STATE OF MAINES

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STATE OF MAINES

• FLEXIBLE BENEFITS PLAN
• JANUARY 1 - DECEMBER 31, 2005

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IN ADDITION TO THE PREMIUM PRE-TAX BENEFIT- TWO
ADDITIONAL BENEFITS AVAILABLE EVERY PLAN YEAR
(JANUARY 1ST - DECEMBER 31ST ) ARE

• MEDICAL EXPENSE REIMBURSEMENT ACCOUNT
• DEPENDENT CARE REIMBURSEMENT ACCOUNT

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ADMINISTERED BYH R SUPPORT
CONSULTING SERVICES FLEX ADMINISTRATION DEPT.
159 WATKINS SHORES RD.CASCO, ME
04105-4309207-655-5396 OR Toll Free
1-866-655-5397FAX [phone]
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MEDICAL CARE
REIMBURSEMENT ACCOUNTS ALLOWS ELIGIBLE
EMPLOYEES TO SET ASIDE PRE-TAX DOLLARS TO PAY FOR
OUT OF POCKET MEDICAL EXPENSES FOR THE
PARTICIPANT AND HIS ELIGIBLE DEPENDENTS
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• DEPENDENT /ELDER CARE
  REIMBURSEMENT ACCOUNTS
• TO BE ELIGIBLE TO USE THIS ACCOUNT
• PARTICIPANT AND SPOUSE MUST
• WORK PART OR FULL TIME
• ATTEND SCHOOL FULL TIME
• BE ACTIVELY SEEKING WORK
• CHILDCARE PROVIDER MUST BE REPORTING
• THE INCOMES FOR INCOME TAX PURPOSES

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HOW MUCH CAN YOU SAVE?

• THE TAX SAVINGS IS DEPENDENT UPON THE TOTAL
  TAXABLE HOUSEHOLD INCOME FOR ANY GIVEN YEAR.
• FOR THOSE IN A 30 TAX BRACKET, THE TAX SAVINGS
  WOULD BE 300 ON EVERY 1,000 SET INTO A
  REIMBURSEMENT ACCOUNT.

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ARE THERE IRS RULES TO TAKE ADVANTAGE OF THIS
PRE-TAX BENEFIT? --- YES

• THERE ARE RULES FOR THE EMPLOYER WHO PROVIDES
  BENEFITS UNDER A CAFETERIA PLAN
• AND
• THERE ARE RULES FOR THE EMPLOYEE WHO ELECTS TO
  PARTICIPATE UNDER THE PLAN(S).

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RULES FOR THE EMPLOYER

• Must select a Plan Year. Usually coincides
  with the employers health insurance plan year
  renewal. For the State, the Plan Year is January
  1st December 31st of each year.
  ___________________________
• Employer must set a medical account maximum
  minimum for the Plan Year and requires that the
  amount elected by the participant for any Plan
  Year be available to him at the time he incurs
  the expense, regardless of the deposits taken.

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THE ANNUAL MAXIMUM AMOUNT FOR THE STATE OF
MAINES MEDICAL REIMBURSEMENT ACCOUNT IS
2,200.00 FOR ANY PLAN YEAR. THERE IS NO MINIMUM
AMOUNT.
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FOR THE MEDICAL ACCOUNT? COBRA applies should
a participant terminate employment during a plan
year and have a positive balance in his account.
? Additionally, the employer must allow him to
continue to participate at 102 of the
participants salary reduction amount for the
remainder of the Plan Year.
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FOR THE DEPENDENT/ELDER CARE ACCOUNT? IRS
sets the Plan Year amount at 5,000 per calendar
year - 2,500 if married, filing separate
returns.

• ? The employer DOES NOT upfront the monies for
  this account. The participant must first receive
  the child care before he can be reimbursed.

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RULES FOR THE PARTICIPANT

• ? The employee must elect to participate each
  Plan Year before the plan year begins during the
  States enrollment period.
• ? Once the decision to participate or not to
  participate has been made, the employee is locked
  into his decision for the full 12-month Plan Year.

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IMPORTANT REMINDER !!!FOR THE STATE OF
MAINE PLAN AN ELIGIBLE EMPLOYEE CAN ONLY ELECT TO
PARTICIPATE DURING THE ENROLLMENT PERIOD HELD
PRIOR TO THE START OF EVERY PLAN YEAR.
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ONLY
PARTICIPANTS ARE ABLE TO MAKE QUALIFYING STATUS
CHANGES --In the event that a participant has a
qualifying status change after the Plan Year has
started, any change he may want to make must be
made within 30 days of the effective date of the
event. The change s/he wants to make must be
consistent with the qualifying event.All
changes must originate with the Benefits
Department representative.
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WHAT KINDS OF MEDICAL EXPENSES ARE REIMBURSEABLE?

