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Flex spending employee handout 2010-201


The Flexible Benefits Plan allows you to pay your portion of the required premiums for any group insurance plan you elect
with TAX–FREE dollars. Your group insurance premium options may include: Group Health Insurance, Group Dental Insurance and perhaps supplemental plans for specific diseases (like cancer) or Accident Plans. You will receive this benefit
automatically if you participate in any of our health related group insurance plans for which you are required to pay
some or all of the premiums.
The Health Care FSA is designed to help you pay for your family’s health care expenses that are not covered by a health,
dental or vision insurance policy by allowing you to use TAX-FREE dollars to pay those expenses. The Plan will reimburse you for qualified out-of-pocket medical expenses for all members of your dependent family regardless of whether or not
they are covered by your employer’s insurance plan. The Account may be used to pay for health care expenses that the
IRS recognizes as treating a specific medical condition, as long as the expenses are not for purely cosmetic purposes and are not for dietary supplements (e.g., vitamins) that are merely beneficial to general health. Eligible medical care expenses include deductibles, co-payments, amounts over your health plan’s maximum and expenses for routine physicals, vision, hearing, dental and mental health services. Additional information about eligible expenses is available on pages 4-5 of this handout. DEPENDENT CARE FLEXIBLE SPENDING ARRANGEMENT (FSA)
The Dependent Care FSA is designed to help you pay for daycare services for your child or dependent that enables you and
your spouse (if married) to work or be a full-time student. To be eligible to use this account, you and your spouse (if married) must be at work or school during the time your eligible dependent receives care. You will be reimbursed from the
Dependent Care FSA for the amount of your claim but only up to the amount that you have actually deposited into
your account via payroll deductions as of the date your reimbursement is made. Remember, the Dependent Care FSA is
a TAX-FREE benefit to you; therefore, if you take advantage of the FSA, you may not also take the child care expense tax credit on your personal federal income tax return for the same expenses. In most cases, the Dependent Care FSA will result in greater tax savings when compared to the personal income tax credit. THE IMPORTANCE OF PLANNING
The benefits you receive through the Flexible Benefits Plan are funded through Pre-Tax payroll reductions. The dollars you
agree to set aside to fund your benefits through this Plan are subtracted from your pay each pay period during the plan year. Before making your selection, consider your ability to afford a reduction in your paycheck because part of your salary is being set aside for future expenses. When deciding how much to allocate to your spending accounts you should be conservative. Federal regulations require you to forfeit any money that you set aside if you do not incur eligible expenses by the end of the plan year unless your plan includes a grace extension period giving you some additional time to incur expenses.* This
restriction placed on the timing of your expenses is commonly known as “use it or lose it”. The best way to avoid forfeiting
money is to estimate your expenses and then elect a little less than you expect to spend for the year. Also remember that once you authorize the company to redirect your money into a spending arrangement, you may not cancel or change your election
unless you have a “change in status event”. Examples of an allowable status change may include, marriage, divorce, death of spouse or dependent, birth or adoption of a child, or change in employment status of you or your spouse. The Summary Plan *Some, but not all, plans may have a provision that allows you a grace extension period of not more than 2.5 months after the end of the plan year to actually incur expenses and use funds left in your account from the prior year. Please consult your plan summary for the details of whether or not this option is available to you prior to making your election for the year. FOR MORE INFORMATION ABOUT YOUR FLEXIBLE BENEFITS PLAN
CALL ADMIN AMERICA AT 770-992-5959 OR 1-800-366-2961
OR SEND AN EMAIL TO [email protected]
Assume an employee earning $2,000 per month with assumed marginal income tax brackets of 15% Federal and 6% State. Also assume the employee pays $300 per month for dependent health insurance Without Flexible Benefits Plan

ORIGINAL GROSS TAXABLE WAGES ---------------------------------- $2,000 Federal Income Tax---------------------------------- 15.00% ---------------- ($300) State Income Tax --------------------------------------- 6.00% ------------------ (120) FICA & Medicare --------------------------------------- 7.65% ------------------ (155) LESS TOTAL PAYROLL TAXES ---- 28.65%---------------------- (575)
NET TAKE HOME PAY-------------------------------------------------------------- 1,425
LESS HEALTH INSURANCE PREMIUMS----------------------------- (300) NET EMPLOYEE PAY CHECK --------------------------------------------- $1,125
In the next example, we wil make only one change. In this case, THE EMPLOYER WILL PAY for the dependent health premium and wil do so by reducing the employee's original monthly taxable wages by With Flexible Benefits – Premiums Only

