Flexible Benefits Guide
2009-10
Welcome to MGM Benefits Group, Section 125 Plans!
With over 30 years experience in the employee benefits administration, MGM Benefits Group
has partnered with your employer to bring you a state of the arts flexible benefits plan.
We’e enhanc
eb
ed
site
o
to
u
b
r
ring you the best advancements in flex administration. Now
you can go to your own participant website to:
?
Create your own account password. You can also re-set your own password in case
you forget!
?
File claims online
?
Create your direct deposit accounts
?
Receive emails regarding information required to process your claims
?
Download our Heath FSA, Dependent Care FSA claim forms, status change and deposit
forms.
We encourage you to review the information in this guide so you can make informed
decisions about using the funds in your account for you and your family.
Contact Us:
Benefit counselors are available to assist you from 8 a.m. to 5:30 p.m. Central Standard Time,
Monday through Thursday and 8 a.m. to 2:00 p.m. on Fridays.
Mail Claims:
MGM Benefits Group
2121 N. Glenville Drive
Richardson, TX 75082
Contact Phone: (800) 833-4028
Fax Claims:
(800) 973-3702
Website:
www.mgmflex.com
Questions:
flexSupport@mgmbenefits.com
Flexible Benefits Guide
A Section 125 Plan is a part of the Internal Revenue Code that
allows employees to convert a taxable cash benefit (salary)
into non-taxable benefits. You may choose to pay for benefit
premiums and other qualified expenses before any taxes are
deducted from your paycheck.
How the Plan Works
Under Section 125, your employers Plan may offer the option
to include the premium cost for your employee benefit plans.
You may pay the premiums pre-tax for your medical, dental,
cancer and vision insurances. Your plan may also offer flexible
spending accounts for your health care and dependent care
needs.
Back to top
Flexible Spending Accounts
A Flexible Spending Account (FSA) is a special account for
healthcare and dependent care expenses. When you enroll in
an FSA, you decide how much to contribute to each account
for the entire Plan Year. This annual contribution is then
deducted in equal amounts from your paycheck, before
Federal & State income taxes and FICA taxes are deducted.
These
-
tax“preed” fuds ar
atical
e
ly d
au
epos
to
ited in your
account through payroll deduction. Unless you have a
qualifying event under Section 125 regulations, your election
amount will not change during the Plan year.
Flexible Benefits Guide
MGM Benefits Group
Back to top
Section 125 Plan
Using Your Flexible Spending Account
Your employer may offer one or both Flexible Spending
Accounts: Health FSA and/or Dependent Care FSA. Although you
can choose to participate in both accounts, funds may not be
co-mingled. Expenses for these accounts must be incurred
durig our eploer’s pla ear.
Expenses for the funds in your flex account must be
incurred
by
the end of the plan year or they will be subject to the
“use it or
lose
rul
i
es
t
reg
”
ulated by the Internal Revenue Service. Based
o our Eloer’s fleile eefits pla, ou have a spefied
date following the end of the plan year to submit your receipts
for reimbursement. All funds still remaining in your account will
be forfeited after this claim period ends.
Please check with the Plan Administrator at your employment
to verify the last date that you may file claims for your
reimbursement expenses.
F
S A’s
MGM Benefits Group
Section 125 Plan
Eligible Health Expenses
The Health Care FSA is a tax-free account that allows you to pay for essential health care expenses that are
not covered, or are partially covered, by your medical, dental and vision insurance plans.
These expenses may be incurred by you or your eligible dependents. Expenses include deductibles, co-
insurance payments, office co-pays, orthodontics, glasses and contacts. The item must not be used for
general health or cosmetic purposes.
OceerollediFS’sth
i
e
lab
ey
le to
i
yo
s
u
a
on
v
th
a
e first day of
the plan. You must spend the funds by the end of the plan year or they will be forfeited from your account.
Orthodontic Expenses
IRS stipulates how orthodontic expenses can be
reimbursed in a health care FSA. You should carefully
plan when deciding on your annual election if it
includes orthodontic expenses.
Special planning should be considered if you are
planning to take advantage of an up-front discount
payment. Please remember, services must be
performed and incurred within the current plan year.
Reimbursement of a lump sum payment to a dentist
may not be eligible if any of the services will be
performed in a subsequent plan year.
