/depts/,/depts/uwhealth/,/depts/uwhealth/benefits/,/depts/uwhealth/benefits/open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/flexible-spending-account-era/,/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/flexible-spending-account-era/resources/,

/depts/uwhealth/benefits/open-enrollment/uwhc-open-enrollment/flexible-spending-account-era/resources/OE-2018-ERA-Enrollment-Brochure_FINAL_9.19.17-pdf.pdf

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Departments & Programs,UW Health,Benefits,UW Health Open Enrollment,UWHC Open Enrollment,Flexible Spending Account (ERA),Resources

2018 ERA Enrollment Brochure

2018 ERA Enrollment Brochure - Departments & Programs, UW Health, Benefits, UW Health Open Enrollment, UWHC Open Enrollment, Flexible Spending Account (ERA), Resources































ENROLLMENT
State of Wisconsin
EMPLOYEE REIMBURSEMENT
ACCOUNTS
2018





Save up to 30% on health care, dependent day care, transit and/or parking
expenses with an Employee Reimbursement Account (ERA)!

It’s Your Choice Open Enrollment
• Annual It’s Your Choice Open Enrollment Period: October 2 – October 27, 2017
• 2018 Benefit Period: January 1 – December 31, 2018
• Note: You must re-enroll in ERAs each year. Enrollments do not carry forward from year to year.
New Employee Enrollment
If you are electing to enroll in an ERA, you must enroll within 30 days of your date of hire (in an eligible position),
or first eligible appointment. Coverage will be effective the first of the month on or following your eligibility date.

Qualified Life Change Event
If you experience a qualified life change event, such as a marriage or divorce, birth or adoption of a child, a
change in employment status, or another qualified life change event, you may have the opportunity to enroll or
change your coverage outside of the open enrollment period. There are various rules related to life change
events. Changes due to a qualifying life change event must be made within 30 days from the date of the event.

Important Program Information
Expense Deadline – You must incur and substantiate
all eligible expenses by December 31 of the
applicable plan year.

Claims Deadline – You must submit all reimbursement
requests by March 31 following the close of the
applicable plan year.
Re-Enrollment – You must re-enroll each year to
continue participation. Enrollments do not carry
forward from year to year. If you do not enroll during
open enrollment or within thirty days of a qualified life
change event, you will not be able to enroll until the
next plan year’s open enrollment or you experience a
qualified life change event.

Carryover – Any unused Health Care Flexible
Spending Account (FSA) or Limited Purpose FSA
(LPFSA) funds over $500 at the close of the plan year
are not refundable. Any unused Dependent Day Care
FSA funds at the close of the plan year will be forfeited.
All unused Transit Account and Parking Account funds
carry over into the next plan year.
Important Program Changes for 2018
ERA Contribution Limits
• The annual Health Care FSA contribution limit will increase by $50, from $2,550 to $2,600.
• The annual Limited Purpose FSA contribution limit will increase by $50, from $2,550 to $2,600.
ERA Payroll Processing
• Contributions for all ERA programs will be distributed evenly over the course of the year, in accordance with
your payroll schedule.
• Biweekly: 24 pay periods | Monthly: 12 pay periods | 9-Month: 9 pay periods

TASC Customer Care
Phone 844-786-3947 or 608-316-2408
Monday – Friday, 8:00 a.m. to 5:00 p.m.

Online https://partners.tasconline.com/ETFEmployee
Email 1customercare@tasconline.com
Mail P.O. Box 7511
Madison, WI 53707

Fax 877-231-1287


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 2

We look
forward to
meeting your
ERA needs!
WELCOME WELCOME




Save on a wide variety of everyday medical, dental, vision, daycare, parking and transit
expenses with an Employee Reimbursement Account (ERA), also known as a Flexible
Spending Account (FSA). It’s a tax break that’s simple to use!

Employee Reimbursement Accounts

Health Care FSA
With a Health Care FSA, you may set aside, for yourself and your tax dependents, tax-free dollars each
year for eligible health care expenses not covered by insurance.



Limited Purpose FSA (LPFSA)
The LPFSA is an account you are eligible for if you enroll in a High-Deductible Health Plan (HDHP) and
participate in a Health Savings Account (HSA). It allows you to set aside additional money tax-free for
certain dental, vision, and post-deductible medical expenses.


