Health

Healthy for Life

Associated Benefits Corporation (ABC) offers a variety of services employers can choose from, including medical, dental, vision, life and disability services. The medical and dental plans are self-insured.

ABC has a well-established relationship with Wellmark/BCBS that provides a competitive nationwide PPO network.

As a not-for-profit organization, ABC collects only enough administrative fees from the cooperatives we serve to cover the cost of administration.

ABC adds value by offering an onsite customer service staff. With 40+ years of combined service, our experienced staff will answer your calls quickly and professionally.

Learn more and find a provider:

 

Health/Welfare Forms (PDF format)


Section 125 Cafeteria Plan

The Section 125 Cafeteria Plan allows employees to utilize tax free contributions to pay for their out-of-pocket medical, dental, vision and dependent care expenses. Employee contributions directed to a Section 125 Cafeteria Plan are EXEMPT from federal, state and FICA taxes. This is not only a savings to the employee, but in addition, the employer will save their portion of the FICA taxes.

An employee may direct contributions to three separate accounts in the Section 125 plan:

  1. Required employee insurance premiums
  2. Out-of-pocket employee insurance premiums
  3. Dependent child care expenses

Each employee may establish contribution levels to meet their own specific needs. As the employee incurs eligible expenses throughout the year, they submit proof of those expenses to Associated Benefits Corporation. The redirected dollars are then reimbursed directly to the participants.

Reimbursement requests are processed twice per week.
ABC provides a complete range of administrative services for Section 125 plans. These include record keeping and employee reports, plan management, government reporting, compliance testing, educational employee meetings, educational videos and our toll free customer service number.

Allowable expenses for reimbursement

The following is a list of expenses which may or may not be eligible for reimbursement through ABC’s Section 125 Cafeteria Plan Medical Expense/Dependent Care accounts. This is only a general list and other expenses may be eligible for reimbursement that are not listed here. Please contact us if you have specific questions.

Procedures, Treatments, and Merchandise

Acupuncture – Medical expenses paid for acupuncture are reimbursable.

Alcoholism and drug abuse – Medical expenses paid to a treatment center for alcohol or drug abuse are reimbursable. This includes meals and lodging provided by the center during treatment.

Ambulance – Medical expenses paid for ambulance service are reimbursable.

Artificial limb – Medical expenses paid for an artificial limb are reimbursable.

Artificial teeth – See medical aids.

Birth control pills and devices – Medical expenses paid for birth control pills and devices prescribed by a doctor are reimbursable.

Braille books and magazines – The amount by which the cost of Braille books and magazines for use by a visually impaired person exceeds the price for regular books and magazines is reimbursable.

Breast augmentation – Expenses related to breast augmentation (such as implants or injections) are not reimbursable because the procedure is cosmetic in nature. However, medical costs related to the removal of breast implants that are defective or are causing a medical problem are reimbursable.

Breast reduction – Medical expenses related to breast reduction surgery are reimbursable only if a physician substantiates that the procedure is medically necessary and not for cosmetic purposes (that is, to prevent or treat an illness or disease).

Breast pumps – Breast pumps and supplies that assist lactation are reimbursable.

Child care Reimbursable through the Dependent Care Account.

Chiropractor – Expenses paid to a chiropractor for medical care are reimbursable.

Clinic – Medical expenses for treatment at a health clinic are reimbursable.

Coinsurance/Co-Pay amounts – Medical coinsurance, co-pay and deductible amounts are reimbursable.

Contact lenses – Reimbursable.

Cosmetic surgery – Medical expenses for cosmetic surgery are reimbursable if the surgery is necessary to improve a deformity arising from or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma or a disfiguring disease. However, medical expenses paid for other cosmetic surgery are not deductible medical expenses under Code Section 213 and thus are not reimbursable by a health FSA. This applies to any procedure that is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. For example, face lifts, hair transplants, hair removal (electrolysis) and liposuction generally are not deductible. If there is a concern that a medical or dental surgery could be considered cosmetic, a doctor’s certification should be obtained explaining how the procedure meaningfully promotes the proper function of the body or prevents or treats an illness or disease. This will help to prove that the claim is reimbursable.

Crutches – Medical expenses paid to buy or rent crutches are reimbursable.

Dancing lessons, swimming lessons, etc – Dancing lessons, swimming lessons, etc., are not reimbursable even if they are recommended by a doctor.

Day care – Reimbursable.

Deductibles – Medical insurance deductibles and coinsurance amounts under the employer’s plan are reimbursable.

Dental treatment – Medical expenses for dental treatment are reimbursable. This includes fees paid to dentists for X-rays, fillings, braces, extractions, dentures, etc.

Dependent care expenses – Dependent care expenses are not reimbursable under a health FSA, but may be reimbursable under a Dependent Care FSA.

Diaper service – Payments for diapers or diaper services are not reimbursable unless they are needed to relieve the effects of a particular disease.

