| This document summarizes all of the benefits available through AFLAC, our current Cafeteria Plan provider. Benefits include pre-tax deductions of your dependent health insurance, flexible spending accounts for medical and dependent care expenses, and voluntary supplemental insurance plans. |
| You can have pre-tax money deducted from your paycheck and placed into a special account for you. This reduces your taxable income. Read this to learn more about the expenses that are eligible for reimbursement (medical & dependent care). NOTE: These benefits changed in 2011 due to Healthcare Reform. More changes are expected in 2013 with regard to the maximums allowed. |
| This sheet spells out how your taxable income changes with respect to the 'pre-tax' deductions. The example uses a smaller tax bracket than some employees will be in. If you are in a higher tax bracket, your tax savings possibilities are higher than indicated here. |
| Please complete this form and attach your receipts to it when you turn them in to Human Resources. The receipts must clearly indicate the service being provided and show that you have paid them in order to be eligible - summary statements cannot be accepted. If you have a number of items to submit, you can use the addendum form below or attach your own spreadsheet to this form. If you are submitting pharmacy co-pays, you can often download and attach a summary detailing your prescriptions from you seelcted pharmacy's web site. This has been found to make the record keeping a little easier. |
| This form can be used in combination with the form above to list a number of medical items for reimbursement. |
| This is an example of the form to elect for or waive benefits. |
