1. Custom Design Benefits, Inc.
5589 Cheviot
Cincinnati, Ohio

2. PLAN BENEFIT YEAR January 1, 2013 through December 31, 2013
Southern State Community College
Flexible Spending Account Plan (FSA)
(Medical Reimbursement Account)
PLAN BENEFIT YEAR
January 1, 2013 through December 31, 2013

3. Southern State Community College Flexible Spending Account
(Medical Reimbursement Account)
Eligible Medical Expense
Deductible, co-pays, co-insurance
Lasik Eye Surgery
Eyeglasses / contact lenses
Dental/Vision (member portion)
Orthodontia
Hearing Aids
Rental of medical equipment
Lab fees, x-rays
Over-the-counter items with a prescription

4. Dependent Care Account
You may set aside up to $5,000
per plan year into this account.
($2,500 for married Plan members who file separate tax returns.)
Eligible Dependent Care Expenses
Daycare expenses for IRS dependent children
Daycare expenses for IRS dependent adults
Preschool (not including Kindergarten tuition)
Latch Key Programs - up to age 13
Summer Day Camp - up to age 13

5. Use care when estimating your annual election amounts!
IRS Guidelines
& Terms of the FSA Plan
Use care when estimating your annual election amounts!
Mid-year election change is only permissible if a qualified Work/Life Status change occurs, and FSA dollars do NOT carry forward year to year.
Active employees must submit for reimbursement within 60 days of 12/31/13.

6. Take Care Debit Card
The easiest way to access the funds in your FSA account is to use your take care VISA debit card. When you pay with the card, your purchase amount is deducted from the appropriate balance in your Flexible Spending Account. Certain payments will require further verification, so please hold on to your itemized bills and receipts. Custom Design Benefits will request documentation only when it is needed.
NEW FOR 2013
Cards now have three-year expiration dates

7. Purchases that do not require receipts
Take Care Debit Card
Purchases that do not require receipts

8. Purchases that may require receipts
Take Care Debit Card
Purchases that may require receipts

9. Debit Card Purchases that always require receipts or paper claims

10. How Do I Get My Money If I Didn’t Use My Debit Card?
Complete a CLAIM FORM only if your debit card was not used.
Medical
Complete required information on claim form and attach an EXPLANATION OF BENEFITS (EOB) or STATEMENT/RECEIPT detailing expenses not
covered by carrier.
Dependent Care
Complete required information on claim form and attach RECEIPT for expenses from Dependent Care provider.
All reimbursements are mailed to the employee at their home address
Or issued by direct deposit if banking information is on hand
Mail completed form and receipts to: Custom Design Benefits, Inc.
5589 Cheviot Road Cincinnati, OH 45247
Fax to OR to

12. CUSTOM DESIGN BENEFIT’S ACCOUNT SERVICES
• Dedicated Claims Administrator
• Daily Claims Adjudication
Allows you to keep the most updated information on your account
• Check Issuing (Daily) or Debit Card
Debit Cards allow you to pay certain out-of-pocket expenses on the front end but you must retain documentation for verification of purchase. We may request some receipts.
• 24/7 Account Balance Information
Internet Services
Interactive Voice Response System

13. Custom Design Hotline:
How Do I Find Out About My Flexible Spending Account & Health Reimbursement Arrangement Balances throughout the Year?
Custom Design Hotline:
Local/National
Custom Design Website:
Enter your SSN# and password
(You will need to set your
password on the first visit only.)
Reimbursement Check
The Y-T-D balance summary is provided on each reimbursement check to help manage your account

14. FLEXIBLE SPENDING ACCOUNTS
INTERNET SERVICE
FLEXIBLE SPENDING ACCOUNTS
You can view:
annual election amount for current & prior plan year
contributions made to FSA Account
claim status and reimbursement
remaining balance
last payment date & amount
You can also access claim forms online at:
CustomDesignBenefits.Com

15. Access Custom Design Benefits Website
The screen will look exactly as the outline of the next few slides. Click on the Member’s tab.
Once you see the options from the drop down box you need to access Section 125-Flex
The first time you access your personal information, you will need to establish a password

20. QUESTIONS???