Health Care
flexible spending account
Eligible Health Care Expenses
Dental Services
Oxygen equipment
Crowns & Bridges
Prosthesis
Dentures
Wheelchair
Exams/Teeth cleaning
Medical Services & Providers
Extractions
Acupuncture
Fillings
Anesthetist
Implants
Chiropractic care
Oral surgery
Hospital services
Orthodontia/Braces
Immunizations & Vaccinations
Insurance
Injections and vaccinations
Co-pays
Nursing Services
Deductibles
Physical therapy
Medications
Operating room fees
Contraceptives
Optometrist/Ophthalmologist fees
Drugs
(prescriptions)
Organ transplant
Insulin treatment
Specialty physicians & surgeons
Over-the-Counter items
Sterilization
Smoking cessation products
Surgery
Laboratory Fees & Tests
Transportation to medical care
Blood tests & transfusions
Transplants
Diagnostic tests/health screenings
Obstetric Services
Lab fees
OB/GYN Exams & treatment
X-rays
OB/GYN Prepaid Maternity fees
Medical Equipment & Supplies
Vision Services
Ambulance service
Contact lenses
(corrective)
& supplies
Crutches
Eye exams
Guide dog
Eyeglasses & Sunglasses
(corrective)
Hearing aids and batteries
Laser eye surgery
Health Care
flexible spending account
Non-eligible items
Cosmetic surgery/Procedures
Dietary supplements
(vitamins)
Electrolysis
Exercise or health club memberships
Insurance premiums
Personal care items
Physical therapy for general well being
Smoking cessation programs
Teeth whitening/Bleaching
Weight reduction
(fees, programs & food)
So ite y euie the sussio of
ce
a
rti
Do
ficati
’s
on
stating the nature of medical condition and required treatment
Partial List of Medically Necessary Items
Over-the-Counter Items
The IRS allows that some over the counter (OTC) drugs and medications which are used to treat sickness
may be reimbursed by Health Care Flexible Spending Accounts.
Eligible expenses include medicines or products that alleviate or treat personal injuries or illness for you
and your dependents.
Fo st OTC’s, you ae ot euied
at
t
em
o
en
p
t f
o
rom
vi
a
d
me
e
dic
a
al
st
provider or indicate a diagnosis in order to receive reimbursement.
Receipts for reimbursement must state the place of purchase, date, amount, item name, and can be
claimed within reasonable quantities. We recommend that you retain copies of all OTC receipts for your
records.
There are some medical items that may not be allowed unless you are diagnosed by a medical
professional for a specific medical condition. Treatment for eligible expenses cannot be for preventative
purposes.
Items purchased for personal care are not eligible for reimbursement. For example, toothpaste,
vitamins, supplements and herbal remedies, and other items used for personal hygiene cannot be
claimed for reimbursement.
Health
flexible spending account
Over The Counter Items
Partial List of
OTC’s
Allergy
Other Items for Medical Care
Antihistamines
Anti-diarrheas
Nasal sprays
Anti-fungals
Antacids
Antibiotics
Heartburn medicines
Asthma medications
Cold Remedies
Bandages, gauze, rubbing alcohol
Cough drops
Carpal tunnel wrist
Decongestants
sCuppold/ohorts
t packs for
Nasal strips
iCnjuontaries
ct lens drops & cleaning
Nasal sprays
sEoye
lutiproons
ducts (reading
Sinus Medications
gFilrasst sesaid )
kits
Throat lozenges
Hemorrhoid treatments
Pain Relief
Laxatives
Bug bite medication
Motion sickness treatments
Fever reducers
Smoking cessation products
First aid creams
(diaper, fever
blister, etc.)
Thermometers
Products for pain & cramp relief
Wart removers
Products for muscle or joint pain
Special ointments or sunburn
creams
Topical creams
Health Care
flexible spending account
Non-eligible items
Cosmetics
Toiletries
Personal hygiene/care items
Items used to promote general health
& well being
Weight loss drugs
Eligible DCAP Expenses
The Dependent Care Assistance account
allows you to pay for
“eployet related
expenses
”
that enable you and your spouse
to be gainfully employed, seek employment,
and/or be a fulltime student. In general,
expenses must b
e for the “e” of a
qualifying individual. Reimbursement may
also include eligible expenses for children or
elder dependents that rely on you for their
care.
Some examples of eligible expenses include:
?
care in and outside the home
?
child-care/dependent care centers
?
before and after school care
?
nursery school and preschool expenses
?
preschool tuition
?
day care camps and facilities
(only
for “car
no
e”
t p
a
rim
d
arily for educational purposes)
Expenses for services provided outside the
employee’s
a
h
d
o
ep
me
enden
y
t care centers
must comply with state and local laws. Your care
provider must report day care income on their
taxes to be considered as eligible.