Drugs – See medicines.

Drug addiction – See alcoholism.

Ear piercing – Expenses for ear piercing are not reimbursable.

Electrolysis or hair removal – See cosmetic surgery.

Employment-related expenses – Employment-related expenses such as employment physicals are not reimbursable. (Note, however, that physical exams that are not employment-related are reimbursable.

Eyeglasses – Eye examinations, eyeglasses, equipment and materials are reimbursable.

Fertility – Medical expenses related to the treatment of infertility, including in vetro fertilization, are reimbursable.

Fitness programs – Fitness programs or physical therapy for general health are not reimbursable.

Flu Shots – Reimbursable.

Fluoridation device or services – Yes, if recommended by a dentist to prevent tooth decay.

Funeral expenses Expenses for funerals are not reimbursable.

Group medical insurance – See insurance premiums.

Hair transplant – See cosmetic surgery.

Health club dues – Health club dues, YMCA dues or amounts paid for steam baths for general health or to relieve physical or mental discomfort not related to a particular medical condition are not reimbursable.

Healthy baby care – Reimbursable.

Hearing aids – Medical expenses for a hearing aid and batteries are reimbursable.

Hospital – Expenses incurred as a hospital in-patient or out-patient for laboratory, surgical and diagnostic services qualify as medical expenses.

Impotence or sexual inadequacy – Medical expenses related to the treatment of impotence are reimbursable if substantiated by a physician.

In vitro fertilization – Reimbursable.

Infertility – Reimbursable.

Insulin – The cost of insulin is reimbursable.

Insurance premiums – Premiums for any health plan other than the employer’s, including health plans maintained by the employer of an employee’s spouse or dependent, are not reimbursable.

Laboratory fees Laboratory fees that are part of medical care are reimbursable.

Learning Disability – Tuition fees you pay to a special school for a child who has severe learning disabilities caused by mental or physical impairments are reimbursable. Your doctor must recommend that the child attend the school. You can also be reimbursed tutoring fees you pay on your doctor’s recommendation for the child’s tutoring by a teacher who is specially trained and qualified to work with children who have severe learning disabilities.

Laser eye surgery Lasik is reimbursable.

LiposuctionSee cosmetic surgery.

Marriage counseling – Expenses for marriage counseling services do not qualify as medical expenses. However, sexual inadequacy or incompatibility treatment is reimbursable if the treatment is provided by a psychiatrist.

Maternity clothes – Expenses for maternity clothes are not reimbursable.

Massage – Fees paid for massages are not reimbursable unless prescribed and substantiated by a physician to treat a physical defect or illness.

Medical aidsMedical aids such as false teeth, hearing aids, crutches and elastic hosiery are reimbursable. Only legal medical services are reimbursable. Amounts paid for illegal operations or treatments, Regardless of whether they are rendered by licensed or unlicensed practitioners, are not reimbursable.

Medicare Part A – The tax paid for Medicare Part A is not reimbursable.

Medicare Part B – Premiums paid for Medicare Part B are not reimbursable.

Medicines – Certain amounts paid for medicines and drugs are reimbursable. Expenditures for drugs that are for cosmetic purposes or are illegally purchased do not qualify.

Optometrist – See Vision Care.

Orthodontia – Expenses for orthodontic care are generally reimbursable, except care for cosmetic purposes.

Personal use items – Items that are ordinarily used for personal living and family purposes are not reimbursable unless they are used primarily to prevent or alleviate a physical or mental defect or illness. For example, the cost of a wig purchased at the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease is reimbursable.

Physical exams – Physical exams are generally reimbursable, except for employment-related physicals.

Pre-existing conditions – Medical expenses not covered because of the plan’s pre-existing condition limitation are reimbursable.

Prescription drugs – See medicines.

Private hospital room – The extra cost of a private hospital room is reimbursable.

Prosthesis – Reimbursable.

Psychoanalysis – Expenses for psychoanalysis are reimbursable if provided for medical care and not just for the general improvement of mental health, relief of stress or personal enjoyment.

PsychologistExpenses for psychological care are reimbursable.

Radial Keratotomy Reimbursable. Corneal ring segments (removable plastic half-rings that correct vision) would also qualify. Reasonable and customary charges, amounts in excess of______. Medical expenses in excess of the plan’s reasonable and customary charges are reimbursable.

Retin-AReimbursable when prescribed by a physician for treatment of acne, but not wrinkles.

Sexual counseling Expenses for counseling regarding sexual inadequacy or incompatibility are reimbursable if the counseling is provided to a husband and/or wife by a psychiatrist.

Smoking program – Reimbursable.  Amounts paid for a stop-smoking program would qualify, as would amounts for prescribed drugs and over-the-counter drugs used to stop smoking.

Sterilization – The cost of a legal sterilization (a legally performed operation to make a person unable to have children) is reimbursable.

