Health Care Flexible Spending Account

If you are a highly compensated team member …

… your contributions to a Health Care Flexible Spending Account may be limited, depending on the participation of lower-paid team members. You will be notified if you are affected by these limits.

The Health Care Flexible Spending Account provides an opportunity to reduce your taxable income and lower your costs for certain health care expenses, and increases your spendable income. You can set aside money from your salary before taxes are calculated and then use those funds to reimburse yourself for eligible health care expenses incurred by you and your eligible family members.

How Much You May Contribute

You can set aside up to $2,000 a year in the Health Care Flexible Spending Account.

Your contribution is automatically deducted from your pay on a before-tax basis and redirected into your account in equal amounts throughout the year. If you are a highly tipped team member, you must have a positive paycheck (a paycheck that still has a positive balance) to make contributions to your Health Care Flexible Spending Account.

Note that if you are defined by the IRS as being “highly compensated,” your contributions to a Health Care Flexible Spending Account may be limited, depending on the participation of lower-paid team members. If team member participation doesn’t reach certain benchmarks, your contributions may be restricted. You will be notified if you are affected by these limits.

Using Your Health Care Flexible Spending Account

You can use your Health Care Flexible Spending Account to pay eligible health care expenses for:

yourself,
persons you claim as dependents on your federal income tax return (whether or not they are eligible for, or covered by, any of the MPTN health care plans), and
dependent children who do not live with you, if you are legally required to pay their health care expenses.

You may not use a Health Care Flexible Spending Account for reimbursing health care expenses incurred by a former spouse.

This Plan Document and SPD supersedes all earlier descriptions of the plans, as of January 1, 2024.

Because the benefits and other programs described in this Plan Document and SPD may change, MPTN will provide updated information as necessary and as required by tribal, federal or other applicable law.

Eligible Expenses

With one exception, any health care expenses that would be deductible on your federal income tax return are eligible for Health Care Flexible Spending Account reimbursement, as long as you do not take a tax deduction for the same expenses and you are not reimbursed for them in any other way. The exception is that expenses for long-term care are not eligible for FSA reimbursement, even though long-term care costs are tax deductible.

Examples of eligible health care expenses include:

any health care deductibles, coinsurance and copayments you or your eligible family members incur
health care expenses for persons you claim as dependents on your federal income tax return (whether or not they are covered by, or eligible for, any of the MPTN health care plans)
health care expenses for dependent children who do not live with you, if you are legally required to pay their health care expenses, and
other expenses not currently covered by the MPTN health care plans, such as:
- hospital charges for a private room (above the average charge for a semiprivate room)
- vision care expenses beyond the vision care plan allowance.

Expense Information

For more information about eligible expenses, please consult IRS Publication 502, Medical and Dental Expenses, under the headings “What Medical Expenses Are Deductible?” and “What Medical Expenses Are Not Deductible?” for details regarding what are and are not eligible expenses.

But use caution when referring to Publication 502, because it is meant only to help taxpayers determine their tax deductions, not to describe the expenses that are reimbursable under a Health Care Flexible Spending Account. For example, the publication states that you may get a deduction for expenses paid during the year.

For purposes of your Health Care Flexible Spending Account, you may be reimbursed for expenses you incur during the year — no matter when you pay for them. (Expenses are incurred on the date you receive the health care services, that is, the date you see the doctor or other health care provider.)

As another example, health insurance premiums, long-term care contracts and long-term care services are listed as deductible expenses in the publication; however, they generally are not reimbursable from your Health Care Flexible Spending Account.

Additional health care expenses that may be eligible for reimbursement from a Health Care Flexible Spending Account include the following:

Acupuncture
Abdominal supports*
Air conditioner where necessary to relieve allergies or breathing difficulties*
Artificial limbs
Back supports*
Birth control pills or other doctor-prescribed birth control items
Braille books (that is, the excess cost of Braille books over the cost of regular editions)
Christian Science practitioner
Contact lenses and lens replacement insurance
Cosmetic surgery (to improve a deformity associated with a congenital abnormality, accident- or trauma-induced personal injury, or disfiguring disease)
Elastic hosiery for medical purposes*
Fluoridation unit in your home*
Guide dogs
Hearing expenses, such as hearing exams, hearing aids and batteries
Home modifications to accommodate a person with a disability*
Nursing services
Orthopedic shoes and arches
Remedial reading instruction for a dyslexic child
Sacroiliac belts*
Sanitariums and similar institutions
Special equipment for deaf persons (TV adapter/telephone-teletype)
Special mattresses and plywood boards for relieving spinal arthritis
Special schools for handicapped children
Sterilization procedures for birth control
Smoking cessation program
Trusses
Weight loss programs prescribed by a doctor for treating hypertension and/or obesity

* These expenses require the completion of a medical necessity form.

Ineligible Expenses

Some expenses are not eligible for reimbursement from your Health Care Flexible Spending Account, such as the following:

Antiseptic diaper services
Athletic club services for physical fitness
Bottled water bought to avoid drinking fluoridated tap water
Contributions to a medical plan offered by your spouse or partner’s employer
Cosmetic surgery to improve personal appearance
Deductions from your wages for sickness insurance under state law
Domestic help, even if recommended by a doctor
Funerals, cremations, burials, cemetery plots, monuments and/or mausoleums
Health programs offered by resort hotels, health clubs and gyms
Hair transplant operations
Illegal operations and drugs
Long-term care expenses and insurance premiums
Marriage counseling
Maternity clothes
Premiums for other coverage
Before-tax contributions for health care coverage
Scientology fees
Weight loss programs undertaken for general health, not for a specific ailment (such as hypertension or obesity)

For More Information …

…

Publication 502 is available from your nearest IRS office or by calling the IRS at 1-800-829-3676. You also may obtain a copy online by accessing http://www.irs.gov.