ORIGINAL GROSS TAXABLE WAGES ------------------------------ $2,000 LESS HEALTH INSURANCE PREMIUM -------------------------- (300) REDUCED TAXABLE WAGES ----------------------------------------- 1,700 Federal Income Tax ------------------------------------------------------- ($250) State Income Tax ------------------------------------------------------------ (100) FICA & Medicare ------------------------------------------------------------- (130) LESS TOTAL PAYROLL TAXES --------------------------------- (480)
NET EMPLOYEE PAY CHECK --------------------------------------- $1,220
ADDITIONAL ANNUAL TAKE HOME PAY (AFTER TAXES ----------------------- $1,140

In this example, the employee wil be alowed to redirect his taxable wages to pay for tax-free benefits that are applicable to his INDIVIDUAL SITUATION. With Flexible Benefits – Premiums & FSA’s

ORIGINAL GROSS TAXABLE WAGES -------------------------- $2,000 LESS INSURANCE PREMIUMS ------------------------------------- (300) LESS DEPENDENT CARE DEDUCTION --------------------------- (300) LESS UNREIMBURSED MEDICAL DEDUCTION -------------------- (40) REDUCED TAXABLE WAGES ------------------------------------------ $1,360 Federal Income Tax --------------------------------- ($204) State Income Tax --------------------------------------- (82) FICA & Medicare -------------------------------------- (104) LESS TOTAL PAYROLL TAXES ----------------------------------- (390)
NET EMPLOYEE PAY CHECK -------------------------------------------- $970
PLUS DEPENDENT CARE REIMBURSEMENT --------------------- 300 PLUS MEDICAL CARE REIMBURSEMENT ---------------------------- 40 TOTAL INCOME ------------------------------------------------------------ $1,310
ADDITIONAL MONTHLY TAKE HOME PAY (AFTER TAXES) ---------------------------- $185
ADDITIONAL ANNUAL TAKE HOME PAY (AFTER TAXES) -------------------------- $2,220
The following lists are examples of expenses that are eligible for reimbursement by our Medical Care Reimbursement Account. Also listed are some expenses that are expressly ineligible for reimbursement pursuant to federal law. These lists do not include every expense that is reimbursable. If you have any questions regarding the eligibility of any expense for reimbursement, please contact the Plan’s Administrator. In addition, reimbursement is subject to the “reasonableness” of the amount of the expense. PRESCRIPTION & OTC DRUGS
Allowable expenses:
Allowable expenses:
Prescription drugs filled by a licensed pharmacist Services of psychotherapists, psychiatrists and Over-the-counter drugs & medicines purchased to treat specific medical conditions without a Legal fees directly related to commitment of Insulin, syringes, blood sugar monitoring devices and related supplies used in the treatment of Expenses specifically disallowed:
Psychoanalysis undertaken to satisfy curriculum Expenses specifically disallowed:
Drugs which are illegal under Federal Law Drugs for purely cosmetic purposes (e.g., Propecia, FEES / SERVICES
Retin-A, etc.) even if prescribed by a doctor Vitamins, supplements or herbs that are merely Allowable expenses:
beneficial to general health even if prescribed by Nursing services for a specific medical ailment MEDICAL EQUIPMENT
Cost of a nurse's room and board if paid by the Allowable expenses:
The Social Security tax paid with respect to wages of Special mattress and plywood boards prescribed to Cosmetic surgery that treats a deformity caused by Oxygen equipment & oxygen used to relieve an accident or trauma, disease, or an abnormality breathing problems that result from a medical Services of chiropractors and osteopaths Fees for anesthesiologists, dermatologists and Wigs (when medically necessary to mental health of individual who loses hair because of disease) Excess cost of orthopedic shoes over cost of ordinary Expenses specifically disallowed:
Cosmetic surgery or procedure that improves the patient's appearance but does not meaningfully Expenses specifically disallowed:
promote the proper function of the body or Vacuum cleaner, furnace filters or special bedding Payments to domestic help, companion, baby sitter, purchased by an individual with dust allergy chauffeur, etc. who primarily render services of a Exercise equipment not related to a specific medical non-medical nature (this may be reimbursable Breast pumps when purchased for convenience, Nursemaids or practical nurses who render general care for healthy infants (this may be reimbursable PHYSICALS
Fees for exercise, athletic or health club memberships when there is no specific health Allowable expenses:
