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Rcps.us

ROANOKE COUNTY
PUBLIC SCHOOLS
FLEXIBLE BENEFIT
July 1, 2011 – June 30, 2012
EMPLOYEE GUIDE
Copyright 1992 - Flexible Benefit Administrators, Inc. INTRODUCTION

FLEXIBLE BENEFIT PLAN:
THE BETTER YOU PLAN, THE MORE YOU SAVE!
It's more than a slogan. The Flexible Benefit Plan is a real solution to issues facing all
of us. Simply stated, by taking advantage of tax laws, the Flexible Benefit Plan works
with your benefits to save you money.
Your insurance programs are designed to help you and your family become financially
secure as well as to protect you against the high cost of medical care including
catastrophic events. However, almost everyone has a number of necessary,
predictable expenses that are not covered by your insurance programs. The Flexible
Benefit Plan will help you pay for these predictable expenses.
The Flexible Benefit Plan offers a unique way to help pay for some of your health care
expenses and dependent care expenses.
The key to the Flexible Benefit Plan is that your eligible expenses are paid for with Tax
Free Dollars
. You will not pay any federal, state or social security taxes on funds
placed in the Plan. You will save between, approximately, $27.65 and $37.65 on every
$100 you place in the Plan. The amount of your savings will depend on your federal tax
bracket.
Using the Flexible Benefit Plan can save you a significant amount of money each year,
however, it is important that you understand how the Plan works and how you can make
the most of the advantages the Flexible Benefit Plan offers.
This handbook will help you understand the Flexible Benefit Plan. The handbook
covers how the Plan works, describes the categories of the Plan, explains the rules
governing the Plan, the reimbursement process and how you can elect to participate in
the Flexible Benefit Plan. Prior to electing to participate in the Flexible Benefit Plan, it is
important that you read and understand the Rules and Regulations section of this
handbook.
After you read this material, if you have any questions please feel free to contact
Flexible Benefit Administrators, Inc. at (757) 340-4567 or (800) 437-FLEX.



FLEX NOTE:


FLEX is authorized by Section 125 of the Internal Revenue Code.

IMPORTANT INFORMATION

PLAN YEAR:
July 1, 2011 – June 30, 2012

ENROLLMENT PROCESS:
You must complete an enrollment form to participate in the Spending Accounts each year
during the enrollment period.
If an enrollment form is not completed during open enrollment, your
enrollment will be canceled and you will not be able to join until the next anniversary date of the Plan.

ELIGIBILITY REQUIREMENTS:
You are eligible to participate in the Plan on the first day of the month following your date of hire if you
are a contracted employee.





HEALTH CARE REIMBURSEMENT ACCOUNT

The Health Care Reimbursement Account allows you to pay for your uninsured medical expenses
with pre-tax dollars. With this account, you can pay for your out of pocket medical expenses for
yourself, your spouse and all of your dependents for medical services that are incurred during your
Plan Year. The maximum you may place in this account for the Plan Year is $5,000.
EXAMPLES OF ELIGIBLE HEALTH CARE EXPENSES
FEES/CO-PAYS/DEDUCTIBLES:
Acupuncture
Prescription Eye glasses/Contact lenses • Artificial limbs & breasts (only if reconstructive) • Birth control pills, patches (e.g. Norplant) • Therapeutic care for drug and alcohol addiction • Take-home screening kits (HIV, colon cancer) • Smoking cessation programs and prescribed drugs designed to alleviate nicotine withdrawal • Mileage, parking and tolls ( you may be reimbursed $.19* a mile plus parking and tolls when
medical reasons make it necessary to travel) • Tuition fees for medical care (if the college furnishes a breakdown of medical charges) • Orthodontic expenses (not for cosmetic purposes)
NOTE: ORTHODONTIC TREATMENT IS REIMBURSED ACCORDING TO YOUR PAYMENT PLAN WITH
THE ORTHODONTIST.
FOR EXAMPLE: If your payment plan is set up to pay $100 a month for the
orthodontic treatment, you can be reimbursed $100 a month for the payments that become due during the Plan
Year.
This above list is compiled from IRS publication 502. If you are unsure that your expected medical expense
will be eligible under tax code regulations, please call Flexible Benefit Administrators at (757) 340-4567 or
(800) 437-FLEX before making your election for the Plan Year. IRS publication 502 can be ordered by calling
the IRS at (800) 829-3676.