Dependent Care FSA must be for children under
13 years of age, unless they meet the
qualifications of physically or mentally incapable
of self-care.
Dependent Care
flexible spending account
Ineligible Expenses
The following items are examples of expenses that are generally considered as ineligible
for reimbursement under a Dependent Care FSA:
?
Educational expenses, except where an eligible child is in preschool or
nursery school
?
Field trips, clothing
?
Late payment or finance charges
?
Payments for lessons
?
Tuition expenses
?
Overnight camps
?
Kindergarten expenses
DCAP Reimbursements
The total amount you choose to contribute should be based on your expected child
and/or dependent care expenses during the plan year. A single parent, or employee that
is married but filing separately is limited to $2,500 for the Plan year. If your spouse has a
dependent care account through their employment, the two accounts cannot exceed
$5,000 during a given plan year.
IRS guidelines require that the amount reimbursed to a participant must first be on
deposit in their account. When your employer submits payroll funds to MGM Benefits
Group, they are credited to your dependent care account. When a claim is filed for
reimbursement, we first verify that there are adequate funds in the account to pay the
entire claim. When sufficient funds are not available, participants are issued the
maximum amount available in their account. The remainder of the reimbursement
request is paid when additional funds are received through payroll deposits.
Dependent Care
flexible spending account
Website Access
Our new MGM Flex system offers participants the ability to manage their own account information.
On our new site, you can:
?
Create your own password
?
Access your account information by provider name, date and amount
?
File your claims online
?
Create your own direct deposit accounts
Once your enrollment in the Section 125 has been processed, you will receive an enrollment
confirmation, along with an attached
docu etitled “Next Steps”. Dowload this docu fro
your email for instructions on setting up your participant portal and to access account options.
Follow these steps to create your Participant Portal
:
1. Open your web browser (e.g. MS Explorer) and go to the following website:
http://mgmflex.com
2. Click on the participants Login. Both the username and password were sent to you via email
with your enrollment confirmation.
3. The login for your username is:
?
The first initial of your first name
?
Your last name
?
The last 4 digits of your social security number
Example username: jdoe9999
(Be sure and not use spaces or commas)
4. The password is your last name and the last four digits of your social security number
Example password: doe9999
You will be prompted to create your own password (6 to 20 upper and lower characters with at least
one number). If you forget or lose your password, you will need to reset it through the system. Pleas
e
be sure to record your password as MGM does not have access. If your password is lost or forgotten,
you will need to re-set it on your participant portal.
Participant Portal
website account
Sign in to your participant portal with your user name and password that you created for
your account.
My Account:
You can view up-to-date account information at any time.
?
Choose
Account Balance
to check the balances of any account. You can also check the claims history of any
account by clicking the
Claims History
link.
?
Select
Profile
to reie your persoal ad depee iforatio that’s o file i the syste.
?
Select
Payment History
to see a detail of the claims that have been paid. You can click
View Detail
for more
information about any claim.
File Claims
: You now have the option to file your claims online.
Plans:
Your Pre-tax plan information is available at any time. To view this information, log on and click on
the
Plans
tab.
Forms:
You can download Pre-tax forms at any time. Log on and click on the
Forms
tab, and select the
form you would like to download.
Participant Portal
Account View
You Have Options!
You may file your claims by one of the following methods:
1. If your employer offers the MGM Flex Visa Card
: you may use your Card at the point of
purchase towards qualified expenses.
Be sure to keep your receipts!
You may be required to
submit them as proof of plan eligibility!
2. Online Claim Filing
: File your claims online via our participant portal website. Instructions were
attached to your enrollment confirmation
o the “et Steps” d
B
o
e s
u
ure to submit
receipts when filing claims online by fax or mail.
If you do not submit your claims and receipts
after filing online, you will be sent a reminder to submit the information. Claims will be denied
after a period of 14 consecutive days.
3. Paper Claim Filing
: You may also file claims using the paper form(s) available on the website
ude the “Fo” ta, ad attaR euied eipts aodig to IRS ules.
Reminders:
Health Care Flexible Spending Claims:
?
Your account balance is available for use on the first day of the plan year
?
Funds remaining in your account that have not been spent, will be subject to the
“use it or lose it rules”
?
Based o ou Eploe s Pla les, ou ill hae a speified tie peiod follog the last da of ou
plan year to request reimbursement for expenses incurred, but not claimed, during the plan year
?
