Q. What is the benefit of participating in the Cafeteria Plan?

A. This is the only way that you can pay for your out-of-pocket medical expenses with dollars which are never taxed. These dollars are not subject to federal income tax, Social Security Tax or Medicare tax.  In addition, it is often the best way to save taxes on your employment-related dependent daycare expenses.

Q. How does this plan actually work?

A. To get the tax benefits offered under this plan, you must estimate your expenses for your plan year. You must estimate your dependent daycare expenses separately from your out of pocket medical expenses. You will then complete an Election Form provided to you by your employer. You will be making a voluntary payroll deduction for the amount you elected. For example, if you are paid every other week, and you have elected $1300, then you will have $50 deducted from each paycheck. Your check will not be $50 less, because that $50 has not been taxed. Your check might be $40 less. When you have a qualifying expense, you will submit your receipt for the expense along with a claim form. If the claim is approved, you will be reimbursed for your expense. If the claim is denied, you will receive a letter or email explaining why.

Q. How do I know what expenses will be permitted?

A. We provide you with a list of most of the expenses that the IRS will allow. Click here to see our Permitted Expenses List.

Q. Will my claims for weight loss be approved?

A. The IRS regulations state that weight loss claims can only be considered once you have submitted a doctor’s diagnosis of obesity. Then, of course, we have to make sure the treatment occurred during the plan year, that the treatment was for a covered individual, and that the treatment itself satisfies the IRS regulations.

Q. How can I get a claim form?

A. All of our forms can be downloaded from this website. Just go to the FORMS tab and click on the form that you want. Your Human Resources department will also have a supply of the forms. Or, just click here to get your claim form.

Q. How long to I have to wait for my claim to be paid?

A. At the beginning of your plan year, you received a packet of information from us. On the back of the first sheet in the packet is a list of all of the claims cut-off dates for the year, the reimbursement process dates, and the date you should receive your reimbursement.

Q. Can I use my canceled check or credit card slip as a valid receipt?

A. No, you must submit a statement from the third party provider of the service showing the name of the patient, the date of service (not the date of payment), the exact service provided, and the cost.

Q. Can I ever use a cash register receipt?

A. Yes, cash register receipts can be used only for over-the-counter drugs, medicines and supplies. The receipt must show the exact product purchased, the date and the cost.

Q. How can I make sure that you received my claim?

A. We upload claim information every night. You can check our website and look at your account. You will see all of your claims and reimbursements for the current plan year. You can also call our office and we will be happy to look that up for you.

Q. How can I arrange to have my reimbursement paid by direct deposit instead of by check?

A. Your employer must request this service. Please let your Human Resources department know if you are interested in direct deposit.

Q. I have been reading about the Debit Cards. How can I get one?

A. Your employer must subscribe to this service. Please let your Human Resources department know if you are interested in the debit card.

Q. I have one of your debit cards? Do I ever have to submit a paper claim?

A. YES! Much of the time, you will need to submit receipts as back-up for your debit card swipe claim. In a few cases, if your swipe exactly matches one of the copays in your health insurance plan, your claim can be autoadjudicated and you will not need to submit a receipt. When you swipe the card, you will receive an email telling you that you need to submit a paper claim. You will have 15 days from the date of the swipe to turn in your receipts.

Q. I don’t like having a deduction from my paycheck and I want to discontinue my deductions. How can I do that?

A. Unless you have a change in status, you are locked into your election for the entire plan year. Your salary deductions will continue until the end of the plan year.

Q. What happens if I don’t use all the money that I elected?

A. If you do not use all of the money that you elected, you will lose it. That is why it is so important to be conservative when you are making your elections. There is a grace period at the end of the plan year to give you time to get your receipts together, not to incur more claims.

Q. Where are all of these rules written down, other than this website?

A. We have provided your employer with a Summary Plan Description. Your employer should have given you either a paper copy of the SPD, or else sent you an electronic copy within 90 days of your enrollment in the plan. If you do not have a copy of your Summary Plan Description, please see your Human Resources Department or click here for instructions to download it from the secure part of our website.

Q. What changes in status would allow me to change my election?

A. Marriage, birth or adoption of a baby, court order, death of a family member, divorce, a dependent gaining or losing eligibility for benefit, and eligibility for Medicare. There is a wonderful website www.changeofstatus.com that you can use for reference. You will also find this information in your Summary Plan Description.  If you are not sure if your particular situation qualifies, please call us.

Q. Are there any special changes of status that apply only to the Dependent Daycare Expense Reimbursement Account?

A. Yes, if your daycare provider changes its price up or down in the middle of the year, and that daycare provider is not related to you, you may change your election. Also, if you change daycare providers in the middle of the year, and your new provider has a different cost than the previous provider, you may change your election.

Q. I submitted a claim, but the amount of my reimbursement was smaller. Why?

A. There are a few reasons why you might be reimbursed for less than your claim amount. The rules for the Dependent Care Account state that you can only be reimbursed for up to the amount that you have already payroll deducted so far, less any prior reimbursements.  For medical expenses, it would mean that either you have been reimbursed for your entire annual election already, or else that part of your claim was denied. If part of your claim was denied, you will be receiving a letter or email from us explaining that denial. You might also receive a phone call from our staff requesting some missing information.

Q. Can I submit expenses or pre-tax the premiums for my non-married domestic partner?

A. Unless you have determined that your domestic partner is a dependent as defined under section 152(d), you would not be allowed any pre-tax benefits for your partner. To determine if your domestic partner fits this definition, you will need to consult with your tax attorney or consultant as Diversified Administration, Inc. would not be able to advise you in regards to this matter.