Dependent Day Care FSA
With a Dependent Day Care FSA, pre-tax dollars may be used for day care or elder care expenses for
eligible dependents allowing you (or your spouse, if married) to work, look for work or attend school full
time.


Parking Account
A Parking Account allows you to pay for eligible work-related parking expenses with pre-tax dollars. You
can enroll and make changes anytime during the year.


Transit Account
With a Transit Account, pre-tax dollars can be used to pay for eligible transit expenses related to your
commute to work. You can enroll and make changes anytime during the year.

Annual Contribution Limits Pre-Tax Savings Example
ERA Pre-Tax Savings Programs 2018 2017 Without FSA With FSA
Health Care FSA Contribution Limit $2,600 $2,550 Gross Monthly Pay: $3,500 $3,500
Health Care FSA Carryover Limit $500 $500
Limited Purpose FSA Contribution Limit $2,600 $2,550 Pre-Tax Contributions $3,500 $3,500
Limited Purpose FSA Carryover Limit $500 $500 Medical/Dental Premiums $0 -$125
Dependent Day Care FSA Contribution Limit $5,000 $5,000 Medical Expenses $0 -$75
Dependent Day Care FSA Carryover Limit $0 $0 Dependent Care Expenses $0 -$400
Transit Account Contribution Limit $130/month* $130/month* Pre-Tax Savings Total: $0 -$600
Transit Account Carryover Limit Unlimited Unlimited
Parking Account Contribution Limit $255/month $255/month Taxable Monthly Income $3,500 $2,900
Parking Account Carryover Limit Unlimited Unlimited Taxes (Fed., State, FIC): -$968 -$802


*Contributions of $130 are pre-tax State and Federal. Employees may contribute up to $255 – however, contributions over $130
up to $255 would be pre-tax Federal and post-tax State.
Post-Tax Expenses: -$600 $0
Monthly Post-Tax Total: $1,932 $2,098
How ERA Plans Work Net Increase in Take-Home Pay: $166/month!
For illustration only. Actual dollar amounts may vary.
When you enroll in an ERA, you determine the dollar amount you want to contribute to each account based on
your estimated expenses for the upcoming plan year – January 1 to December 31, 2018. Your contributions will
be deducted in equal amounts from each paycheck, pre-tax, throughout the Plan Year.

The more you contribute to your ERA accounts, the more you reduce your taxable gross salary. When you pay
less in taxes, your take-home pay increases!


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 3

ERA OVERVIEW




A Health Care Flexible Spending Account (FSA) allows you to set aside tax-free dollars each year for
health care expenses not covered by insurance. You may use these funds to pay for eligible health
care expenses incurred by you, your spouse, and your qualified dependents.*
What are the benefits? How does it work?
• Pre-tax contributions reduce your taxable
income.
• Easiest way to pay for out-of-pocket eligible
health care expenses with tax-free money.
• Your total annual Health Care FSA contribution
amount is available immediately at the start of
the plan year.
• You can carry over up to $500 remaining in your
account from one plan year to the next, so there
is minimal “use-it or lose-it” risk.
• Multiple self-service tools available to easily
manage your TASC Account and TASC Card
transactions.


• Use the tax-savings calculator or annual expense
estimate worksheet to help determine how much
you should contribute per year.
• Your annual contribution is deducted pre-tax from
your paycheck in equal amounts throughout the
plan year and deposited into your TASC Account.
• As eligible health care expenses are incurred, you
can either use your TASC Card to pay at the point
of purchase or submit a request for
reimbursement.
• Manage your account 24/7 via the TASC Benefits
mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee.
Enrollment Eligibility
• Most full-time or part-time state and UW employees are eligible to participate in a Health Care FSA.
• Note: Employees who are classified as fellows, scholars, and research assistants in the UW System, as well as
limited term employees, student hourlies, per diems, and other temporary employees are not eligible.
• Note: Employees who are enrolled in a High Deductible Health Plan (HDHP) are not eligible. If you are enrolled
in an HDHP, see the Health Savings Account Enrollment Brochure and Limited Purpose Flexible Spending
Account information on pages 6 and 7 for benefit options.
Important Considerations
• The It’s Your Choice Health Plan imposes an annual deductible of $250 individual/ $500 family, office visit copays
and an annual out-of-pocket limit of $1,250 individual/ $2,500 family on most illness or injury related services in-
network. These expenses can be reimbursed through this account.
• Remaining Health Care FSA funds over $500 do not carry over. It is important to be conservative in making
elections because any unused funds over $500 left in your Health Care FSA at the close of the plan year are not
refundable to you.
• It is a participant’s responsibility to read and adhere to the ERA terms and conditions. By accepting and using
your TASC Card, you agree to the Cardholder Agreement. You are obligated to satisfy any documentation
requirements and to retain those documents and records for tax purposes or in the event of an IRS audit. Refer to
the TASC Card Section of the Employee Reimbursement Account (ERA) Participant Guide for more information.
• You may change your Health Care FSA elections during the plan year only if you experience a qualified life
change event, such as, a marriage or divorce, birth or adoption of a child, or a change in employment status.
Refer to the Change in Status During the Year Section in the ERA Participant Guide for more information.

