
Message to State
Employees
What is Island Flex
Flexible Spending Accounts?
How Do I Qualify for Island
Flex?
When Does My Coverage
Begin?
If I am a New Employee
or Become Eligible During the Plan Year, Must I Wait Until Open
Enrollment to Enroll?
How Can the Money in Island
Flex Be Used?
Is There a Fee for Using
This Program?
How Do The Spending
Accounts Work?
Is There a Maximum
Amount I May Contribute Each Plan Year?
How Do I Get Reimbursed
For My Eligible Expenses?
If I Send My Child to a
Baby-sitter, Will That Qualify for the Dependent Care FSA?
When May I File a Claim
for Reimbursement?
May I Change the Amount
of My Contribution During the Year?
What Happens If I Don"t
Spend All of the Money by the End of the Plan Year?
What Happens When I Take
Paid Leave, Such as Vacation or Sick Leave, or Leave Without Pay?
If I Work for the DOE or
UH and Take a Job During My Summer Vacation, Can I Claim for Dependent
Care Services During That Period?
Can I Transfer Money
From the Dependent Care FSA to the Medical FSA Or Vice Versa?
How Will I Know How Much
Money Is In My Account(s)?
How Do I Know If I Will
Benefit From the Medical FSA?
How Can I Tell Whether I
Should Use the Dependent Care FSA or the IRS Child Care Tax Credit?
Will Participating in
Island Flex Affect My Retirement Benefits, Social Security, Deferred
Compensation, Tax Sheltered Annuity, or Premium Conversion Plan?
Once I Enroll, How Will I Know if FSA
Contributions are Being Deducted From My Paycheck?
Do All of My Receipts Need to be Turned in by
the End of the Plan Year - June 30th?
Must I Complete a New
Compensation Reduction Agreement Each Year?
What Happens If I
Terminate My Employment?
What Rights Do I Have If
the Third-Party Administrator Does Not Pay My Claim?
What Other Services Can
the Third-Party Administrator Provide Me at No Cost?
Who Do I Call If I Have
Questions?
Examples of Eligible
Medical Expenses
Examples of Medical
Expenses That May Not Be Reimbursed
Personal
Expenses Worksheet

Aloha,
As the cost of living rises,we often find ourselves making critical health choices or putting off necessary health care because of the high unexpected costs not budgeted for in family finances. Dependent care is also a financial concern for many families where both parents, or especially single parents,need to work to support the household and must find suitable arrangements for dependent care,whether it be a babysitter,pre-school,or after-school program.
We understand that every penny counts. That
is why we want to provide for a better lifestyle for the people of
Hawaii.We are pleased to offer you,Island Flex ,one of our employee
benefit programs which may help you save in taxes while you strive to
maintain a quality lifestyle.For many state employees,an Island Flex
flexible spending account is a great way to turn certain out-of-pocket
medical,dental,drug,and vision expenses,as well as de-pendent care
expenses into tax savings and greater take-home pay. We hope that you
will find this booklet informative and helpful as you learn more about
the Island Flex program 
Linda Lingle
Governor
State of Hawaii

Island Flex flexible spending accounts is an employee benefit program that provides you with a way to pay for your eligible health care expenses (Medical FSA) and dependent care expenses (Dependent Care FSA) with TAX FREE money. By directing "before tax" money from your paycheck into one or both of these accounts, you can put up to 41% of the money you are spending on eligible expenses back into your pocket.
You must be an employee of the State of Hawaii and be eligible to participate in the Employees' Retirement System.
For employees who turn in their Compensation Reduction Agreement form (enrollment form) to the third party administrator, Comprehensive Financial Planning, Inc. (CFP), during the open enrollment period, coverage will begin July 1st. For employees who become eligible during the plan year, coverage begins on the 1st day of the month following CFP's receipt of the Compensation Reduction Agreement, provided the Compensation Reduction Agreement is received within 90 days of the employee becoming eligible.