Allowable expenses:
Allowable expenses:
Dental care including x-rays, fillings, dentures, etc. Fluoridation of home water supply advised by dentist Expenses specifically disallowed:
Teeth bleaching/whitening or other cosmetic procedure that does not prevent or treat an illness Allowable expenses:
Prescription sunglasses including frames & lenses Radial keratotomy, laser eye surgery and corneal Allowable expenses:
Treatment for alcohol, tobacco or drug dependency Expenses specifically disallowed:
Treatment for obesity when diagnosed by a Non-prescription sunglasses for wearer of contacts Vaccines or immunizations to prevent diseases MISCELLANEOUS CHARGES
Allowable expenses:
Physical therapy received as rehabilitative medical Expenses of services connected with donating an Cost of computer storage of medical records Expenses specifically disallowed:
Tuition fees paid to special school for child with severe learning disabilities caused by mental or physical impairment with a letter from attending physician (but not for disciplinary/behavioral Physical treatments unrelated to a specific health problem (e.g., massage for general health, stress Infertility treatments such as shots, surgery, etc. Weight loss programs not related to obesity or other Expenses specifically disallowed:
Expenses of divorce when doctor or psychiatrist Cost of toiletries, cosmetics, and sundry items (e.g., ASSISTANCE FOR THE HANDICAPPED
Allowable expenses:
Cost of note-taker for a deaf child in school Distilled water purchased to avoid drinking Cost of Braille books and magazines in excess of Installation of power steering in automobile Seeing eye dog (including cost of buying, training Mobile telephone used for personal calls as well as Hearing-trained cat or other animal to assist deaf person (including cost of buying, training and Insurance against loss of income, loss of life or limb Union dues for sick benefits for members Household visual alert system for deaf person Excess costs of specifically equipping automobile for Auto insurance providing medical coverage for all handicapped person over the cost of an ordinary automobile; device for lifting handicapped person Parking fees and mileage (most, but not all, plans Special devices such as a tape recorder and are written to disallow these expenses; you should check your specific plan summary to determine whether or not these are allowed MEDICAL CARE SPENDING ACCOUNT WORKSHEET
This worksheet has been prepared to help you determine the amount of money, if any, you wish to al ocate to your Medical Care Spending Account. You may want to review receipts from last year for expenses you paid out of your own pocket. Using your receipts and this worksheet, you can estimate the amount of dol ars you wish to al ocate, on a pre-tax basis, to your Medical Care Spending Account. Keep in mind to budget only for those expenses specifical y eligible under the Medical Care Spending Account.
List medical care expenses you paid last year. These could include:
• Deductibles (medical and dental services) • Coinsurance or Benefit Percentage (not paid by insurance) • Amounts you paid in excess of health Insurance plan limitations such as . . . . . . fees over reasonable & customary al owance . . . fees over psychiatric lifetime maximum . . . fees over al owable hospital room al owance . . . fees over orthodontic lifetime maximum • Expenses you paid which were NOT covered by your group health insurance plan Physicals or “wel care” (preventive, school, work) Doctor’s office visits for medical care (copays) Prescription drugs (copays & drugs not on formularies) Over-the-counter drugs/medicines (not vitamins/supplements) $ __________________ Vision Care (glasses, contacts, laser eye surgery, etc.) Hearing expenses (hearing aids, batteries, etc.) Psychiatric care (psychotherapists, psychiatrists, psychologists) $ __________________ Dental & orthodontic care (not including teeth bleaching) Treatments & Therapy (not including massage therapy) Fees for medical services (x-ray, hospital, physician, etc.) Medical equipment (wheelchair, crutches, etc.) Medical supplies (syringes, test strips, etc. for diabetic care) Miscel aneous charges (infertility treatments, etc.)
$ __________________

Compare your typical expenses to those eligible under your Medical Care Spending Account and

budget accordingly. Remember to be conservative. You should elect a little less than you actually
expect your out-of-pocket expenses to be.


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