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PayFlex Website: www.payflex.com/utflex

NEW Grace Period Q&A

PayFlex Forms
:

Claim Form

Direct Deposit Authorization Form

Letter of Medical Necessity Form

U T FLEX Plan Booklet
Give Yourself A Pay Raise! Brochure


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Plan Year

UT FLEX

NEW: Express Claims!
This new online feature enables your paper claims to be processed within three hours! Simply visit http://www.utflex.com.
Express Claims Fax Number:
866-WEBCLMS (932-2567)

PayFlex Systems USA, Inc. is the administrator for the UT FLEX flexible spending accounts.

Authorized by the IRS, the UT FLEX plan lets you set aside money from your pay before taxes are withheld. The UT FLEX flexible spending accounts are a way for you to pay for certain out-of-pocket health care for all dependents claimed on your income tax return and work-related day care expenses for your claim dependents while receiving a tax advantage. As medical care expenses and/or dependent day care expenses are incurred throughout the plan year, you will be reimbursed with tax-free dollars from your UT FLEX account after you submit a claim. This reduces the amount you pay in taxes, and increases your spendable income. If you elect the PayFlex Debit Card, you will use your card at the time of service and the payment will be automatically deducted from your UT FLEX account.

Your UT FLEX elections must be renewed each Annual Enrollment. Your election amounts are not continued from the previous year.

The UT FLEX plan has two types of accounts:

  • The Medical Expense Reimbursement Account; and
  • The Day Care Reimbursement Account.
FLEX Benefit Summary
UT FLEX Reimbursement Account Your Monthly Payroll Deduction1 Eligible Expenses
Medical Expense $15 minimum to $416 maximum Medically necessary health care expenses, including dental and vision related expenses and certain over-the-counter medications incurred and paid during your period of coverage. These expenses should not be paid by other benefit plans.
Day Care $15 minimum to $416 maximum
or ($208 maximum if married filing separate federal income tax returns). IMPORTANT: In any given calendar year (Jan. 1 – Dec. 31), the dependent day care deductions cannot exceed $5,000 for tax-filing purposes.
For children under age 13 or qualified disabled dependents of any age who are claimed as dependents for federal income tax purposes. Dependent day care expenses that are necessary for you and your spouse (if married) to work or attend school full-time, such as child care services in a home, licensed day care, and adult day care.
1 Nine-month employees may deduct a maximum of $555 monthly. If your UT campus has chosen to allow for an annual amount calculated over the deduction period, the maximum amount is $5,000 per plan year.

How the Plan Works

  • Decide how much you want deducted from your paycheck and transferred to your UT FLEX account. (See www.utsystem.edu/benefits for a "Savings Calculator.")
  • During Annual Enrollment, you enroll in one or both UT FLEX accounts through the UT Touch enrollment system.
  • When you have a medical expense or day care expense, send a claim form with your receipts to PayFlex. (See Flex Convenience® Card information below for medical expenses.)

Tips:

  • Plan carefully as any amount left in your account after the claims run-out period will be forfeited.
  • You decide if you want the reimbursement check mailed to your home or directly deposited to your bank account. If you choose “Direct Deposit,” be sure to fill out and submit a special PayFlex Direct Deposit authorization form with a “voided” check. Forms located at www.utsystem.edu/benefits.

Medical Expense Reimbursement Account

Eligible Medical Expenses

Eligible medical expenses are amounts paid for the diagnosis, cure, mitigation or treatment of a disease, or for treatments affecting any part or function of the body. The expense must be primarily to alleviate a physical or mental illness.

The following are examples of eligible expenses:
  • Deductibles, co-pays, coinsurance
  • Prescription drugs, allergy shots, insulin & syringes, annual physicals, contraceptives
  • Chiropractor treatments, psychiatric/psychologist fees
  • Smoking cessation programs
  • Wheelchair/crutches or other durable medical equipment
  • Dental exams, x-rays, fillings, crowns, bridges, dentures, orthodontia
  • Eye exams, prescription eyeglasses and prescription sunglasses, LASIK surgery
  • Contact lenses and cleaning solutions
  • Hearing aids and batteries

Eligible Over-the-Counter Items

You can be reimbursed for certain over-the-counter items, such as:
  • Antacids
  • First-aid antibiotic ointments and creams
  • Anti-fungal ointments and creams
  • Cold remedies, including nasal sprays and cough syrups
  • Eye drops
  • Hemorrhoid ointments and creams
  • Pain relievers, such as aspirin, and acetaminophen
  • Stop-smoking gums and patches

The Medical Expense Reimbursement Account offers two conveniently accessible features for your health care needs:

  • Certain over-the-counter items are eligible for reimbursement;
  • PayFlex Debit Card is available to use as a "debit card."