* Mileage reimbursement rate is based on IRS regulation and subject to change.

FLEX NOTE:


You can save between 28% and 38% in taxes on every $100 you place in the Plan.

Health Care Reimbursement Account (continued)

OVER-THE-COUNTER DRUGS
Please be advised that recent Senate legislation has stated that effective January 1, 2011,
participants are required to have a prescription for Over-the-Counter (“OTC”) products to be eligible
under their FSA plan. Therefore a prescription or letter of medical necessity would be required after
January 1, 2011 for OTC items.
OVER-THE-COUNTER EXPENSES
and drugs that may be purchased in reasonable quantities with a
prescription or letter of medical necessity:

Pain relievers/aspirin Cough & cold medications Ointments & creams for joint pain Laxatives Anti-diarrhea medicine Bug-bite medication OVER-THE-COUNTER EXPENSES THAT ARE NOT ELIGIBLE • The following examples are OTC items that are not eligible and will not be reimbursed under
any circumstances because the items are considered dietary supplements, toiletries, cosmetic or personal use items: (even if dentist recommends a special one) DUAL PURPOSE DRUGS & ITEMS
EXPENSES THAT NEED DOCUMENTATION FROM YOUR PHYSICIAN TO BE ELIGIBLE
THROUGH THE HEALTH CARE ACCOUNT
• The following items are examples of products that are considered as having both a medical purpose and a general health, personal/cosmetic purpose and require a medical practitioner’s note stating the name of the patient, the specific medical condition for which the OTC is recommended, the time frame of the treatment and that the treatment is not cosmetic: (to treat a medical condition for a limited time) OTC Hormone therapy (to treat menopausal symptoms) Health Care Reimbursement Account (continued)
EXPENSES FOR IMPROVEMENT OF GENERAL HEALTH are not eligible for reimbursement
even if a doctor prescribes the program. However, if the program is prescribed for a specific medical condition (e.g. Obesity, Emphysema), then the expense would be eligible. We must have a letter from your doctor on file for each Plan Year stating specifically what illness or disease is being treated or prevented and the length of time you will be required to use this treatment in order to reimburse for any of these types of expenses. NOTE: For Weight Loss Programs, only the cost of the program is an eligible expense. Any
cost for food or food supplements is not an eligible expense.

COSMETIC expenses, prescriptions and treatments are not eligible. This applies to any procedure
that is directed at improving the patient's appearance and does not meaningfully promote the proper
function of the body or prevent or treat an illness or disease. If cosmetic treatment is necessary to
correct a deformity or abnormality, a personal injury or a disfiguring disease, it must meet IRS
eligibility guidelines outlined in IRS publication 502 and will require a physician’s letter of medical
necessity.

OTHER EXPENSES THAT ARE NOT ELIGIBLE FOR REIMBURSEMENT THROUGH THE
HEALTH CARE ACCOUNT

/ ESTIMATES for medical expenses that have not been rendered cannot be reimbursed. Medical
services do not have to be paid for, however, the services must have been rendered during the Plan Year, to be eligible for reimbursement. / PREMIUM EXPENSES for any insurance policies are not eligible for reimbursement through
the Health Care Account. This includes contact lens insurance. / EXPENSES PAID BY AN INSURANCE COMPANY are not eligible for reimbursement through
the Health Care Account. Only the portion you have to pay out of your pocket for your medical expenses is eligible for reimbursement. Health Care Reimbursement Account (continued)

