Flexible Benefits Plan
Who is Eligible?
- Full-time employees regularly scheduled to work 30 hours per week
- Seasonal or part-time employees with 24 months of service and certified by their appointing authority to work at least 1,450 hours per fiscal year, (July-June)
Who are Eligible Dependents?
- Your legal spouse
- Your own unmarried children
- Children for whom you have been appointed legal guardian
- Stepchildren and legally adopted children (provided they reside in your household and primarily depend on you for support).
When Does Coverage Begin?
- You have from the first day of employment through the last day of the first full calendar month worked to submit your enrollment form.
- Coverage begins on the first day of the month after you have been employed one full calendar month.
- If you do not complete a form during this initial eligibility period, you must wait until the next Annual Enrollment/Transfer Period or until you experience a valid Change in Status (see page 14 of the Flexible Benefits Plan booklet).
- Medical Expense Flexible Spending Account – you may direct pre-tax dollars to pay for valid medical expenses incurred by yourself or your eligible dependents.
- Once you decide how much to contribute, the maximum annual amount elected by you for reimbursement of eligible uninsured, out-of-pocket medical expenses, will be available throughout your period of coverage (reduced by prior reimbursements made during the same period of coverage), provided the request does not exceed your annualized contribution.
How to Request Reimbursement
- To receive reimbursement from your Medical Expense FSA, you must complete a Reimbursement Request Form (FSA), include receipts showing the following:
- A receipt, invoice or bill from your healthcare provider listing the date you receive the service, the cost and the type of service and the person for whom the service was provided.
- An Explanation of Benefits (EOB) from your health insurance provider that shows the type of service you received, the date and cost of the service, and any uninsured portion of the cost or a written statement from your healthcare provider that the service was medically necessary if those services could be deemed cosmetic in nature.
- If the service for which you are requesting reimbursement is not covered by an insurance plan, indicate “no insurance” on your FSA Reimbursement Request Form;
- If your medical care is provided through an HMO, your receipt or FSA Reimbursement Request Form must state that the amount requested is for a co-payment.
- Dependent Care Flexible Spending Account – this account can help recover some of the money you spend to ensure your dependents (child, adult or elder) are taken care of while you are working.
- Please see the FBMC Flexible Benefits Handbook for qualifying expenses.
What Happens If I Terminate Employment?
- If you experience an event permitting a mid-plan year FSA election change such as termination of employment or unpaid leave, you can continue to contribute to your Medical Expense FSA on an after-tax basis if you apply for continuation of your Medical Expense FSA within 30 days of the event.
- As long as you make full after-tax contributions to your Medical Expense FSA, you can receive reimbursements on eligible healthcare expenses incurred during your period of coverage, which is Jan. 1 – Dec. 31.
- You cannot continue contributing to your Dependent Care FSA. You can, however, continue to request reimbursement for eligible expenses until you exhaust your account balance or the plan year ends.
How to Request Reimbursement
- You must complete a Reimbursement Request Form (FSA), include receipts showing the following:
- the date your dependent received the care
the name, address and tax identification number of the facility or
the name, address, social security number and signature of the individual providing the dependent care service. This information is required with each request for reimbursement.
Mid-Plan Year Election Changes
- You may be permitted to make a mid-year election change or vary a salary reduction amount depending on the type of pre-tax coverage and the triggering event.
- Fringe Benefits Management Company, the Tennessee Board of Regents’ designee, will in its sole discretion, review on a uniform and consistent basis, the facts and circumstances of each mid-year change.
- A Completed Change in Status/Election Form must be submitted within 60 days of the event.
- Both new and current participants must complete and submit an enrollment form to set up FSA deductions for the new plan year.
- Human Resources will make the dates of the Annual Enrollment/Transfer Period available to all employees once confirmed by the State each year.
- The plan year will be Jan. 1 – Dec. 31 each year.
Questions Regarding Coverage