Filing a Health Care Flexible Spending Account Claim

You need to file a claim to be reimbursed through your Health Care Flexible Spending Account for eligible expenses. You must include proof of incurred expense — an itemized receipt, itemized bill, or Explanation of Benefits (EOB) — with your claim. (An EOB is a statement from your health care plan that shows the amount of your expenses, the amount covered by insurance, and the amount you paid.) You will not be reimbursed without proper documentation.

With each reimbursement, you will receive a statement showing your balance and any payments made from your account.

The plan reimburses in full — up to the amount of your annual Health Care Flexible Spending Account election — regardless of how much you have in your account at the time of your claim. You have until March 31 of the following year to submit claims for eligible expenses incurred through December 31. You may be reimbursed only for health care expenses incurred while you are contributing to the Health Care Flexible Spending Account.

On October 31, 2013, the Internal Revenue Service (IRS) issued Notice 2013-71 which modifies the longstanding “use-or-lose” rule for Health FSAs. Employees participating in the Health FSAs will be allowed to carry over up to $550.00 of unused amounts remaining at year-end into the following year.

MPTN has adopted this ruling and allows Health FSA participants to carry over up to $550.00 into the following year.

Tax Deductions for Unreimbursed Health Care Expenses

For each eligible expense, you can either use a Health Care Flexible Spending Account or you can deduct the expense on your income tax return — but not both.

Keep in mind that, for your income tax return, you can only deduct health care expenses that exceed a certain percentage of your income. Generally, this means only people with very high medical expenses are able to take this deduction.

Claims must be submitted to the Health Care Flexible Spending Account administrator at the following address:

Claims Administrator
Pequot Plus Health Benefits Services
P.O. Box 3620
Mashantucket, Connecticut 06338

Phone: 1-888-779-6872
Fax: 860-396-6403

The administrator reviews your claim and reimburses all eligible expenses. If you submit an ineligible claim you will be notified.

If you are not satisfied with the outcome of a benefits claim you have submitted, you can ask that the claim be reviewed. See “Claims Review and Appeals Procedures” in the Rules and Regulations section for information.

Leaving MPTN

If you leave MPTN with an outstanding Health Care Flexible Spending Account balance, you can submit claims for eligible expenses incurred through your last day of work. If you want to continue to submit claims for expenses after your employment ends (until March 31st of the following year), you must continue to make FSA contributions on an after-tax basis under MPTN COBRA. For more information, see the COBRA Health Care Coverage section.

When Contributions End

Your before-tax contributions to a Health Care Flexible Spending Account stop whenever the first of the following events occurs:

The plan year in which you have elected to participate ends,
You end your employment (whether voluntarily or involuntarily),
You take a leave of absence, including a leave under the MPTN leave policy that applies to your division (For more information about FSA contributions during an MPTN Family Medical Leave (FML), see “Continuing Contributions — FML” on the following page),
You no longer meet the eligibility requirements to participate (for example, if your status changes so you are no longer eligible),
MPTN discontinues the plan, or
You die.

If your participation in the Health Care Flexible Spending Account ends, you will not necessarily forfeit your account balance. You may be eligible to continue making contributions to the Health Care Flexible Spending Account on an after-tax basis through the end of the year under the provisions of MPTN COBRA. If you have a significant balance in your account, continuing to make contributions can give you time to incur eligible expenses and file claims to be reimbursed, rather than forfeiting the account balance. See “Continuing Contributions – MPTN COBRA,” below, for more information.

Continuing Contributions — MPTN Family Medical Leave

Under the MPTN Family Medical Leave (FML) Policy, you may be able to continue participating in the Health Care Flexible Spending Account when your participation would otherwise end. The FML offers two options if you are contributing to a Health Care Flexible Spending Account when you begin an unpaid FML leave. You may either:

continue your participation (by making contributions) on an after-tax basis, or
suspend participation (that is, make no contributions) while you are on leave, but resume participation when you return. If you suspend participation:
- you are not eligible to be reimbursed for expenses incurred during the suspension, and
- your annual contribution election will be pro-rated to reflect the period of your leave.

If you continue to participate in the Health Care Flexible Spending Account while you are on an MPTN leave and do not return to work at the end of the leave, you may continue participation on an after-tax basis through MPTN COBRA, as described in “Continuing Contributions – MPTN COBRA” below.

Continuing Contributions – MPTN COBRA

If you become eligible to continue your health care benefits under MPTN COBRA, you may continue your contributions to your Health Care Flexible Spending Account, but only on an after-tax basis, and only until the end of the plan year in which you become eligible for MPTN COBRA.

COBRA participants are not eligible for the $550.00 carryover into the following year.

Even though you would not realize the tax advantages of before-tax contributions, this may be a good strategy for you if your balance is significantly higher than the eligible expenses you have already incurred. By continuing to contribute on an after-tax basis through MPTN COBRA, you could give yourself more time to incur eligible health care expenses, such as purchasing a new pair of eyeglasses — so that you could use up the before-tax balance you had already contributed. (Remember, you may file claims only for eligible expenses incurred while contributing.)

For information on the terms and conditions of MPTN COBRA, see the COBRA Health Care Coverage section.