CLAIMS SUBMISSION
OBTAINING A REIMBURSEMENT FROM YOUR HEALTH CARE ACCOUNT

To obtain a reimbursement from your Health Care Account, you must complete a Claim Form. This
form is available from your employer (See sample Claim Form in back of handbook). You must
attach a receipt or bill from the service provider which includes all the pertinent information
regarding the expense:
• Amount covered by insurance (if applicable)
Cash register receipts, credit card receipts and canceled checks alone are not eligible forms of
documentation for medical expenses. These items are not considered third party receipts because
they only reflect that payment has been made and do not provide the required information listed
above. Prescription documentation must include the name of the prescribed medication.
OBTAINING A REIMBURSEMENT FOR OVER-THE-COUNTER ITEMS
For the purchase of over-the-counter medications, with a prescription or letter of medical
necessity,
cash register receipts will be accepted as documentation if the receipt is detailed and
indicates the name of the service
provider, the date of the purchase, the amount of the
purchase and the name of the product
purchased. You must also send in a copy of the
prescription or letter of medical necessity signed by a physician along with your claim form.
If
the receipt does not specifically reflect the name of the product we cannot accept the claim for
reimbursement of that item. The name of the patient does not have to be on the receipt, however,
the name of the patient must be listed on the claim form.
NOTE: In order to be eligible for reimbursement through the Health Care Account, the medical
expense must be incurred during the Plan Year. IRS defines "incurred" as when the medical care is
provided (or date of service), not when you are formally billed, charged for, or pay for the care. FOR
EXAMPLE:
If you go to the doctor on June 26th and your Plan Year begins on July 1st, this expense is
not eligible in the new Plan Year. Even if you pay for this expense after July 1st, the "date of service"
was before the Plan Year began and therefore is not eligible.

THE HEALTH CARE ACCOUNT IS A PRE-FUNDED ACCOUNT
This means that you can submit a claim for medical expenses in excess of your account balance.
You will be reimbursed your total eligible expense up to your annual election. The funds that you are
pre-funded will be recovered as deductions continue to be deposited into your account throughout the
Plan Year.
FLEX NOTE:
The maximum you can place in your Health Care Account is $5,000.
DEPENDENT CARE REIMBURSEMENT ACCOUNT
The Dependent Care Reimbursement Account allows you to pay for day care expenses for your
dependents with tax-free dollars.
ELIGIBLE DEPENDENT
• A child under 13 who qualifies as a dependent on your Federal Income Taxes • Any other dependents, including a disabled spouse, disabled children over age 13 and
elderly parents, who depend on you for financial support, qualify as dependents for tax
purposes, and are incapable of self care
• Please refer to Page 11 for the latest definition of a dependent, as revised under Section 152 of the Code by the Working Families Tax Relief Act of 2005 (WFTRA)
ELIGIBLE DEPENDENT CARE EXPENSES
For dependent care expenses to be eligible for reimbursement, you must be working during the time
your eligible dependents are receiving care. If you are married, your spouse must be:
• Working at the time the day care services are provided; • A full-time student for at least five months during the year; or • Mentally or physically disabled and unable to provide care for him or herself
EXPENSES FOR KINDERGARTEN are not eligible for reimbursement since they are generally for
education, and not for custodial care. In order for an expense to be eligible for reimbursement from the Dependent Care Reimbursement Account, the primary purpose for the care of the qualifying individual must be to assure the individual’s well-being and protection. Dependent care must still be primarily for custodial care, not education, in order to qualify as an eligible employment-related expense from the Dependent Care Reimbursement Account.
EXAMPLES OF DEPENDENT CARE EXPENSES

• Babysitters or Nannies that claim the child care as income on their taxes • Day care for an elderly or disabled dependent
EXPENSES THAT WOULD NOT BE ELIGIBLE THROUGH THE DEPENDENT CARE ACCOUNT
/ Kindergarten (kindergarten & above is considered an educational expense) / Days you or your spouse are not working, including sick leave, vacation days, and maternity / Transportation, books, clothing, or entertainment (Note: These expenses will be covered if
provided by the nursery school or day care center as part of its preschool care services. If
these types of expenses are billed separately, they are not an eligible expense.)
/ Care provider may not be a child of yours under the age of 19 or anyone you claim as a dependent for federal income tax purposes / Babysitting for social events
/ OVERNIGHT CAMP: Overnight camp is not an eligible expense, only DAY CAMPS are
eligible. Remember that this account is set-up so that you and your spouse are able to go to
work and Overnight camp is 24-hour care.
Dependent Care Reimbursement Account (continued)

ANNUAL MAXIMUM FOR THE DEPENDENT CARE REIMBURSEMENT ACCOUNT
Must Not Exceed The Lesser Of:
• $5,000 for one or more children ($2,500 if you are a married individual filing a separate tax • Your wages or salary for the Plan Year; or If your spouse is either a full time student or is incapable of taking care of himself or herself then he or she is deemed to have monthly earnings of $250 if there is one (1) child or dependent, and $500 if there are two (2) or more children or dependents. USING THE DEPENDENT CARE REIMBURSEMENT ACCOUNT
FILING FOR A TAX CREDIT ON YOUR TAXES