All claims must be submitted by November 30 following the end of each plan year to be eligible for reimbursement.

If you enroll in the Medical Expense Reimbursement Account, you can be reimbursed for eligible out-of-pocket expenses you incur during the plan year (September 1 through August 31) and grace period (September 1 through November 15), up to the amount you have elected and while you are covered by the plan.

The UT FLEX Grace Period

UT FLEX Medical Expense Reimbursement Account participants have an additional 2-1/2 months each year to incur eligible expenses at the end of each plan year. This means that instead of forfeiting any UT FLEX contributions that are not spent by August 31, you may be reimbursed for eligible health care expenses incurred through November 15.

PayFlex Debit Card

If you enroll in the Medical Expense Reimbursement account, you have the option to use the PayFlex Debit card for qualified medical expenses. This card works like a debit card.

The advantages to the PayFlex Debit Card are:
  • Improved cash flow - You don't have to pay money when you use the card at participating merchants and providers.
  • It's easy to use - You don't have to complete a claim form. PayFlex will request receipts to verify that expenses are eligible under the plan; therefore, you must save your receipts. (IRS guidelines require appropriate documentation of qualifying expenses.)

The annual fee for this card is $9. The fee is deducted at the beginning of the plan year from your annual elected amount.

This plan year, everyone who elects the card will receive a new PayFlex Debit Card which will replace your existing MBI Flex Convenience® Card

You can use this card only for the UT FLEX Medical Expense Reimbursement Account. It cannot be used for the Day Care Reimbursement Account. For more detailed information about the PayFlex Debit Card, visit www.utsystem.edu/benefits.

All medical expenses incurred during the 2005-2006 plan year that are filed for reimbursement after August 31, 2006 must be submitted with a PayFlex claim form. If you use your PayFlex Debit Card during the grace period your claim will be deducted from your 2006-2007 election. Following the end of the run-out period (November 30) if you had a 2005-2006 account balance remaining, PayFlex will automatically adjust the balance for expenses incurred during the grace period. In other words, your 2005-2006 account will be reduced and your 2006-2007 account balance will be increased by the corresponding amount.

DAY CARE REIMBURSEMENT ACCOUNT


You can be reimbursed for qualified dependent care expenses that meet the requirements described below.

Reimbursements can be made up to the amount actually contributed to your account, less prior reimbursements.

Eligible Dependent Day Care Expenses

  • Work-related expenses incurred so that you and, if married, your spouse can work;
  • Custodial care for qualified tax dependents;
  • Before/after school care;
  • Preschool/nursery school for pre-kindergarten;
  • Day care center expenses for custodial care
  • Au pair or nanny dependent care expenses; adult day care expenses
  • The annual expense reimbursement may not exceed the lesser of:
    • your earned income,
    • if married, your spouse's earned income; or,
    • $5,000 ($2,500 if married, filing separate income tax returns).

Ineligible Dependent Care Expenses

  • Educational/tuition - kindergarten, first grade or higher
  • Registration/reservation/holding fees
  • Activity fees or fees for supplies or materials/field trip expenses
  • Overnight camp
  • Transportation expenses, food, clothing, entertainment expenses
  • Payment of services not yet provided (advance payments)

The amount which you may consider in calculating the tax credit under the Federal Tax Credit is reduced, dollar-for-dollar, by any amount that you place into the Day Care account. The tax credit limits are $3,000 for one qualifying dependent, and $6,000 for two or more qualifying dependents. You should carefully review the benefits of the Federal Tax Credit with the benefits of the Day Care account and seek advice from your tax advisor before making your final decision.

Other Important UT FLEX Plan Features

"Use it or lose it." To qualify as a tax exempt plan, the UT FLEX plan must comply with all applicable Internal Revenue Service requirements including forfeiture of of non-reimbursed funds. . In other words, the UT FLEX plan is a "use it or lose it" plan. Any amounts you do not use throughout the plan year and during the grace period for health related expenses will be forfeited, so it is very important to plan carefully. Review your prior year's expenses to estimate your medical and day care expenses for the upcoming plan year. Be conservative and plan only for predictable expenses.

Your UT FLEX elections must be renewed each Annual Enrollment. Your election amounts are not continued from the previous year. However, if more than $10 remains in your UT FLEX account(s), you will receive a notification and reminder during July, 2007.

Read additional information about plan features and exclusions in the Flexible Spending Plan guide, also available from your campus Benefits Office.

UT FLEX (PayFlex Systems USA, Inc.)
www.utflex.com
Phone: (866) 887-3539 (UTS-FLEX)
Fax: (877-230-4283)