diagnostic tests

Drug addiction treatment

Eye examinations and eyeglasses

Guide dog or other animal (purchase, training and care of animal)

Hearing aids and examinations

Hospital services

Injections

Insulin

Laboratory fees

Lasik eye surgery

Learning disabled child – specialschool/teacher

Athletic club dues for general health

Athletic lessons or training for general health

Body or ear piercing

Breast pump without medical necessity

Chauffeur services

Cosmetic surgery, procedure or productswithout medical necessity

Diapers for infants

Diaper service

Educational/training classes without medical necessity

Electrolysis

Exercise equipment for general health

Fees not paid to provider

Funeral services

Hair transplants

Home nursing care for a healthy infant

Household or domestic help

Illegal operations or treatments

Insurance premiums

Late fees or missed appointments

Liposuction

Long-term care service

Maternity clothes

Massage therapy for general health

Medical savings accounts

Personal hygiene products

Personal items

Pre-payment of services

Tattoos or tattoo removal

Teeth whitening or bonding

Transportation to and from work

Trip or vacation for well-being

Weight loss programs/Food for general health

Wellness programs

Uniforms

Vitamins, supplements or herbs without medical necessity

Acne Medications, such as Clearasil

Allergy Relief (oral medications and nasal sprays)

Analgesics, such as fever and pain reducersTylenol and Ibuprofen

Antacids & heartburn relief, such as Alka-Seltzer, Mylanta, Milk of Magnesia,Pepcid and Zantac

Antibiotic ointments, such as Neosporin andMycitracin

Anti-itch & hydrocortisone creams

Arthritis pain-relieving creams & medications

Athlete’s foot treatments, such as nail and footanti-fungal creams and sprays

Blood pressure aids, such as monitors andrelated equipment

Cholesterol test equipment

Cold medicines, such as tablets, syrups,drops and lozenges

Denture adhesive creams

Diabetes aids, such as glucose monitors andrelated equipment

Diaper rash ointments, such as Balmex and Desitin

Eye care, such as reading glasses, saline solution and lubricant eye drops

Family planning and contraceptives, such as pregnancy tests and condoms

Feminine care relating to treatment of vaginal infections

First aid, such as heat wraps, compresses,bandages, tape, gauze, dressing, adhesivepads, band aids and pain-relieving creams

Hemorrhoid treatments such as Preparation H

Incontinence products, such as Depends andSerenity pads

Joint support bandages & hosiery, such asknee supports and elbow supports

Joint and muscle pain creams, such asBenGay and Flex All

Laxatives

Motion sickness preventives, such asDramamine, patches and bracelets

Nutritional and dietary supplements*

Shampoo treatments relating to treatment ofpsoriasis, lice

Cosmetics, such as makeup, lipstick, Q-tips,cotton balls and baby oil

Denture care, such as denture cleansers

Skin care, such as sunblock, skin and body moisturizing lotion, and lip balm

Hair care, such as hair color, shampoo, conditioner, brushes and hair loss products like Rogaine

Routine dental care, such as toothpaste, toothbrushes, dental floss, mouthwashesincluding anti-bacterial mouthwash and fluoriderinses), breath strips and teeth whitening

Nail care and personal grooming, such as scissors and nail files

Personal hygiene, such as deodorant, soap,powder, shaving cream and razors, tissues,feminine care and sanitary products.

F O R Q U E S T I O N S R E G A R D I N G M E D I C A L C A R E R E I M B U R S E M E N T S T H R O U G H Y O U R F S A , C O N T A C T F L E X P L A N C U S T O M E R S E R V I C E A T 1 - 8 6 6 - 3 5 9 - 4 5 4 2 .This listing does not represent all allowable or non-allowable charges.

* Expense requires a physician statement of medical necessity.

Sleep aids, such as oral medications and snoring/breathing strips

Smoking cessation relief, such as patches and gum

Stomach and digestive relief, such as Pepto-Bismol, Imodium, Colace, Lactaid and Pedialyte

Tooth and mouth pain relief, such as Orajel and Anbesol

Urinary pain relief

Vitamins*

Wart removal medications

Weight reduction aids*

T H E G U A R D I A N L I F E I N S U R A N C E C O M P A N Y O F A M E R I C A , N E W Y O R K , N Y 1 0 0 0 4 . 2006-8974

ELIGIBLE OTC FLEXIBLE SPENDING ACCOUNT (FSA) EXPENSES INELIGIBLE OTC FLEXIBLE SPENDINGACCOUNT (FSA) EXPENSES

Over The Counter (OTC) Medical Expenses