Annual Health Care FSA Limits 2018 2017
Individual Health Care FSA Limit $2,600 $2,550
Annual Health Care FSA Carryover Max $500 $500 Note: The $2,600 contribution limit applies on an employee-by-employee
basis. Thus, $2,600 is the limit each employee may make per plan year,
regardless of the number of other individuals (spouse, dependent, etc.) whose
medical expenses are reimbursable under the employee’s Health Care FSA. If
two spouses are eligible for a Health Care FSA, each spouse may elect to
make contributions of up to $2,600 to his or her Health Care FSA, even if both
participate in the same Health Care FSA sponsored by the same employer.

This is the amount the Internal Revenue Service (IRS) allows to be
contributed to a Health Care FSA.

*Refer to the Health Care FSA – Qualified Dependents Section of the ERA Participant Guide for more
information.
TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 4

HEALTH SAVINGS
ACCOUNT
Annual Health Care FSA
Contribution Limits
HEALTH CARE FSA

Eligible Health Care FSA Medical Expenses

Below is a partial list of eligible expenses that are reimbursable through a Health Care FSA. Eligible expenses
can be incurred by you, your spouse, or qualified dependents. For more information, see your ERA Participant
Guide. For the complete list of eligible and ineligible expenses, visit www.IRS.gov and see IRS Publications 502
and 969.
Medical Expenses Dental Expenses
• Acupuncture
• Ambulance services
• Birth control/contraceptive devices
• Birth classes/Lamaze1
• Blood pressure monitor
• Blood sugar test kits/test strips
• Chiropractic therapy/exams/adjustments
• Co-payments
• Crutches1
• Flu shots
• Hearing aids and batteries1
• Incontinence supplies
• Insulin and diabetic supplies
• Infertility treatments
• Laboratory fees
• Lactation expenses
• Legal sterilization
• Physical exams
• Physical therapy1
• Sleep apnea services/products1
• Smoking cessation programs
• Treatment for alcohol or drug dependency
• Vaccinations
• Wrist supports/elastic straps
• X-ray fees

1: Restrictions may apply. See IRS Publication 502 for more details.

• Cleanings and exams
• Crowns and bridges
• Dental plan co-pays
• Dental surgery
• Dental x-rays
• Dentures
• Diagnostic services
• Fillings
• Orthodontia
• Root canals

Vision Expenses
• Contact lenses and
lens solution
• Diagnostic services
• Eye exams
• Eye surgery
• Laser eye
surgery/LASIK
• Optometrist/
ophthalmologist fees
• Prescription
eyeglasses and
sunglasses
• Seeing eye dog
(buying, training, and
maintaining)
• Vision plan co-
insurance
• Vision plan deductible

OTC Medicines and Drugs
Over-the-counter (OTC) medicines and drugs, except for
insulin, require a prescription from your physician to be
reimbursable with your Health Care FSA. The prescription
must be included with each request for reimbursement.
• Antihistamines
• Cold medicines
• Diaper rash ointments
• First Aid supplies
• Hemorrhoid treatments
• Nicotine patches
• Pain relievers
• Sinus medications
• Yeast infection
medications
Ineligible Health Care FSA Expenses
Note: If you pay for anything other than eligible expenses with your Health Care FSA, the amount will be
taxable, and you will be required to repay the amount or pay an additional tax penalty. Below is a partial
list of ineligible expenses. For more information, see your ERA Participant Guide. For the complete list of
eligible and ineligible expenses, visit www.IRS.gov and see IRS Publications 502 and 969.
• Athletic mouth guards
• Contributions to state disability funds
• Cosmetic supplies (makeup, cleansers,
moisturizers, etc.)
• Cosmetic surgery (unless due to trauma or
disease)
• Dental floss
• Diaper services
• Electrolysis or hair removal
• Eye drops for general comfort
• Funeral, cremation & burial expenses
• Gasoline
• Health club or athletic club membership dues