Under current IRS regulations, you may be eligible to receive a tax credit for dependent care costs.
You may claim a credit for dependent care, up to $3,000 for one child and $6,000 for two or more
children, on your income taxes through the child care tax credit. However, through the Dependent
Care Reimbursement Account you may set aside up to $5,000 per year, for one or more children, if
you are married and filing a joint tax return or if you are a single parent. If you are married and filing
separate tax returns, you may set aside only $2,500.
Typically, more money is saved by paying for dependent care through the FSA Dependent Care
Reimbursement Account than by taking the dependent care credit on your tax return. This is because
the total for federal, state, and FICA savings usually exceeds the dependent care credit. At taxable
incomes greater than $14,000, participants will probably benefit more from taking reimbursement
from the Flexible Benefit Plan. These assumptions are based on the inclusion of your state income
tax.
You can also file for the tax credit while participating in the Dependent Reimbursement Care
Account.
If the amount you have placed through the reimbursement account does not meet the
maximum allowed by the IRS, you can claim the difference between your Dependent Care deductions
and the IRS maximum allowable expenses for the tax credit. You can claim a tax credit for any
additional dependent care expenses incurred over the $5,000 maximum FSA limit up to the $6,000
child care tax credit limit on your taxes. You cannot claim the tax credit for any dependent care
expenses paid from the Dependent Care Reimbursement Account. It is your responsibility to report
the Dependent Care amount on your tax form 2441. The amount is listed on your W-2 under
Dependent Care Benefit for the tax year. If you are not sure about the eligibility of an expense, phone
Flexible Benefits Administrators at (757) 340-4567 or (800) 437-FLEX or refer to IRS Publication 503:
“Dependent Care Expenses”. This publication can be ordered by calling the IRS at (800) 829-3676.



FLEX NOTE:


FLEX can help you cope with the high cost of quality day care.

Dependent Care Reimbursement Account (continued)

OBTAINING A REIMBURSEMENT FROM YOUR DEPENDENT CARE REIMBURSEMENT
ACCOUNT

To obtain a reimbursement from your Dependent Care Reimbursement Account you must complete a
Claim Form. This claim form is available from your employer (See sample Claim Form in back of
handbook). You must attach a receipt from the service provider which includes all of the following:
• Date(s) care was provided (must match Claim Form) • Social Security or Tax I.D. number of the provider
NOTE: Dependent care expenses can only be reimbursed after the care is provided. This means
that advance payments of dependent care expenses cannot be made.
FOR EXAMPLE: If you
pay for a summer day camp for your child in May but the camp is the first week in July, we cannot
reimburse you for this expense until July when the service is provided.

THE DEPENDENT CARE REIMBURSEMENT ACCOUNT IS NOT A PRE-FUNDED ACCOUNT
This means that you will only be reimbursed up to your account balance at the time you submit your
claim. If your claim is for more than your account balance, the unreimbursed portion of your claim will
be tracked by Flexible Benefit Administrators. You will be automatically reimbursed as additional
deductions are taken and deposited into your account, until your entire claim is paid out.

RULES AND REGULATIONS

CLAIM FILING DATES

All claims received in the office of Flexible Benefit Administrators, Inc. will be processed within one week
via check or direct deposit.
COMMON ERRORS TO AVOID WHEN FILING CLAIMS
• Canceled checks, cash register receipts or credit card receipts are sent in place of receipts or • Cash register receipts for OTC item(s) do not indicate the specific name of the product(s) • “Previous balance” statements or “payment on account” receipts submitted in place of actual date of service itemized bills or receipts
Your claim form may be returned to you or delayed in processing for improper or insufficient
documentation. If you have questions about your claims, you may contact Flexible Benefit Administrators,
Inc. at (757) 340-4567 or (800) 437-FLEX, from 8:30a.m. to 5:00p.m., Monday through Friday.