No. As soon as you become eligible (become a member of the Employees' Retirement System), you are eligible to enroll right away. You must complete a Compensation Reduction Agreement form and send it to CFP within 90 days of becoming eligible. Your date of participation will begin on the first day of the month following CFP's receipt of your Compensation Reduction Agreement. However, if you choose not to enroll within 90 days of becoming eligible, you will have another opportunity during the next annual open enrollment period.
Medical FSA
The money in your Medical FSA can be used to reimburse yourself for
medical, dental, drug and vision expenses incurred by you or your
family members, which aren't covered by your health insurance plans.
Examples of items not covered by your health insurance plans that could
be covered under Medical FSAs include such things as: co-payments,
deductibles, glasses, contacts, orthodontic work, fees to doctors and
hospitals, etc. See the section entitled Examples
of Eligible Medical Expenses for a more detailed list.
Dependent Care FSA
The money in your Dependent Care FSA can be used to reimburse yourself for dependent care expenses incurred. You must be working in order for these expenses to qualify for reimbursement. If you are married, both you and your spouse must both be working, or your spouse must be a full-time student or disabled. To be considered a “dependent,” the person receiving care must be eligible to be claimed as your dependent on your federal income tax return and be either:
Examples of eligible dependent care expenses include:
Yes. You will be charged a nominal
administration fee each month. The fee will be deducted from your
paycheck each pay period on a BEFORE-TAX basis. You pay one fee whether
you enroll in one or both accounts. Generally, if you expect your
annual, out-of-pocket expenses to exceed $160 annually, you will
probably save taxes even after paying the administration fee.
First, you establish a Dependent Care FSA,
Medical FSA, or both if you have both types of expenses. You do this by
completing a Compensation Reduction Agreement form and turning it into
CFP during the open enrollment period. Or, if you become eligible
during the plan year, you have 90 days to complete and submit your
Compensation Reduction Agreement.
The amount you designate on the Compensation Reduction Agreement will be deducted from your pay check before taxes are calculated, and deposited into your account. This makes your contributions TAX-FREE.
Let's look at an employee example: Employee Leilani has one child attending pre-school, for which she pays the pre-school $400 per month. Leilani also has approximately $50 per month of unreimbursed health care expenses. Leilani is married, claiming two exemptions.
|
$1,200 Per Check
|
|
Currently
|
With
Island Flex |
|
| Gross Pay |
$
|
1,200.00
|
$
|
1,200.00
|
| Medical FSA |
$
|
0.00
|
$
|
25.00
|
| Dependent Care FSA |
$
|
0.00
|
$
|
200.00
|
| Taxable Income |
$
|
1,200.00
|
$
|
975.00
|
| Federal Withholding |
$
|
76.53
|
$
|
45.18
|
| State Withholding |
$
|
55.03
|
$
|
40.18
|
| FICA (Social Security) |
$
|
91.80
|
$
|
74.59
|
| Net Pay |
$
|
976.64
|
$
|
$815.05
|
| Medical Expenses |
$
|
25.00
|
$
|
0.00
|
| Dependent Care Expenses |
$
|
200.00
|
$
|
0.00
|
| Spendable Income |
$
|
751.64
|
$
|
815.05
|
|
|
|
|
||
| Savings Per Paycheck |
$
|
63.41
|
||
| Savings Per Month |
$
|
126.82
|
||
| Savings Per Year |
$
|
1,521.84
|
Yes. Maximum amounts are set for Medical FSA
and Dependent Care FSA as follows:
Medical FSA
Dependent Care FSA
It's simple. Once an eligible service is provided by a doctor, hospital, pharmacy, etc., or for dependent care expenses performed by your dependent care provider, you pay that expense as usual. Then you:
It’s that easy. Medical reimbursement claims are processed on a daily basis, and Dependent Care reimbursement claims are processed on a monthly basis at the end of each month. Please keep in mind that the service has to be “completed ” before a claim can be submitted. Your check will be mailed once the claim is verified and processed. With your check, you will receive a statement showing your account balance(s) and a new claim form. And best of all, you don’t pay taxes on the money you use to reimburse yourself.
