«Summary Plan Description SAS Institute Inc. Premium Conversion and Flexible Spending Account Plan Full-Time and Part-Time Employees of SAS and ...»
You must retain this receipt for one year following the close of the year in which the expense is incurred. Even though payment is made under the debit card arrangement, you may be required to submit to the Claims Administrator a written third-party statement to substantiate the expense. If you receive a request for a third-party statement from the Claims Administrator, you must provide the statement to the Claims Administrator within 45 days of the request (or such longer period provided in the request from the Claims Administrator).
You must pay back any improperly paid claims. If you are unable to provide adequate or timely substantiation as requested by the Claims Administrator, you must repay your employer for the unsubstantiated expenses. In addition, your usage of the card may be terminated. If you do not repay the unsubstantiated expenses, they may be treated as taxable income to you.
The debit card will be turned off when employment or coverage terminates. The debit card will be turned off when you terminate employment or your coverage under the Health Care FSA Plan ends. You may not use the card during any applicable COBRA continuation coverage period.
Failure to abide by the debit card rules and procedures will result in termination of card use privileges.
Claims for which the debit card has been used cannot be submitted as traditional paper claims.
Excess Reimbursements If, as of the end of any Plan Year, it is determined that you have received payments under this Health Care FSA Plan that exceed the amount of Eligible Medical Expenses that have been properly substantiated during the Plan Year or reimbursements have been made in error (e.g. reimbursements exceeding the amount available in your Health Care FSA), the Employer may recoup the excess
reimbursements in one or more of the following ways:
Following notification of such excess amount, you will be required to repay the excess amount to your employer within 60 days.
Your Employer may offset the excess reimbursement against any other Eligible Medical Expenses submitted for reimbursement (regardless of the Plan Year in which submitted).
Your Employer may withhold such amounts from your wages (to the extent permitted under applicable law).
If your Employer is unable to recoup the excess reimbursement by the means set forth above, your Employer will treat the excess reimbursement as it would any other bad business debt. This means any erroneous or excess reimbursements that you may have received may be treated as taxable income to you.
Orthodontics Reimbursement Policy
Qualified orthodontia expenses that are paid up front, in a lump sum may be eligible for Health Care FSA reimbursement in full (up to Plan limits) provided the lump sum is paid during the same Plan Year from which reimbursement is being requested and while the participant is covered under the Plan. Proof of payment is required.
Participants that do not pay up front and opt for monthly payments can be reimbursed by the Health Care FSA as those monthly payments are made (provided the monthly payment is paid during the same plan year from which reimbursement is requested and while the Participant was covered under the Plan).
If you are seeking reimbursement under the Health Care FSA Plan for orthodontic treatment that
requires installment payments, benefits will be paid as follows:
The orthodontist should send a treatment plan to the Third Party Administrator for determination of payment.
Any initial upfront payment is eligible for reimbursement during the Plan Year in which the payment is made. This usually coincides with the time that the braces are placed.
Scheduled monthly payments are eligible for reimbursement during the Plan Year in which they are scheduled to be made. For example, if you had six scheduled payments due from the previous Plan Year and you pay the orthodontist those payments in the current Plan Year, you cannot be reimbursed using your current year available funds.
A paid receipt must be submitted with the claim Orthodontic reimbursements must otherwise comply with the claims filing procedures detailed in this section.
WHERE TO FILE CLAIMS
Flexible Spending Account claims should be submitted to the Claims Administrator:
Flores & Associates P.O. Box 31397 Charlotte, NC 28231-1397 Fax: 1-800-726-9982
CLAIMS RUN-OUT PERIODFlexible Spending Account claims incurred during the Plan Year (January 1 – December 31) can be filed up to three months after the end of the Plan Year. Claims received after March 31 of the year following the Plan Year will not be processed.
PROCESSING OF CLAIMSReimbursement checks or direct deposit reimbursements will be issued and deposited on a weekly basis.
You will receive written notice of the determination within 30 days of the Claims Administrator receiving the Flexible Spending Accounts claim for reimbursement. If additional information is needed to process the claim, the Claims Administrator will notify you. You then have 45 days to provide the requested information. If for reasons beyond the control of the Claims Administrator, an extension of time is required to process your claim, you will receive written notice of the extension, an explanation of the circumstances requiring extension and the expected date of the decision prior to the end of the 30-day period. In no event shall the extension exceed a period of an additional 15 days from the end of the initial 30-day period. If your claim is denied, you are entitled to appeal the decision as detailed in the section entitled “Appeal Procedures.”