REIMBURSING THE PROVIDER OF SERVICE

All reimbursements will be sent to you directly. After receiving payment from your account, you are
responsible for paying your providers.
ELIGIBLE DEPENDENTS
An individual is considered to be a dependent if he or she is a qualifying child or qualifying relative of the
taxpayer. The following qualifying criteria now apply. To be a “dependent child”: the individual is a child
to the participant, and the individual doesn’t turn 27, regardless of any other status by the end of the
taxable year.
In addition, the following qualifying criteria apply to be a “dependent relative”: the individual has a
specific family type relationship to the taxpayer, the individual is not a qualifying child of any other
taxpayer, the individual receives more than half of his or her support from the taxpayer, and the
individual’s annual gross income is less than the Section 151 limit ($3,200 for 2005; this criteria does not
apply to health plans).
Rules and Regulations (continued)

GRACE PERIOD FOR INCURING EXPENSES
To help participants avoid forfeiting funds, the IRS offers a 2 month 15 day grace period. This means
you have an additional 2 months & 15 days after the end of your Plan Year to incur expenses in your
Dependent Care Reimbursement Account and HealthCare Reimbursement Account. For the Plan
Year 07/01/11-06/30/12, you may be reimbursed for expenses that were incurred 07/01/11-09/15/12.
**When estimating your expenses and calculating your annual election, do not include
expenses that will be incurred during the grace period; this is offered for participants that
overestimated expenses incurred during the Plan Year to help eliminate forfeiture of funds.**

RUNOFF PERIOD FOR FILING CLAIMS
You have the entire Plan Year plus 90 days to file all claims that were incurred during the Plan Year
and the 2 month & 15 day extension. All claims must be received in the office of Flexible Benefit
Administrators, Inc. by 5:00 p.m. on the 90th day, following the end of your Plan Year. Therefore, for
the Plan Year 07/01/11-06/30/12, all claims must be in our office by 5:00 p.m. on September 28,
2012. If claims are not received during this time frame for expenses incurred during the Plan Year,
your remaining funds will be forfeited. (Remember “90 days” does not mean 3 months and “received
in the office” does not mean the day it was postmarked). Please, do not delay, complete your
claims early.


FORFEITING FUNDS

Any money you do not use from a reimbursement account for expenses incurred during a Plan Year
and the 2 month 15 day extension will be forfeited. The forfeited funds will be returned to your
employer to offset the cost of the program. If you plan carefully, you can avoid being affected by this
IRS restriction.

Rules and Regulations (continued)

CHANGES IN YOUR ELECTION

No, generally you cannot change the elections you have made after the beginning of the PLAN YEAR.
However, there are certain limited situations when you can change your elections. You are permitted to
change elections if you have a “change in status” and you make an election change that is consistent with
the “change in status.” Currently, Federal law considers the following events to be “changes in status”:
• Marriage, divorce, death of a spouse, legal separation or annulment; • Change in the number of dependents, including birth, adoption, placement for adoption, or death of • Any of the following events for you, your spouse or dependent: Termination or commencement of employment, a strike or lockout, commencement or return from an unpaid leave of absence, a change in worksite, or any other change in employment status that affects eligibility for benefits; • One of your dependents satisfies or ceases to satisfy the requirements for coverage due to change in age, student status, or any similar circumstance; and • A change in place of residence of you, your spouse, or your dependent. This applies ONLY to Dependent Care and ONLY if that change in residence results in a change of dependent care service provider and its cost. In addition, if you are participating in the Dependent Care Reimbursement Account, then there is a “change in status” if your dependent no longer meets the qualifications to be eligible for dependent care. You may not change your election under the Dependent Care Reimbursement Account if the cost change is imposed by a dependent care provider who is your relative. To make a change in your elections, a STATUS CHANGE FORM must be completed within 30 days of the event. Flexible Benefit Administrators, Inc. or your benefits contact person will determine if your requests for an election change meets IRS Regulations.
TRANSFERRING FUNDS BETWEEN ACCOUNTS

IRS regulations do not allow money to be transferred between reimbursement accounts. If you elect
funds to be placed in your Health Care Account, you must submit eligible medical expenses to be
reimbursed from these funds. This IRS regulation also applies to the Dependent Care Account.


Rules and Regulations (continued)

TERMINATION OF EMPLOYMENT
If you have funds in your Health Care Account and you submit receipts for expenses incurred prior to
your termination, you can be reimbursed for funds remaining in your account up to your annual
election. However, if you have money left in your Health Care Account and do not have receipts for
expenses incurred prior to your termination, you cannot be reimbursed for the money remaining in
your account unless you elect to participate in the federal program, COBRA. If you elect to
participate in COBRA, you will need to continue to set aside dollars on an after tax basis to be
deposited into your Health Care account. You can receive information concerning this program from
the contact person in your company.
Your Dependent Care Account functions differently. If you have funds remaining in these accounts,
this money will be reimbursed to you if appropriate receipts are submitted. You can receive
reimbursement for expenses incurred during the Plan Year if receipts are submitted within the Plan
Year and before the end of the 90 day grace period following the Plan Year end.

