Advantages of a Flexible Spending Account (FSA)

A valuable pre-tax benefit with innovative services!

FlexSystem FSA increases your take-home pay by reducing your taxable income. A Flexible Spending Account (FSA) allows you to save up to 30% on your eligible healthcare and/or dependent care expenses every year by using pre-tax dollars.

Consider how much you spend on healthcare and/or dependent care expenses for you and your qualified dependents in one year:

•prescription drugs/medications.

•medical/dental office visit co-pays.

•eye exams and prescription glasses/lenses.

•vaccinations.

•daycare tuition.

Why not reduce these expenses by using pre-tax dollars instead of after-tax dollars? With rising healthcare costs, every penny counts! By using pre-tax dollars, you are taxed on a lower gross salary, thereby saving money that would otherwise be spent on federal, state and FICA taxes, and thereby you increase your take home pay!

Employee salary reductions to a medical Flexible Spending Account (FSA) are limited to $2,700 per Plan Year, indexed for inflation. Check with your employer for your Plan’s maximum annual election amount.

How FlexSystem Works

FlexSystem FSA is offered through your employer and is adminstered by TASC. When you choose to enroll in a FlexSystem FSA Healthcare and/or Dependent Care, you choose the dollar amount you want to contribute to each account based on your estimated expenses for the upcoming Plan Year. Your contributions will be deducted in equal amounts from each paycheck, pre-tax, throughout the Plan Year. The more you contribute to these accounts, the more you save by paying less in taxes!

Your total Healthcare FSA annual contribution amount is available immediately at the start of the Plan Year; Dependent Care FSA funds are available up to the current account balance only.

Reimbursements and the TASC Card

As you incur eligible expenses, simply swipe your TASC Card. The card automatically pays for and substantiates most eligible expenses at the point of purchase. If you do not use the TASC Card to pay for an eligible expense, simply submit a request for reimbursement via the MyTASC Mobile App, online Request for Reimbursement Wizard in MyTASC, text message, fax, or mail. Your reimbursement is deposited in your MyCash account. You can access your MyCash funds in three ways: (1) swipe your TASC Card at any merchant that accepts major credit cards, (2) withdraw at an ATM using your TASC Card (with PIN), or (3)transfer to a personal bank account from MyCash Manager within MyTASC.

FSA Eligible Expenses

FlexSystem FSA funds may only be used for eligible expenses under your healthcare FSA and/or dependent care FSA. Some eligible expenses include:

• Medical care services

• Dental care services

• Vision care expenses

• Prescriptions

• Certain over-the-counter medications

• Daycare tuition

More detailed lists can be found at www.irs.gov in IRS Publications 502 & 503. Please note insurance premiums are NOT eligible for reimbursement.

Multiple Methods for Account Management

You may use any of the following self-service options to access your FlexSystem accounts and TASC Card transactions:

• MyTASC Online: www.tasconline.com

• MyCash Manager: within MyTASC at www.tasconline.com

• MyTASC Mobile App: free download at www.tasconline.com/mobile

• MyTASC Text Messaging: elect through your MyTASC account online

Important Considerations

FSA Funds do not Rollover:

It is important to be conservative in making elections because any unused funds left in your FSA at the close of the Plan Year are not refundable to you. (The only exception to this rule is for the Healthcare FSA where funds may carryover to the next Plan Year’s healthcare FSA (up to $500) when elected by your employer.) You are urged to take precautionary steps, such as tracking account balances on the FlexSystem website and/or using the Interactive Voice Response System, to avoid having funds remaining in your account at year-end.

Changing Elections

During the Plan Year:

You may change your FSA elections during the Plan year only if you experience a change of status such as:

• a marriage or divorce

• birth or adoption of a child, or

• a change in employment status

Refer to the Change of Election Form (available from your employer) for a complete list of circumstances acceptable for changing elections mid-year.

Plan features:

-You may see any dentist. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards.

- Find an in-network provider at unumdentalcare.com

-Manage benefits online with AlwaysAssist.com and on-the-go with the AlwaysAssist mobile app. Overview:

Deductible $1500 per benefit year. Maximum 3 per family. Applies to Basic (Class B) and Major (Class C) Services.

Carryover Benefit

Carryover benefit: $350

Threshold limit: $700

Carryover account limit: $1250

$750 per benefit year. Maximum 3 per family. Applies to Basic (Class B) Services Major (Class C) Services.

Carryover benefit: $150

Threshold limit: $300

Carryover account limit: $500

Reimbursement on covered procedures {40% UCR} {Based on In-network negotiated fee within the general geographic area, made for the same covered procedure.}

{40% UCR} {Based on In-network negotiated fee within the general geographic area, made for the same covered procedure.}

Covered procedures and waiting periods:

Class A

Preventive Services

Waiting Period: None

• Routine exams (2 per 12 months)

• Prophylaxis (2 per 12 months) (1 additional cleaning or periodontal maintenance per 12 months if member is in 2nd or 3rd trimester of pregnancy)

• Bitewing x-rays (max 4 films:1 per 12 months)

• Full mouth x-ray (1 per 36 months)

• Fluoride to age 16 (1 per 12 months)

• Sealants to age 16 (permanent molars, 1 per 36 months)

• Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+)

Waiting Period: None

• Routine exams (2 per 12 months)

• Prophylaxis (2 per 12 months) (1 additional cleaning or periodontal maintenance per 12 months if member is in 2nd or 3rd trimester of pregnancy)

