«Summary Plan Description SAS Institute Inc. Premium Conversion and Flexible Spending Account Plan Full-Time and Part-Time Employees of SAS and ...»
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.”
DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT AND DEPENDENT
CARE TAX CREDIT
Before deciding what to do, you should compare the credit and salary reduction to see which provides the greater tax benefit to you, based on your particular facts. To assist in this decision, it is recommended that you perform a projection of your expected tax situation under both options and seek the advice of your tax consultant.
EMPLOYER PROVIDED/SUBSIDIZED DEPENDENT CAREEmployer provided or subsidized dependent care benefits will offset any dollars that you can contribute to a Dependent Care FSA and will offset the amount you may claim under a dependent care tax credit. If the sum of the value of Employer provided dependent care or the Employer subsidy exceeds $5000 (maximum allowed under a dependent care flexible spending account), then you will not be eligible to elect to participate in the Dependent Care FSA. If the Employer value or subsidy is less than $5000, then the difference between the value or subsidy and the $5000 maximum for the Dependent Care FSA is the amount that you can elect to contribute to your Dependent Care FSA.
MID-YEAR BENEFIT ELECTION CHANGESYou may make mid-year changes to your Premium Conversion Plan, Health Care FSA, and Dependent Care FSA elections only in limited circumstances prescribed by law. These
circumstances may include:
Events that trigger special enrollment rights under the Health Insurance Portability and Accountability Act (HIPAA).
Certain significant Changes in Cost.
Certain judgments, decrees and orders.
Medicare and Medicaid Eligibility.
The determination of whether a mid-year benefit election change is permitted is made by the SAS Benefits Department on behalf of the Plan Administrator, in its sole discretion consistent with Section 125 of the Internal Revenue Code. If you wish to make a mid-year benefit election change, you must notify the SAS Benefits Department by making a request, in writing, either on the form provided by the SAS Benefits Department or through the SAS online benefits selfservice website, within 60 days of a change. The Plan Administrator retains the right to request any relevant documentation. If the request for the change and any required documentation are not timely and properly provided, then the request will not be considered timely and coverage for your dependent(s) may not be available.
If, during the Plan Year, you change your election(s) for coverage under a SAS Health Care Plan, the Health Care FSA and/or the Dependent Care FSA, you will be deemed to have made a corresponding change in your election to pay for such coverage on a pre-tax basis under the Premium Conversion Plan. The change in your election to pay for coverage must be consistent with and on account of the Special Enrollment Event, Change in Status, Change in Coverage or Change in Cost.
If an employee does not enroll his or her domestic partner or such individual’s children in one of the SAS Health Care Plans during their initial eligibility or during the annual open enrollment period, the employee may enroll them or terminate their coverage if the reason for the change is comparable to an event which qualifies as a Change in Status, Change in Cost or Change in Coverage described above, as determined by the Plan Administrator in its sole discretion.
CHANGE IN STATUSYou are permitted to change your elections if there is a Change in Status that affects coverage eligibility for you or your dependent(s). The change in your elections must be on account of and
consistent with the Change in Status. The “Change in Status” events include:
A change in your legal marital status including marriage, death of spouse, divorce, legal separation, or annulment, as recognized under both state law and the Internal Revenue Code.
A change in your number of dependents for income tax purposes, including birth or death of a child, or adoption or placement for adoption of a child.
Any of the following events that changes your employment status or the employment status of your dependent: termination or commencement of employment, a strike or lockout, commencement of or return from an unpaid leave of absence, a change in worksite, or any other change in employment status that causes the individual to become eligible for or to cease to be eligible for coverage under a SAS Health Care Plan.
If you were reasonably expected to average at least 30 hours of service per week, changes in your employment status such that you will reasonably be expected to average less than 30 hours of service per week following such change, even if the reduction does not result in termination of eligibility for a SAS Health Care Plan.
If you are eligible to enroll during a Special Enrollment Period in a Qualified Health Plan through a Marketplace based on guidance issued by the Department of Health and Human Services and any other applicable guidance, or you seek to enroll in a Qualified Health Plan through a Marketplace during the Marketplace’s annual open enrollment period.