EFFECT ON SOCIAL SECURITY BENEFITS

As you are not paying social security tax on the portion of your income that has been placed in the
Plan, your social security benefits may be slightly reduced. We suggest putting part of your tax
savings into your Employer’s Retirement Program or some other savings vehicle.

ACCOUNT BALANCES

You may call Flexible Benefit Administrators, Inc. at (757) 340-4567 or (800) 437-FLEX from 8:30am
to 5:00pm, Monday through Friday, to check your account balances. You may also access your
personal account information at your convenience via our secure website: Each reimbursement check stub will show your contributions, request for reimbursements, and
disbursements for each account. It will also show your annual election and the balance to request by
the end of the Plan Year for each account. A reminder letter will be sent two months prior to the end
of the Plan Year if you have funds left in your accounts.
FLEX NOTE:

You must enroll in the reimbursement accounts each year before the
Plan effective date to participate during the Plan Year.
ESTIMATING YOUR EXPENSES
This worksheet will help you determine your annual expenses for each reimbursement account. Good planning and careful estimating is the best way to take full advantage of your Flexible Benefit Plan. ESTIMATING YOUR QUALIFYING HEALTH CARE EXPENSES
EXPENSES FOR THE PLAN YEAR (Max. $5,000) _______________ ESTIMATING YOUR DEPENDENT CARE EXPENSES
EXPENSES FOR THE PLAN YEAR (Max. $5,000) _______________ ROANOKE COUNTY PUBLIC SCHOOLS
FLEXIBLE BENEFIT PLAN – CLAIM FORM

Employee’s name _____________________________________ SSN# ________________
HEALTH CARE EXPENSES______I, the participant, hereby file claim for the medical
expense(s) noted below and certify that each expense was incurred on the date and for the
person and reason noted. The expense(s) listed below was incurred for medical care not
general health purposes and exclude cosmetic and/or toiletries expense(s). I, the participant,
certify that I have not been reimbursed for the expense(s) noted below and that I will not seek
reimbursement under any other plan covering health benefits. Attached are receipts or bills
as evidence of my expenses incurred during the Plan Year
.
** Please note: A doctor’s note must be attached if considered a “dual purpose” drug
Date of
___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ DEPENDENT CARE EXPENSES___I, the participant, hereby file claim for the child or
dependent care expense(s) noted below and I certify that each expense was incurred on the
dates and for the persons noted. I, the participant, certify that I have not been reimbursed for
the expense(s) noted below and that I will not seek reimbursement under any other plan.
Attached are receipts or bills as evidence of my expenses incurred during the Plan Year.
Please note that receipts must come from the day care provider and have the dates of service,
a description of the expense, the amount charged and the provider’s SS# or Tax ID#.
Care Provided
___________________ ___________________ ___________________ $__________________ NAME ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ADDRESS ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ ___________________ ___________________ $__________________ ___________________ ___________________ ___________________ $__________________ TAX ID # OR SS# ___________________ ___________________ $__________________ I authorize the service provider to release any information requested by the Plan Administrator in connection with this request for reimbursement. ________________________________________________________ Mail This Claim Form To:
Fax Claim Form To:
P.O. Box 8188, Virginia Beach, VA, 23450 Scan and Email This Claim Form To:
View your account on our website or call FBA at (757) 340-4567.
PLEASE:
· DO NOT mail your claim form if you fax it.
· KEEP a copy of all claim forms and receipts for your records
· NOTIFY Flexible Benefits Administrators, Inc. if you have a change in address

Copyright 2003 - Flexible Benefit Administrators, Inc.
FLEXIBLE BENEFIT ADMINISTRATORS, INC.
509 VIKING DRIVE, SUITE F
P.O. BOX 8188
VIRGINIA BEACH, VA 23450
(757) 340-4567 or (800) 437-FLEX
FAX: (757) 431-1155
[email protected]

Source: http://rcps.us/perinst/documents/FlexBenefitsEmployeeGuide.pdf

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