• PLEASE REFER TO THE ALLOWABLE MEDICAL EXPENSES
  SHEET PROVIDED WITH YOUR COMMUNICATION MATERIALS.
• COMMON REIMBURSEABLE EXPENSES INCLUDE SUCH THINGS
  AS CO-PAYS, DEDUCTIBLES, EYE EXAMS, DENTAL WORK,
  AND PERSCRIPTION CO-PAYS. DONT FORGET
  OVER-THE-COUNTER DRUGS AND MEDICINES.

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• OVER-THE-COUNTER DRUGS
• MEDICINES ARE REIMBURSEABLE!
• SEE INFORMATION MATERIALS FOR
• RULES AND A PARTIAL LIST OF
• QUALIFYING DRUGS AND MEDICIATIONS.

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WHAT KINDS OF EXPENSES ARE NOT ALLOWED?

• ? EXPENSES FOR WELLNESS, SUCH AS GYM MEMBERSHIP
  OR THOSE THAT ARE COSMETIC IN NATURE, SUCH AS
  TEETH WHITING ARE NOT ALLOWABLE. ALSO, VITAMINS
  ARE STILL NOT ALLOWED.
• ? EXPENSES MUST BE TO TREAT, CURE OR MITIGATE AN
  EXISTING MEDICAL CONDITION AS PER IRS REGULATIONS.

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HOW TO DETERMINE HOW MUCH MONEY TO PUT INTO YOUR
MEDICAL REIMBURSEMENT ACCOUNT.

• THE BEST WAY IS TO REVIEW YOUR CHECKBOOK AND SEE
  WHAT YOU HAVE SPENT OVER THE PAST 12-MONTHS IN
  OUT-OF-POCKET MEDICAL EXPENSES. (Jan. 1st Dec.
  31st )
• THIS WILL GIVE YOU A STARTING POINT.

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MAKE A LIST OF KNOWN EXPENSES FOR YOU AND
QUALIFYING DEPENDENTS FOR SUCH THINGS AS
MAINTENANCE PERSCRIPTIONS.

• LIST OTHER MEDICAL EXPENSES YOU ARE COMFORTABLY
  SURE YOU WILL HAVE TO PAY OUT-OF-POCKET OVER THE
  UPCOMING 12-MONTH PLAN YEAR JANUARY 1ST
  DECEMBER 31ST , 2005. DONT FORGET
  OVER-THE-COUNTER DRUGS AND MEDICINES!

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IF YOURE NEW TO THE BENEFIT, ITS ALWAYS WISE TO
GO A LITTLE LESS THAN ANTICIPATED TO AVOID
PUTTING TOO MUCH INTO THE ACCOUNT.

• FOR THE DEPENDENT CARE ACCOUNT ITS EASY. --
  SIMPLY DETERMINE WHAT YOU CURRENTLY PAY FOR CHILD
  CARE FOR THE 12-MONTH PLAN YEAR PERIOD.

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HOW DO YOU GET REIMBURSED AFTER ENROLLING IN THE
PLAN?

• COMPLETE THE REIMBURSEMENT REQUEST FORM (ONE IS
  PROVIDED WITH YOUR MATERIALS).
• SUBMIT IT WITH YOUR RECEIPT(S) OR BILL WHICH
  CONTAINS THE NAME OF THE PROVIDER, THE DATE OF
  SERVICE, THE DOLLAR AMOUNT OWED/PAID AND A
  DESCRIPTION OF THE SERVICE.

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!!! IMPORTANT !!!YOU CANNOT SUBMIT A CANCELED
CHECK AS A RECEIPT. IT IS AGAINST IRS REGULATIONS.

• 
  
• YOU MAY FAX OR MAIL YOUR FORM AND RECEIPTS TO THE
  ADDRESS ON THE FORM.
• CHECKS ARE MAILED THURSDAY OF EACH WEEK TO YOUR
  HOME ADDRESS.

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IT IS IMPORTANT THAT YOU REVIEW ALL THE
COMMUNICATION MATERIALS PROVIDED BEFORE
ENROLLING.SHOULD YOU HAVE ANY QUESTIONS,
CONTACT YOUR BENEFITS REPRESENTATIVE AT THE
OEHBOR, IF YOU PREFER, CONTACT H R SUPPORT
DIRECTLY AT 1-866-655-5397.
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DONT FORGET !!!

• ALL FORMS MUST BE SIGNED, DATED AND
• RETURNED TO
• THE STATE OF MAINE
• OFFICE OF EMPLOYEE HEALTH AND
• BENEFITS
• 114 STATE HOUSE STATION
• AUGUSTA, ME 04333-0114
• NO LATER THAN
• THURSDAY DECEMBER 30,2004.