• Hygiene products
• Insurance premiums (all types)
• Marriage counseling
• Maternity clothes
• Medicare premiums
• Nutritional supplements and vitamins
• Sunglasses and sun clips (non-prescription)
• Safety classes (non-prescription)
• Swimming lessons
• Teeth whitening
• Toiletries
• Weight-loss programs (unless prescribed to treat
a specific disease)
TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 5




A Limited Purpose Flexible Spending Account (LPFSA) is a pre-tax benefit used to pay for eligible
dental, vision care, and post-deductible medical expenses for participants enrolled in a High-
Deductible Health Plan (HDHP) and a Health Savings Account (HSA). You may use these funds to pay
for eligible expenses incurred by you, your spouse, and your qualified dependents.*

What are the benefits? How does it work?
• The LPFSA is used to pay for eligible vision and
dental expenses that are not covered by your
insurance.
• It can also be used to pay for eligible post-
deductible medical expenses.
• Pre-tax contributions reduce your taxable income.
• Easiest way to pay for everyday out-of-pocket
eligible dental, vision, and post-deductible medical
expenses, with tax-free money.
• Your total annual LPFSA contribution amount is
available immediately at the start of the plan year.
• You can carry over up to $500 remaining in your
account from one plan year to the next, so there is
minimal “use-it or lose-it” risk.
• Multiple self-service tools available to easily
manage your TASC Account and TASC Card
transactions.


• The LPFSA is similar to the regular Health Care
FSA but is designed to work in conjunction with
your HDHP and HSA.
• Use our tax-savings calculator or annual
expense estimate worksheet to help determine
how much you should contribute per year.
• Your annual contribution is deducted pre-tax
from your paycheck in equal amounts
throughout the plan year and deposited into your
TASC Account.
• As eligible expenses are incurred, you can either
use your TASC Card to pay at the point of
purchase or submit a request for
reimbursement.
• Manage your account 24/7 via the TASC
Benefits mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee.

Enrollment Eligibility
• To be eligible for a LPFSA, you must be enrolled in a qualified HDHP and participate in a HSA.
• You must meet the eligibility criteria for a HDHP and HSA to enroll in an LPFSA.
• Employees who are not enrolled in an HDHP are not eligible for an LPFSA.
o If you are not enrolled in an HDHP, see Health Care Flexible Spending Account information on
pages 4 and 5 for benefit options.
o The LPFSA cannot be paired with a Health Care FSA.
o Note: Participation in the HSA and/or LPFSA has no bearing on participation in the Dependent Day
Care FSA, Parking Account, or Transit Account.
• Most full-time or part-time state and UW employees are eligible to participate in an LPFSA.
• Note: Employees who are classified as fellows, scholars, and research assistants in the UW System, as well
as limited term employees, student hourlies, per diems, and other temporary employees are not eligible.

Annual LPFSA Limits 2018 2017
LPFSA Contribution Limit $2,600 $2,550
LPFSA Carryover Limit $500 $500
Note: The $2,600 contribution limit applies on an employee-by-
employee basis. Thus, $2,600 is the limit each employee may
make per plan year, regardless of the number of other
individuals (spouse, dependent, etc.) whose medical expenses
are reimbursable under the employee’s LPFSA. If two spouses
are eligible for a LPFSA, each spouse may elect to make
contributions of up to $2,600.

