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Flexible Benefits Plan

Who could use a little more money? When you sign up for one or more of the Office of Group Benefits (OGB) Flexible Benefits Plan options, you are allowed to set aside a portion of your salary, before taxes, to pay for a qualified medical or dependent care expense. Because that portion of your income is not taxed, your spendable income increases! If applicable, this might produce lower Social Security benefits.

Active employees can enroll in one or several flexible Benefits Plan options:
Premium Conversion - By enrollment in an OGB health plan, life insurance, and/or a voluntary product that is eligible for pre-tax deductions, employees are automatically enrolled in the Flex Plan and the Premium Conversion option. Premium Conversion is mandatory for the 2015 plan year.

Employees can participate in the General-Purpose Health Care FSA option, Limited-Purpose Dental/Vision FSA or Dependent Care FSA option even if they are not enrolled in an OGB health plan or the Premium Conversion option.

Money deducted from an employee’s pay into a Flexible Spending Arrangement (FSA) is not subject to payroll taxes, resulting in substantial tax savings. These tax savings are through the available FSAs: General-Purpose Health Care FSA; Limited-Purpose Health Care FSA; and the Dependent Care FSA.

FSA Eligibility and Enrollment Rules - To enroll in the General-Purpose FSA, Limited-Purpose FSA and the Dependent Care FSA, an employee must:
  • Be an active, full-time employee in a participating payroll system.
  • Enroll during Annual Enrollment or after experiencing a qualifying event.
  • New hires may enroll within their first thirty (30) days of full-time employment. Your participation will be effective the first of the following month after your first full calendar month of employment. For example: if your date of hire is August 20th, your effective date is October 1st.
  • Re-enroll each year to continue participation and agree to pay the $36 annual administrative fee.
General-Purpose Health Care Flexible Spending Arrangement (GPFSA) allows an employee to use pre-tax dollars to pay eligible out-of-pocket medical, dental and vision care expenses for himself or herself, his or her spouse and any other federal tax dependents – even if they are not covered by an OGB health plan. An employee cannot participate in the GPFSA and the Health Savings Account (HSA) options at the same time. This is a HIPAA-excepted benefits plan.

Limited-Purpose Dental/Vision Flexible Spending Arrangement (LPFSA) allows an employee to use pre-tax dollars to pay for eligible out-of-pocket dental and vision expenses only for yourself, spouse and any other eligible federal tax dependents. An employee cannot participate in the GPFSA and the LPFSA options at the same time. However, an employee who enrolls in the Pelican Health Savings Account (HSA) 775 can participate in the LPFSA option. This is a HIPAA-excepted benefits plan.

Dependent Care Flexible Spending Arrangement (DCFSA) allows an employee to use pre-tax dollars to pay eligible dependent care expenses for a child, disabled spouse, elderly parent or other dependent incapable of self-care, while the employee is at work.

The Health Savings Account (HSA) option allows a plan member and his or her employer to contribute pre-tax dollars to an HSA. Active employees can contribute to the Health Savings Account option only when they choose the Pelican HSA 775 health plan and are not covered by other disqualifying non-high-deductible health plan coverage. The deductible amount for plan members enrolled in the Pelican HSA 775 will reset at the beginning of each plan year.

The initial state contribution is $200 per plan year. The state also matches additional HSA contributions, dollar-for-dollar, up to $575 per plan year. The maximum HSA contribution amounts for the 2015 plan year are:

Pelican HSA 775
Coverage level State contribution Employee Contribution Maximum HSA contribution
Single $200, plus up to $575 more in
dollar-for-dollar match of
employee contributions
Single $2,575 $3,350
Employee plus 1 Employee plus one $5,875 $6,650
Employee plus 2 or more Employee plus two $5,875 $6,650
An employee age 55 or older can contribute an additional $1,000 to his or her HSA during the plan year.

The initial $200 state contribution is paid by the employee's agency in the first month of the new plan year (based on the level of coverage on January 1, 2015).

For more information on the Pelican HSA 775, call 1-800-392-4089 or visit the Blue Cross website.

Discovery Benefits, Inc.

Discovery Benefits, Inc. (DBI) is OGB's third party administrator for OGB's Flexible Spending Arrangements (FSAs). The Discovery Benefits website features other tools to help you understand the benefits of your Flexible Spending Arrangement with a Health and Dependent Care FSA Worksheet; eligible and ineligible expenses; how to use your debit card; how to get a reimbursement and more.

Log on to and learn how to maximize your FSA in three easy steps:
  • Plan how much money you want to set aside;
  • Spend your eligible dependent care and medical expenses; and
  • Collect the money you've set aside.
Discovery Benefits is accessible 24/7 CST, so call their toll-free customer service number, 1-866-451-3399, for lost/stolen/not received cards, or questions with your FSA. Be prepared to verify your identity when calling.

Filing a Claim for Reimbursement

Your choice! Plan members can be reimbursed from Discovery Benefits for eligible expenses in three ways:

  • Enter your claim information online.
  • Upload your receipt.
  • Your reimbursement will be processed once your information is received.
  • Download, print and complete the Discovery Benefits Reimbursement Request form.
  • Fax the Reimbursement Request form along with your receipts to fax number 1-866-451-3245
  • Download, print and complete the Discovery Benefits Reimbursement Request form.
  • Mail the Reimbursement Request form along with your receipts to:
    Discovery Benefits
    P.O. Box 2926
    Fargo, ND 58108-2926
You can choose your reimbursement method by direct deposit or by check. You will automatically receive a check unless you enroll in direct deposit.

Medical or Limited FSA COBRA

FSA COBRA is also offered to participants in the medical or limited purpose FSA, who have been termed due to employer lay-off, resignation, dismissal, retirement, or other events. Discovery Benefits administers FSA COBRA and sends the FSA COBRA notices directly to the termed participants.

EBIA - for Eligible Medical Expenses

Log in to the website to view the EBIA Health Care Expenses Table