Substance abuse – See Alcoholism and drug abuse.

Therapy – Amounts paid for therapy received as medical treatment are reimbursable.

Vaccines – Expenses for vaccines are reimbursable.

Vasectomy  Reversals – Medical expenses related to a vasectomy reversal are reimbursable.

Vasectomy Medical expenses related to a vasectomy are reimbursable.

Vision care – Optometric services and medical expenses for eyeglasses and contact lenses needed for medical reasons are reimbursable. Eye exams and expenses for contact lens solutions are also reimbursable. However, premiums for contact lens replacement insurance are not reimbursable.

Vitamins – Only expenses for vitamins prescribed by a physician that are only available by prescription and are to treat a specific medical condition are reimbursable.

Weight loss program – The cost of a weight loss program for general health is not reimbursable even if a doctor prescribes the program. It is reimbursable if the weight loss program is recommended by a physician to treat an existing disease (such as obesity, heart disease or diabetes) and is not simply to improve general health. The costs of food associated with a weight-loss program would not qualify.

Well baby care – Reimbursable.

Wigs – See personal use items.

X-ray fees – Amounts paid for X-rays taken for medical reasons are reimbursable.

Over-the-counter (OTC) medications

You may submit claims for reimbursement of over-the-counter drugs from your cafeteria plan medical expense account.

 A receipt clearly indicating the date of purchase and type/name of the over-the-counter (OTC) drug purchased must accompany claims.

Specifically excluded in the listing of eligible over-the-counter drugs are those which are merely beneficial to an individual’s health (vitamins, dietary supplements, etc.). When submitted for reimbursement, ABC will make the determination as to whether the specific item is reimbursable.

While we cannot provide an all-encompassing list of reimbursable medications, the information below should provide some clarity regarding what is reimbursable, what is reimbursable with a medical necessity letter and items that are excluded.

The following is a list of over-the-counter medications and expenses which may or may not be eligible for reimbursement through ABC’s Section 125 Cafeteria Plan Medical Expense account.

OTC supplies / equipment – eligible with a receipt

Bandages

Band-Aids

Blood sugar test kits and test strips

Blood pressure monitoring devices

Carpal tunnel wrist supports

Cold/hot packs for injuries

Condoms

Contact lens solution and cleaners

Crutches

Dentures and denture adhesives

Diabetic supplies

First-aid kits

Gauze pads

Incontinence supplies

Nicotine gum or patches

OTC shipping charges or sales tax

Ovulation kit

Pregnancy test kits

Reading glasses

Thermometers

Nasal strips

OTC drugs / medicines – A prescription is required for the following:

Allergy medications

Antacids

Anti-diarrhea medications

Antihistamine

Anti-itch cream

Aspirin

Bactine

Ben Gay or products for muscle pain

Bug bite medication

Calamine lotion

Cold medicine

Cough drops

Cough syrups

Decongestants

Diaper rash ointments and creams

First aid cream

Heartburn medicines

Hemorrhoid cream

Hydrogen peroxide

Laxatives

Liquid adhesive for small cuts

Menstrual relief products

Motion sickness pills

Muscle and joint pain products

Nasal sprays

OTC shipping charges or sales tax

Pain relievers

Prenatal vitamins

Rubbing alcohol

Sinus medications

Spermicidal foam

Sunburn remedies

Suppositories

Throat lozenges

Toothache and teething pain relievers

Visine and other eye products

Wart removal treatments

Throat lozenges

OTC items needing a letter showing medical necessity

Acne treatments

Dietary supplements

Ear plugs

Exercise equipment & programs

Fiber supplements

Glucosamine/chondroitin

Health club dues

Herbal supplements

Hormone therapies

Lactose intolerance pills

Medicated shampoo

Nasal sprays for snoring

Orthopedic shoes and inserts

Retin-A

Sleeping aids

St. John’s Wort

Sunscreen

Weight loss supplements

OTC excluded items

Cosmetics

Cosmetic procedures

Deodorants

Face creams

Feminine hygiene products

ChapStick

Illegal drugs under U.S. law

Imported medications not FDA approved

Moisturizers

Non-medicated shampoos

Non-medicated soaps

Suntan lotions

Toothbrushes (electric or manual)

Toothpaste

Vitamins-for general well-being

When determining what is eligible, ask yourself…

Would I use this item if I didn’t have the medical condition?
If your answer is, “Yes, I would be using the item even without the medical condition” (i.e. toothbrush, toothpaste), the item is not eligible for reimbursement. However, if you would not be using the item except for the medical condition, it may be an eligible expense.

What kind of documentation do I need to submit?
Receipts for over-the-counter medications and supplies should contain the name of the item, the date of purchase, and the total amount of the purchase. The receipt need not include the name of the person incurring the expense. If a receipt does not include the name of the drug, you must submit additional third-party substantiation (for example, a box top that includes the name and a price tag matching the price on the receipt).

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