This is the amount the Internal Revenue Service (IRS) allows to be contributed
to a LPFSA.
*Refer to the LPFSA – Qualified Dependents Section of the ERA Participant guide for more information.
TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 6

HEALTH SAVINGS
ACCOUNT
Annual LPFSA Contribution Limits
LIMITED PURPOSE
FSA

Important Considerations
• Keep in mind that the LPFSA can only be used to pay for eligible dental, vision, and post-deductible medical
expenses.
• Post-deductible medical expenses must be submitted online via your TASC Online account.
• Remaining LPFSA funds over $500 do not carry over. It is important to be conservative in making elections
because any unused funds over $500 left in your LPFSA at the close of the plan year are not refundable.
• It is a participant’s responsibility to read and adhere to the ERA terms and conditions.
• By accepting and using your TASC Card, you agree to the Cardholder Agreement. You are obligated to
satisfy any documentation requirements and to retain those documents and records for tax purposes or in
the event of an IRS audit. Refer to the TASC Card Section in the ERA Participant Guide for more
information.
• You may change your LPFSA elections during the plan year only if you experience a qualified life change
event, such as, a marriage or divorce, birth or adoption of a child, or a change in employment status. Refer
to the Change in Status During the Year Section in the ERA Participant Guide for more information.

Eligible Limited Purpose FSA Expenses
Below is a partial list of eligible expenses that are reimbursable through an LPFSA. Eligible expenses can be
incurred by you, your spouse, or qualified dependents. For more information, see your Employee
Reimbursement Account (ERA) Participant Guide. For the complete list of eligible and ineligible expenses, visit
www.IRS.gov and see IRS Publications 502 and 969.

Dental Expenses Vision Expenses
• Cleanings and exams
• Crowns and bridges
• Dental plan co-pays
• Dental plan co-insurance
• Dental plan deductibles
• Dental reconstruction and implants
• Dental surgery
• Dental x-rays
• Dentures
• Diagnostic services
• Fillings
• Occlusal guards
• Orthodontia
• Over-the-counter dental products that contain a
drug or medication1
• Root canals
• Contact lenses and lens solution
• Diagnostic services
• Eye exams
• Eye related equipment/materials/repair kits
• Eyeglasses (over-the-counter and prescription)
• Eye surgery
• Laser eye surgery/LASIK
• Optometrist/ophthalmologist fees
• Orthokeratology
• Over-the-counter vision products that contain a
drug or medication1
• Seeing eye dog (buying, training, and
maintaining)
• Sunglasses (prescription only)
• Vision plan co-insurance
• Vision plan deductibles
1: Over-the-counter dental and vision medications and drugs require a prescription to be LPFSA eligible. Restrictions may apply. See IRS Publications 502
and 969 for more details.
Note: After you meet your health plan’s deductible, you may be reimbursed for all eligible medical expenses,
such as co-payments, physical exams, and vaccinations. Reimbursements for post-deductible medical
expenses must be submitted online. Expenses may be incurred by you, your spouse, or qualified dependents.
Ineligible LPFSA Expenses
Note: If you pay for anything other than eligible expenses with your LPFSA, the amount will be taxable,
and you will be required to repay the amount or pay an additional tax penalty. Below is a partial list of
ineligible expenses. For more information, see your ERA Participant Guide. For the complete list of eligible and
ineligible expenses, visit www.IRS.gov and see IRS Publications 502 and 969.

• Elective cosmetic surgery
• Eye serums or wrinkle creams
• Insurance premiums


• Mouthwash
• Teeth bleaching/whitening
• Toothpaste and toothbrushes
TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 7





A Dependent Day Care Flexible Spending Account (FSA) is a pre-tax benefit used to pay for eligible
day care expenses for qualified dependents in order for you (or your spouse) to work, look for work, or
attend school full-time.

What are the benefits? How does it work?
• Pre-tax contributions reduce your taxable
income.
• Your Dependent Day Care FSA Funds become
available to you as payroll deductions are taken.
• Easiest way to pay for everyday out-of-pocket
eligible dependent day care and/or elder care
expenses, with tax-free money.
• Multiple self-service tools available to easily
manage your TASC Account and TASC Card
transactions.
• Use your TASC Card to pay for eligible
dependent day care expenses, or easily submit
requests for reimbursement online.


• Use our tax-savings calculator or annual expense
estimate worksheet to help determine how much
you should contribute per year.
• Your annual contribution is deducted pre-tax from
your paycheck in equal amounts throughout the
plan year and deposited into your TASC Account.
• The Dependent Day Care FSA is a money-in
money-out benefit. Each pay period a contribution
posts to your account, after which you may submit
reimbursement requests for eligible expenses.
• Manage your account 24/7 via the TASC Benefits
mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee

Enrollment Eligibility
• Most full-time or part-time state and UW employees are eligible to participate in a Dependent Day Care FSA.
• Note: Employees who are classified as fellows, scholars, and research assistants in the UW System, as well
as limited term employees, student hourlies, per diems, and other temporary employees are not eligible.

