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Plan Description
Colonial Life & Accident > Health Care FSA
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Note: This page contains a brief summary of coverage. It does not
state all provisions and limitations of the plan. The terms and provisions of
each plan, as outlined in the plan document, will determine coverage and
eligibility.
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Broker Name:
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BrokerXYZ
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Policy Number:
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34512435
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Original Plan Effective Date:
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12/11/2002
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Rate Guarantee Expiration Date:
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12/11/2002
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Plan Anniversary Date:
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12/11/2202
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Billing Cut-off Day of the Month:
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25
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Retroactive Termination Limit:
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60
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Division:
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All Divisions
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Location:
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California
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Employee Classes:
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Full Time
Manager
Officer
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General Plan Information
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Maximum Annual Contribution
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$5,000.00
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Minimum Annual Contribution
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$1,000.00
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Benefit Attributes
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Contribution Tax Status
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Pre-tax
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Frequency of Disbursements
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Once a Month
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Minimum Reimbursement Amounts
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$25
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Reimbursement Method
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Direct Deposit
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Qualified Expenses
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Medical and Dental Deductibles
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Yes
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Medical and Dental Co-insurance and Co-payments
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No
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Prescription Drugs Co-payments
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Yes
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Vision and Hearing Expenses
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Yes
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Orthodontia Expenses for Children and Adults
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Yes
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Waiting Period Information
Eligible employees are eligible as of the 1st of the month following the employee's hire date.
Termination of Coverage Information
When a plan participant is terminated from the company, the plan coverage ends on the last day of the month following the employee's termination date.
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Health Care FSA Plan
http://www.bluesss.com
Member Services
John Carpet
600 Lafayette East
Detroit, MI 48226
(313) 225-5890
Fax (313) 225-3453
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