Take Care Debit Card The take care® Visa® flex benefits card is issued by Bancorp Bank pursuant to a license from Visa U.S.A. Inc. TAKE CARE plans are not administered by Bancorp Bank.

Keep all Documentation If you have co-pay’s, an expense amount equal to your co-pay for doctor visits will be automatically substantiated, without having to provide receipts. An expense up to a five-times multiple of eligible co-pays will be automatically substantiated as well. A recurring expense that has previously been substantiated will “auto substantiate” after the first time as long as the amount and provider remain the same. Card will only work for a purchase that is equal to or less than your remaining available balance, otherwise your card will be declined. Goods or services paid from your employer’s flexible benefit plan which are not substantiated must be repaid by you to your employer or your card will be suspended. This Debit Card should only be used to pay for eligible medical expenses, and cannot be used at any ATM. Card is pre-loaded with your annual election amount Additional cards can be ordered for your spouse at no additional charge at Accepted at medical/dental/vision service providers using approved MCC (merchant category codes) Money is instantly deducted from spending account- no waiting for reimbursement No PIN required Card is automatically activated at first use Cards will be issued for a 3 year period. Understanding How Your Debit Card Works!!

Swipe flex debit card like any other VISA credit card for eligible medical expenses. Swipe personal debit/credit card for other expenses that are not eligible. You may be asked to supply substantiation for your card swipe if it is not “auto substantiated.” If so, you will be notified by or letter. There will be a link in the that will take you to At this time you will need to set up your username and password if you have not already done so. Please use the next few slides as a guide to send in your form for substantiation. Using your Debit Card and providing substantiation

Example ( letter) asking for debit card substantiation

The website will open to your Account Summary page. To locate debit card payments to be reviewed you will see “ Click here to review”, which is just above “View My Statement”.

“Review Card Payments”

Follow instruction on this page (only add items to form that you are submitting right away then click “continue”)

Print, sign and date form. Submit your debit card claim form and proper documentation, usually an Explanation of Benefits, to Glynn Griffing and Associates, Administrators by , mail, fax, or scan. We need this debit card form to complete your claim. Please do not send substantiation before you are notified by .

“Reminder” Information needed for Substantiation of Debit Card Transaction What type of receipt is acceptable? 1. Itemized bill (a medical provider or retailer’s detailed receipt), or 2. Explanation of benefits (EOB), or These documents must show: 1. Provider name or where item was purchased 2. Date of Service 3. Detailed description of item purchased or service provided 4. Amount paid and /or the portion not reimbursed through your insurance carrier 5. Person who received the service or who the item is for

Approved Merchants Kroger Pharmacy CVS Pharmacy DrugStore.com Super D Pharmacy Winn-Dixie Pharmacy Wal-Mart Pharmacy Walgreens Pharmacy Sam’s Club Pharmacy Fred’s Pharmacy See website for more…

Effective January 2011 What you need to know... As a consumer with an FSA or HRA debit card, it is important that you understand how the Patient Protection and Affordable Care Act (PPACA) may impact you. What has changed: Expenses for OTC drugs or medicines (other than insulin) incurred on or after January 1, 2011 will only be considered "medical care" for IRS purposes if they are "prescribed". Note: Under the new OTC Rules, "prescribed“ means an electronic or written order that meets the legal requirements of a prescription in the state in which the medical expense is incurred and that is issued by an individual authorized to issue a prescription in that state.

What remains the same: OTC medical supplies and equipment such as contact lens solutions, bandages, crutches, durable medical equipment or diagnostic devices, such as blood sugar test kits may continue to be purchased with the current SIGIS IIAS process. Effective January 2011 What you need to know...

Eligible Products “List” Changes for IIAS Merchants Categories No Longer Eligible without a Prescription: Acid Controllers Allergy & Sinus medicine Antibiotics Anti-Diarrheas Anti-Gas Products Anti-Itch & Insect Bite Anti-Parasitic Treatments Baby Rash Ointments/Creams Cold Sore Remedies Cough, Cold & Flu Digestive Aids Epsom Salts Feminine Anti-Fungal/Anti-Itch Hemorrhoid Preps Homeopathic Remedies Laxatives Mineral Oils Motion Sickness Pain Relievers Respiratory Treatments Sleep Aids & Sedatives Stomach Remedies Categories Still Eligible: Examples of OTC items to remain available without a doctor’s prescription: Band Aids Elastic Bandages & Wraps Birth Control (limited) First Aid Supplies Braces & Supports Insulin & Diabetic Supplies Catheters Ostomy Products Contact Lens Supplies & Solutions Reading Glasses Denture Adhesives Wheelchairs, Walkers, Canes Diagnostic Tests & Monitors

How can I use my FSA funds for Prescribed OTC Medicines and Drugs? The IRS guidance provides for two methods for Participants to access FSA Funds: Non-Debit Card Purchase: Participants can use another form of payment for purchase then submit the items for manual reimbursement with their plan administrator. Participants will need to submit either a) receipt showing description, date of service with amount of purchase and a copy of the doctor’s prescription or b) a receipt that includes prescription number, patient name, date and amount. Debit Card Purchase: Participants can use their FSA card for payment at an IIAS merchant that supports IRS Notices and regulatory requirements by presenting the prescription to the pharmacist and having the pharmacist dispense the OTC drug or medicine in accordance with applicable law and regulations by which an Rx Number in generated and processed.