CONTINUATION OF COVERAGE (COBRA)
Your right to COBRA continuation coverage with respect to the Health Care FSA is separate from your right to COBRA continuation coverage under a SAS Health Care Plan. You must file separate election forms and pay separate premiums to continue coverage under a SAS Health Care Plan and the Health Care FSA. Your right and your covered dependents’ rights to continue coverage under a SAS Health Care Plan is described in the summary plan description for each plan.
When Coverage May Be Continued
If the Health Care FSA is an under-spent account (as explained below), a Qualified Beneficiary has the right to continue coverage if he or she loses coverage (or should have lost coverage) as a result of certain Qualifying Events. A “Qualified Beneficiary” is the Participant, covered spouse and/or covered dependent child at the time of the qualifying event. The table below identifies the events that may entitle a Qualified Beneficiary to continuation coverage. The event is a “Qualifying Event” for a covered person if a check mark appears in the appropriate box.
COBRA coverage with respect to the Health Care FSA Plan is only available to a Qualified Beneficiary if the Health Care FSA is an under-spent account. The Health Care FSA is considered an under-spent account only if the cost of COBRA coverage for the remainder of the coverage period does not exceed the maximum amount that would be available to the Qualified Beneficiary for reimbursement. If available, COBRA coverage will be in an amount equal to your applicable coverage amount for the Plan Year, less amounts reimbursed or paid through the date of the Qualifying Event.
Note: The domestic partner and the children of such an individual are not eligible for continuation coverage under the terms of COBRA unless they qualify as the employee’s dependent under federal tax law.
Type of Continuation Coverage
If you choose Health Care FSA Plan continuation coverage, you may continue the level of coverage you had in effect immediately preceding the Qualifying Event. The maximum period of coverage is the end of the Plan Year in which the Qualifying Event occurred. However, continuation coverage is subject to earlier termination in the event you fail to pay for the coverage, you become covered under another employer’s group health plan, you enroll in Medicare, or this Health Care FSA Plan is terminated.
If you do not choose continuation coverage, your coverage under the Health Care FSA Plan will end on the date you would otherwise lose coverage.
Notice Requirements The Health Care FSA Plan will offer COBRA continuation coverage to Qualified Beneficiaries only after the Plan Administrator has been notified that a Qualifying Event has occurred. When the Qualifying Event is the end of employment or reduction of hours of employment, death of the employee, or the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), SAS will notify the Plan Administrator of the qualifying event.
You Must Give Notice of Some Qualifying Events. You or your covered dependents (including your spouse) must notify the Plan Administrator of a divorce, or a child losing dependent status under the Health Care FSA using the SAS Benefits Enrollment/Change Form or an online benefits self-service enrollment within 60 days of the later of (i) date of the event (ii) the date on which coverage is lost because of the event.
Notice of the Qualifying Event must be provided to the SAS Benefits Department in the manner specified. The paper Benefits Enrollment/Change Form may be obtained by contacting the SAS Benefits Department at 919-531-9090. Your written notice must identify the Qualifying Event, the date of the Qualifying Event and the Qualified Beneficiaries impacted by the Qualifying Event. The Plan Administrator will then notify you that you have the right to choose continuation coverage by sending you the appropriate election forms. Notice to an employee’s spouse is treated as notice to any covered dependents who reside with the spouse.
You may be required to provide additional information or documentation to support that a particular Qualifying Event has occurred (e.g. divorce decree). If such information is requested and it is not provided within 15 business days of the request, the notice will not be considered timely and continuation coverage may not be available. The notice and required documentation must be postmarked no later than the applicable deadline for giving the notice.
An employee or covered dependent is responsible for notifying the Plan Administrator if he or she becomes covered under another group health plan.
Notice to the Plan Administrator should be sent by First Class Mail, faxed or hand delivered to:
SAS Institute Inc.
Benefits Department U-1 SAS Campus Drive Cary, NC 27513 Fax: 919-531-0201 Election Procedures After receiving notice of a Qualifying Event, the Plan Administrator will send COBRA election materials (including a description of COBRA rights and other pertinent information) to each Qualified Beneficiary. Each Qualified Beneficiary is entitled to make a separate election for continuation coverage under the Health Care FSA Plan if they are not otherwise covered as a result of another Qualified Beneficiary’s election. In order to elect continuation coverage, the Qualified Beneficiary must complete the election form(s) and return the form(s) to the Plan Administrator within 60 days of the later of (a) the date coverage terminates because of the Qualifying Event; or (b) the date the notice of continuation is sent to you, your spouse or your other eligible dependent.
Coverage will be effective retroactive to the date of the Qualifying Event.