• Bitewing x-rays (max 4 films:1 per 12 months)

• Full mouth x-ray (1 per 36 months)

• Fluoride to age 16 (1 per 12 months)

• Sealants to age 16 (permanent molars, 1 per 36 months)

• Adjunctive pre-diagnostic oral cancer screening (1 per 12 months for ages 40+)

Class B

Basic Services

Waiting Period: None

• Emergency pain (1 per 12 months)

• Space maintainers

• Fillings

• Posterior composite restorations

• Simple extractions

Class C

Major Services

Waiting Period: None

• Anesthesia (subject to review, covered with complex oral surgery)

• Non-surgical periodontics

• Periodontal maintenance (in combination with Prophylaxis)

• Oral surgery (surgical extractions & impactions)

• Endodontics (root canals)

• Surgical periodontics (gum treatments)

• Inlays

• Onlays

• Crowns, bridges, dentures, and implants

• Repairs: crown, denture, and bridges

Waiting Period: None

• Emergency pain (1 per 12 months)

• Space maintainers

• Fillings

• Posterior composite restorations

• Simple extractions

Class D

Orthodontics

Waiting Period: None

• Separate Lifetime maximum: $1000

• Up to 25% of lifetime allowance may be payable on initial banding.

• Dep. Children to age 19 only

Not Covered

• Anesthesia (subject to review, covered with complex oral surgery)

• Non-surgical periodontics

• Periodontal maintenance (in combination with Prophylaxis)

• Oral surgery (surgical extractions & impactions)

• Endodontics (root canals)

• Surgical periodontics (gum treatments)

• Inlays

• Onlays

• Crowns, bridges, dentures, and implants

• Repairs: crown, denture, and bridges

Waiting Period: None

• Separate Lifetime maximum: $1000

• Up to 25% of lifetime allowance may be payable on initial banding.

• Dep. Children to age 19 only

Dental carryover benefit

How it works:

Each benefit year a member must have:

- One cleaning,

- One regular exam, and

- Total dental claims for preventive, basic and major covered procedures paid during the year below the threshold limit. If all three criteria above are met, a portion of the annual maximum will carry over to the next year.

Other Specifications:

- Each covered family member receives their own carryover benefit.

- Group carryover benefit rider must be in effect for one benefit year before any members can utilize carryover benefits.

- A member must be on the plan for a minimum of three months before accruing carryover benefits.

- Carryover benefit may be used toward preventive, basic and major covered services only

- A member’s carryover account will be eliminated, and the accrued carryover benefits lost if the insured has a break in coverage for any length of time or any reason.

Dependent children: Dependent age guidelines vary by state. Please refer to your policy certificate or contact customer service at (888) 400-9304.

Services not listed: If you expect to require a dental or vision service not included on this brochure, it may still be covered. Please contact customer service at (888) 400-9304 to confirm your exact benefits.

Alternate treatment: There are multiple options for dental treatment, all of which provide acceptable results. An Alternate Benefit may be applied if there is a less expensive Covered Procedure appropriate for the course of treatment, capable of producing acceptable results. When an Alternate Benefit is applied, the less expensive Alternate Benefit is used to determine the amount payable under the certificate.

Exclusions/limitations: The following dental services are not covered unless stated otherwise in the Certificate of Coverage:

• any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior elective or cosmetic restorations;

• replacement of a removeable device or appliance that is lost, missing or stolen, and for the replacement of removeable appliances that have been damaged due to abuse, misuse, or neglect. This may include but not be limited to removable partial dentures or dentures;

• replacement of any permanent or removeable device or appliance unless the device or appliance is no longer functional and is older than the limitation in the Schedule of Covered Procedures. This may include but not be limited to bridges, dentures and crown;

• any appliance, service, or procedure performed for the purpose of splinting, to alter vertical dimension or to restore occlusion;

• any appliance, service or procedure performed for the purpose of correcting attrition, abrasion, erosion, abfraction, bite registration, or bite analysis;

• charges for implants (except noted above), removal of implants, precision or semi-precision attachments, denture duplication, or dentures and any associated surgery, or other customized services or attachments;

• services provided for any type of temporomandibular joint (TMJ) dysfunction, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain. Takeover benefits: Takeover benefits apply if we are taking over a comparable benefits plan from another carrier and only if there is no break in coverage between the original plan and the takeover date. Takeover is available to those individuals insured under the employer’s dental plan in effect at the time of the employer’s application. If takeover benefits are included, then waiting periods for service will be waived for the individuals currently insured under the employer’s previous plan during the month prior to coverage moving to Unum Dental. Application of takeover benefits is subject to Underwriting review and approval.

Takeover is also available to new hires, those who enroll during open enrollment, or due to a Qualifying Life Event with priorlike group dental coverage, provided there has not been a lapse in coverage greater than 63 days. Individuals are responsible for providing proof of Prior Plan which should include, but not be limited to, coverage effective dates, a benefit summary, certificate of coverage, etc.

The prior carrier is responsible for reimbursement of costs for procedures begun prior to the effective date.

Dental Cancellation: We may cancel the Policy at any time by providing at least 45 days advance written notice to the Policyholder. The Policyholder may cancel the Policy at any time by providing written notice to Us at least 31 days prior to the cancellation date. Such cancellation shall be without prejudice to any claim originating prior to the effective date of such cancellation