Yes. As long as your child is under 13 years old and the baby-sitter:
As soon as you have accumulated a minimum of $25 in eligible expenses for each account, you may file for reimbursement.
The IRS requires your enrollment in Island Flex to continue for the entire plan year. However, you may modify your contributions if you have a valid "status change." Examples of valid status changes include, without limitation, marriage, divorce, birth or adoption of a child, death of a spouse or dependent, or spouse's change in employment. If you have a valid "status change," you must complete a status change form and return it to CFP within 90 days of the status change event. Approved changes are effective on the first day of the month following CFP's receipt and approval of the required status change forms. Cancellations are effective on the last day of the month following CFP's receipt and approval of the required status change forms. Any increase, decrease, or cancellation of your Island Flex payroll deduction must be consistent with the status change. If CFP does not receive the status change form within 90 days of the status change event, you will not be allowed to make a change.
IRS regulations say that any money left in your Medical FSA or Dependent Care FSA after all reimbursements have been processed cannot be returned to you or carried forward to the next plan year. This is known as the "use-it-or-lose-it" rule. Therefore, it is important to be conservative when estimating your eligible expenses for the year.
Medical FSA
As long as you are on paid leave, your payroll deductions will
continue, your eligibility to participate in Island Flex will continue, and any eligible medical, dental,
drug, and vision services performed will be eligible for reimbursement.
However, if you are on leave without pay, you must make arrangements
with CFP to pay your contributions and administration fees on an
out-of-pocket basis. If you do not pay your contributions and
administration fees, you will be canceled from the plan. Only services
performed prior to the cancellation will be eligible for reimbursement.
Unused balances cannot be returned to you.
Dependent Care
As long as you are on paid leave, your payroll deductions will continue
and your eligibility to participate in Island Flex will continue. However, services performed during any paid
leave period, such as vacation, sick, funeral, sabbatical, industrial
injury, accidental injury, family leave or compensatory time off will not
be considered eligible expenses and, therefore, you may not be
reimbursed for those expenses during those periods.
If you are on leave without pay, you must make arrangements with CFP to
pay your contributions and administration fees on an out- of- pocket
basis. If you do not pay your contributions and administration fees,
you will be canceled from the plan. Unused balances cannot be returned
to you. Services
performed while you are on leave without pay will not be
considered eligible expenses and, therefore, you may not be
reimbursed for those expenses during those periods.
Yes. If you work for a public or private employer you may claim for eligible dependent care services during that period. However, if you attend school/classes to enhance your skills, you may not claim for services during that period.
No. The Internal Revenue Code does not allow monies to be moved from one account to the other.

You will receive statements from the Island
Flex claims processor within 30 days of the end of each
calendar
quarter. Additionally, you will receive a statement showing your
contributions, reimbursements, and account balance(s) each time you
receive a reimbursement.
If you and your family members have predictable out-of-pocket medical, dental, drug, and/or vision expenses, this account will benefit you. The actual dollar amount you will save depends on your income tax bracket. For assistance in determining your personal tax savings benefit, please call Comprehensive Financial Planning, Inc. at 596-7006 or neighbor islands may call toll free at 1-877-550-5552. You may also e-mail Comprehensive Financial Planning, Inc. at cfpii001@hawaii.rr.com. For further information, see Is There A Fee For Using the Program? and the Personal Expenses Worksheet.