Some health care items may be eligible
only
if you are diagnosed by a medical professional for a
specified medical condition. For these expenses, you will be asked to provide a copy of diagnosis and
treatment from your physician.
No matter which option that you may choose for claim reimbursement, always be sure to keep your
receipts.
Dependent Care Flexible Spending Claims:
?
The MGM Flex Card does not accept charges for dependent care related expenses
?
Claims may be filed by
Pape o “aual”
s
l
or
ai
online through the Participant Portal website
?
Funds must be available in dependent care accounts prior to reimbursement. IRS regulations do not
allow pre-funding of DCAP accounts.
How to File Claims
The MGM Flex Card
The MGM Flex Card makes using your Health FSA quick and easy. Just
swipe it as payment for your eligible expenses and the funds are
automatically deducted from your account
If your Employer offers the MGM Flex Card
, it is an
automatic way to pay for qualified health care expenses.
It is not a credit card, but can be used to pay for your
eligible health flexible spending account (FSA) purchases.
The card is similar to a Visa Card, and the value of the
partii
an
p
n
a
ual
t’
c
s
ontribution is loaded on it. The
amount of the qualified purchases will be automatically
deducted from the account.
The Card may be used for eligible flexible spending account (FSA) expenses as determined by Section 213(d) of
the Internal Revenue code. You may use the Card for co-pays at hospitals, physician offices, dental offices, vision
service locations and pharmacies, wherever they accept MasterCard
®
or Visa
®
debit cards for purchases.
Only
eligible expenses that have been incurred during the current plan year and/or grace period can be claimed as
eligible expenses.
O
er the outer produts (OTC’s) are eli
, b
g
ut
i
th
l
e
e
item
t
s
op
must
u
be
r
u
h
sed
ase
for trea
t
ti
h
ng
the Card
symptoms of injury and illness. Examples include: cold and allergy remedies, first aid supplies, pain remedies,
etc. Personal care items are not eligible for Card use.
Here’s ho it ks:
?
Take your purchases to the register
?
Preset our MM e Card for pae ad selet the optio for “redit”
?
The system will identify eligible
ard purhase (presriptios ad OTC’s)
?
Pay for your non-eligible items separately with another form of payment
?
If the purchase is approved, the amount will be deducted from your card account balance.
You can also fill in your Card number on health related bills received from providers to pay on your account
balance.
The card cannot be used to pay expenses that were incurred prior to your current Section 125 Plan
year.
Be sure and save all receipts for purchases made with the MGM Flex Card
Introducing . . .
the MGM Visa Card
Claims
Logon to www.mgmflex.com
1. Click the
File Claims
tab.
2. Click the
File Claim
button next to the plan you wish to file a claim for.
Online Claim Filing
Participant Login
Home Page
3.
Enter your claim information and submit the claim. Make sure you have valid receipt(s)
for your expenses, as you will need to send these in.
4.
If you have re tha oe clai you’d lik
Ad
e
d a
t
New
o f
Cl
i
aim
le, you choose to
from your claim basket.
5.
Once all claims are entered, you must agree to the
Terms & Conditions
and submit
the claim.
Online Claim Filing
continued
6.
Print the
Confirmation Page
. This is your verification that all claims have been successfully submitted!
7.
Attach the Confirmation Page with a copy of your receipt; fax or mail to MGM for processing.
Fax Number:
(800) 973- 3702
Mailing Address:
MGM Flex
2121 N. Glenville Drive
Richardson, TX 75082
Online Claim Filing
continued
Claim forms for Health flexible spending accounts and Dependent Care flexible
spending accounts may be downloaded from the participant portal. Click the Forms
tab and choose the applicable form for your expense.
?
Complete the correct reimbursement claim form
?
Submit an Explanation of Benefits (EOB) or your eligible receipts
?
Make copies of your receipts and EOB
?
Do not send your original receipts, but retain originals for your records
?
An eligible receipt will have the following:
o
Provider name
o
Date of service
o
Description of service
o
Payment amount
o
Sales repts ith totals “oly” are ot
acceptable based on IRS guidelines
?
Submit your claim form and receipts by fax or mail to the address on the form
?
Paper claims are processed and checks issued within 72 hours (on business days) after receipt of
claims
Dependent Care Claims:
Depedet Care lai ill oly e reiursed ased o the fuds aailale i the partiipat’s
account. Claims will not be pre-funded. For claims submitted that exceed the account balance,
funds will be reimbursed as they are deposited to the account.
Manual Claim Filing