Any event that causes your dependent to satisfy or cease to satisfy an eligibility requirement for a SAS Health Care Plan, the Health Care FSA or the Dependent Care FSA.
A change in your, your spouse’s, or your dependent’s place of residence that affects your or your dependent’s eligibility, or Any other event authorized under Section 125 of the Internal Revenue Code.
If you wish to make a change to your election based on a Change in Status, you must inform the Plan Administrator and complete a new election within the period that begins 60 days before the event and ends 60 days after the event. A new election may be made only if the election change is on account of and corresponds with the Change in Status event. The Plan Administrator (in its sole discretion) will determine whether a requested change is on account of and corresponds with a Change in Status.
Enrollment resulting from birth, adoption or placement for adoption may be retroactive up to 60 days. In all other cases, changes in your benefit coverage elections are prospective and will be effective the day following the date that the election change form and supporting documentation are received by the Plan Administrator. If the Plan Administrator is not notified of a change until after health premiums have been deducted from your wages, the paid premium will not be refunded to you.
Special rules apply to the Change in Status events described below:
Health Care FSA: You may increase or terminate your election under the Health Care FSA only if the election change is on account of and corresponds with a Change in Status that affects eligibility for coverage under this Plan, or, in certain cases, a plan sponsored by the employer of a dependent. Note, for instance, that a reduction in hours below an average of 30 hours that leads to a change in status event, as described in more detail above, does not permit you to change your Health Care FSA election. If you have a Change in Status event, you may elect to revoke or to increase, but not decrease, your contributions to the Health Care FSA.
Dependent Care FSA: You may change or terminate your election upon a Change in Status if the election change is on account of and corresponds with the Change in Status event that affects the eligibility of dependent care expenses for the tax exclusion available under Code Section 129.
SPECIAL ENROLLMENT EVENTSIf you or your dependents are entitled to special enrollment rights under a group health plan, you may change your elections under the SAS Health Care Plans to correspond with the special enrollment right. For example, you may change your elections under this Plan to enroll yourself and
your eligible dependents in group health plan coverage in the following situations:
If you declined coverage under a SAS Health Care Plan for yourself or your eligible dependent because of other health care coverage and eligibility for such other coverage is subsequently lost due to certain reasons (e.g., due to divorce, death, termination of employment, reduction in hours, or exhaustion of COBRA), you may change your Plan elections to enroll the affected individuals in a SAS Health Care Plan provided that you do so within 60 days of the loss.
If you or your eligible dependent is covered under a Medicaid plan or a state child health insurance plan (CHIP) and the Medicaid or CHIP coverage of such individual is terminated as a result of loss of eligibility for such coverage, you may change your Plan elections to enroll the affected individuals in the applicable SAS Health Care Plan provided that you do so within 60 days after the date the Medicaid or CHIP coverage terminates.
If you or your eligible dependent becomes eligible under a Medicaid or CHIP plan for premium assistance with respect to paying for coverage under a SAS Health Care Plan, you may change your Plan elections to enroll the affected individuals in the SAS Health Care Plan provided that you do so within 60 days after the date such individual is determined to be eligible for such assistance. Or, If you gain a new dependent as a result of marriage, birth, adoption, or placement of adoption, you may change your Plan elections to enroll in a SAS Health Care Plan provided that you do so within the period that begins 60 days before the event and ends 60 days after the event.
If you or your eligible dependent loses other coverage as a result of your failure to pay premiums or for cause, such as making a fraudulent claim, you will not have a special enrollment right.
An election change that corresponds with a special enrollment is prospective, unless the special enrollment is due to birth, adoption, or placement for adoption of a child, which may be retroactive to the date of the event, up to 60 days. If you elect retroactive coverage, your first pre-tax contribution after such election may be increased to pay for the coverage for the period prior to your election.
For information about special enrollment rights, see the coverage booklet for the SAS Medical, Dental and Vision Plans.