Each person's tax situation is different, so the benefit is not the same for everyone. Generally, though, if your family's taxable income is more than $28,000, you may save more money using the Dependent Care FSA. The IRS child care tax credit only allows a maximum benefit of $3,000 for one child and $6,000 for two or more children, per year. Also, depending on your total income, only a certain percentage may be allowed on your tax return. Through the Dependent Care FSA, you can benefit up to $5,000 per year regardless of the number of children in child care or your income. Plus, the tax savings are realized on a monthly basis in your paycheck instead of having to wait to file your tax return at the end of the year. You still must file the IRS Form 2441 for either benefit. You should use caution in enrolling in the Dependent Care FSA if your dependent care expenses are not consistent or are unpredictable. You may wish to consult with your tax advisor on this matter.
Your paycheck stub will show two or three of
the following codes under the "DEDUCTIONS/ REDUCTIONS" column:
"FA200" (Administration Fee)
"FD200" (Dependent Care FSA)
"FM200" (Medical FSA)
No. You have 90 days after the end of the plan year, June 30th, to turn in your receipts. However, it is advised that you turn in your claims well before the end of the 90 day grace period following the end of the plan year or your termination date. No corrections to claims are allowed after the 90 day grace period under the IRS guidelines, even though your claims are received before the end of the 90 day grace period. In addition, the services must have been performed during the plan year. If you have monies left in your account(s) during the 90 days, the administration fee will be deducted from your account balance.
Yes. If you do not complete a new Compensation Reduction Agreement each plan year, your enrollment will not continue.
Your participation in Island Flex will end on your termination date. Eligible expenses for services performed up to your termination date may be reimbursed to you. And, you have 90 days after your termination to turn in receipts to the Island Flex claims processor for eligible expenses incurred prior to your termination. The administration fee will still be deducted from your account balance during this 90 day period.
In addition, you may be eligible to continue in the Medical FSA under COBRA. Be sure to check with CFP to see if you are eligible for COBRA.
If you are not reimbursed after filing your claim form or reimbursed for an amount less than you requested, you may appeal their decision. You have 60 days from the date you receive notification to send an appeal to the Director of the Dept. of Human Resources Development at 235 S. Beretania St. 14th Floor, Honolulu, Hawaii 96813.
CFP will be providing the following additional services at no cost to you upon request. They are:
Details of these services will be provided at additional workshops to be announced at a later date or you may call CFP for additional information. For further details, please see Free Services.
Please call Comprehensive Financial Planning, Inc. at 596-7006 or e-mail us at cfpii001@hawaii.rr.com. Neighbor islands may call toll free at 1-877-550-5552.
| Acupuncture Alcoholism treatment Ambulance service Artificial limbs Artificial teeth Birth control pills Braille books & magazines for use by a person with a visual impairment Car controls for use by a person with a disability Chiropractic care Contact lenses, solutions, and enzyme cleaners* Co-payments Crutches, amount paid to buy or rent Dental fees, includes x-rays, fillings, braces, extractions, dentures, etc. Deductibles for health insurance Dental implants Diagnostic tests Doctors' fees Drug addiction treatment at a therapeutic center for drug addiction Experimental medical treatment Eye glasses and eye examinations Guide dogs/trained animals used to assist persons with a physical disability Hearing aids, batteries to operate them, and hearing exams Hospital services Injections Inpatient therapy for mental or nervous disorder |
In vitro fertilization Lab fees that are part of your medical care Laser eye surgery (RK, PRK, LASIK, etc.) Learning disability tuition for a child who has severe learning disabilities Nursing services Operations Optometrist fees Orthodontic treatment* Orthopedic shoes Over the counter medicine and drugs Oxygen Parking fees while visiting a doctor Periodontal fees Prescription drugs** Psychoanalysis Psychologist fees Smoking cessation programs and associated prescription drugs Special schools for individuals with disabilities Sterilization Surgery TDD phones for individuals who are deaf or hard of hearing Therapy Transplants Transportation for medical care Vaccinations Wheelchairs X-rays |
| Health insurance premiums Cosmetic procedures Hair growth drugs Diet foods Lamaze class fees Ear piercing |
Amounts paid by your
medical plan Nicotine patches (over-the-counter) Weight-loss programs Health club dues Nonprescription drugs Funeral expenses |