1. When treatment begins, an orthodontist will provide the employee with the case fee information, including:

•  Total case fee
•  Expected insurance coverage / discounts
•  Expected length of treatment (in months)
•  Date treatment began

2. An employee will pay the complete fee up front OR pay an initial fee followed by a monthly payment plan.

3. A copy of the orthodontic contract containing the case fee information and the payment option selected must be submitted to the FBA Department along with a fully completed, signed and dated reimbursement sheet.

4. Once FBA receives the total case fee information and reimbursement request, FBA will reimburse you the participant as follows:

FBA will reimburse an employee for 1/3 of the total case fee (after subtracting the amount expected to be paid by insurance up front). The remainder of the total case fee will be distributed equally over the months of treatment. For example, if an employee submits the following charge for an expected length of treatment of 24 months:

$3,000.00 total case fee, minus
$1,000.00 paid by insurance up front
-----------------------------------
= $2,000 remaining

FBA would reimburse 1/3 up front: $666.67. The remaining $1,333.33 would be divided into 24 equal monthly payments of $55.56 each, payable over the length of treatment.

Important facts to consider

When planning an orthodontic treatment in conjunction with Health FSA participation, please consider:

• The initial 1/3 reimbursement is ONLY reimbursable during the plan year that treatment begins and the employee MUST be enrolled in the Health FSA at the start of the treatment in that plan year. For example, if treatment begins in December of 2007, the employee must be enrolled during the 2007 plan year (including December)
• To continue to receive reimbursement for monthly adjustments, the employee MUST continue to enroll in the Health FSA in subsequent treatment years. For example, if treatment begins in January 2008 and you are enrolled in a calendar-year Health FSA from January 1, 2008 to December 31, 2008, the employee will qualify for the 1/3 initial reimbursement and 12 monthly adjustment fee reimbursements. However, to continue to receive the monthly adjustment reimbursement in 2009, you would need to re-enroll in the FSA for 2009.
• Claims must be submitted for monthly reimbursements – they are not automatic
• Even if an employee prepays for the entire service, FBA cannot reimburse the entire amount at once. We must obtain the case fee information and reimburse according to these guidelines
• If an employee enrolls in the Health FSA after the orthodontic treatment has begun, we must review the case fee information to determine what would be reimbursable, in conjunction with any amount already reimbursed from any previous FSA