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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 28 Special Rule. If you pay for care on at least a weekly basis, without deduction for days on which care is not provided, you are not required to allocate expenses for short, temporary absences from work, such as vacations and sick days. You are also not requir ed to allocate expenses on a daily basis if you (or your spouse) work on a part-time basis and you pay for care on at least a weekly basis without deduction for days on which care is not provided. (d) Who and Where Rules. Expenses that would otherwise be “Eligible Expenses” cannot be reimbursed if they are paid to: (1) an individual who is your child under the age of nineteen (19) at the end of the calendar year; (2) an individual you (or your spouse) claim as a dependent on your tax return; (3) an individual who was your spouse at any time during the calendar year; or (4) a parent of a Qualifying Individual who is your child under age thirteen (13). Expenses that would otherwise be “Eligible Expenses” for services provid ed outside of your home may be reimbursed only if the care is for a Qualifying Individual who is: (1) your (or your spouse’s) “child” under the age of thirteen (13); or (2) is another Qualifying Individual who regularly spends at least eight (8) hours per day in your home. 4.8 How do I receive reimbursements under the Dependent Care FSA? (a) Periodic Reimbursements. When you incur an expense that is eligible for reimbursement, you submit a claim to the Claims Administrator on a claim form that will be supplied to you. The claim form may be submitted via email, facsimile, mail, or the Claims Administrator’s website. The claim form will typically set forth: (1) the amount, date and nature of the expense ; (2) the name of the person or entity to which the expense was pai d; (3) your statement that the expense has not been reimbursed, and you will not seek reimbursement for the expense, from any other source; and (4) such other information as the Plan Administrator may require. You may also be required to submit copies of bills or receipts from the provider(s) to support your claim. If there are enough dollars credited to your account, you will be reimbursed for your Eligible Expenses according to the schedule established by the Plan Administrator. Claim Deadline. You may submit claims for reimbursement of Eligible Expenses incurred during the Plan Year for ninety (90) days following the end of that Plan Year. This period following the end of the Plan Year during which claims for reimbursement may be filed is referred to as the “claims run-out period.” (b) Electronic Payment Card. The electronic payment card allows you to pay for Eligible Expenses at the time that you incur the expense. The electronic payment card works as follows: (1) You must make an election to use the card. In order to be eligible for the electronic payment card, you must agree to abide by the terms and conditions of the electronic payment card program as set forth herein and in the electronic payment cardholder agreement (the “Cardholder Agreement”), including agreeing