• For a married individual to be eligible for the Dependent Day Care FSA, your spouse must be unable to
provide dependent day care and/or elder care because he/she works full-time, is actively looking for work,
enrolled in or attending school full-time, or physically/mentally incapable of self-care.

Important Considerations
• The Dependent Day Care FSA is not eligible for annual carryover. It is important to be conservative in
making elections because any unused funds in your Dependent Day Care FSA at the close of the plan year
are not refundable to you.
• It is a participant’s responsibility to read and adhere to the ERA terms and conditions.
• By accepting and using your TASC Card, you agree to the Cardholder Agreement. You are obligated to
satisfy any documentation requirements and to retain those documents and records for tax purposes or in
the event of an IRS audit. Refer to the TASC Card Section in the ERA Participant Guide for more
information.
• You may change your Dependent Day Care FSA elections during the plan year only if you experience a
qualified life change event, such as, a marriage or divorce, birth or adoption of a child, or a change in
employment status. Refer to the Change in Status During the Year Section in the Employee Reimbursement
Account (ERA) Participant Guide for more information.

Annual Dependent Day Care Limits 2018 2017
Dependent Day Care FSA Contribution Limit $5,0001 $5,0001

Dependent Day Care FSA Carryover Limit $0 $0
This is the amount the Internal Revenue Service (IRS) allows to be
contributed to a Dependent Day Care FSA.


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 7

HEALTH SAVINGS
ACCOUNT
Annual Dependent Day Care
Contribution Limits
DEPENDENT DAY
CARE FSA
1: Restrictions may apply.

Additional Dependent Day Care FSA Criteria
• Dependent Day Care FSA expenses must be work related. The care must be necessary for you (and your
spouse) to work, look for work, or attend school full-time, or if you are physically unable to care for your
eligible tax dependent.
• Dependent Day Care FSA expenses submitted for reimbursement during a calendar year may not exceed
$5,000.
• The IRS sets the annual contribution limits for the Dependent Day Care FSA. You can contribute up to a
maximum of:
o $2,500 per year if you are married and file a separate tax return.
o $5,000 per year if you are married and file a joint tax return, or if you are single or head of household.
• If you and your spouse are both eligible to contribute to a Dependent Day Care FSA through your
respective employers, you and your spouse cannot each claim $5,000. The individual limit is $2,500.
• Dependent Day Care FSA is not eligible for annual carryover. All claims must be incurred by December 31
and submitted by March 31. Any unused funds left in your Dependent Day Care FSA at the close of the plan
year (December 31) are not refundable to you and will be forfeited.
• Special considerations apply to parents who are divorced or separated. A child is a qualified dependent for
the custodial parent only, which is the parent with the greater portion of custody during the calendar year, no
matter who is entitled to the tax deduction for the child.
• Note: Dependent Day Care FSA can only be used for care of eligible dependents, not for health care
expenses.

Eligible Dependent Day Care FSA Expenses
Below is a partial list of eligible expenses that are reimbursable through a Dependent Day Care FSA. Eligible
expenses may only be incurred by your qualified dependent(s). Health care expenses are not eligible. For more
information, see your ERA Participant Guide. For the complete list of eligible and ineligible expenses, visit
www.IRS.gov and see IRS Publication 503.

• Adult daycare
• After-school and before-school care/program2
• Au pair/nanny salary and fees
• Babysitting in your home or someone else’s home1
• Babysitting by your relative who is not a tax
dependent 1
• Care when one parent works days and other parent
works nights1
• Care while looking for work
• Care while on family, personal or medical leave
• Care while you/spouse is working at self-
employment1
• Child daycare or day camp2
• Custodial elder care1

• Employer-provided on-site daycare2
• Federal employment taxes (FICA, FUTA) of
Dependent Day Care provider
• Household services related to dependent care
• In-home care1
• Nighttime care1
• Nursery school/ preschool fees or tuition
• Payroll taxes related to eligible dependent care
• Room and board for caregiver (au pair, nanny, etc.)
• Senior daycare1
• Sick child care1
• Specialized daycare
• Transportation to and from eligible dependent care
(provided by the care provider)
1: Care must be work-related. Restrictions may apply. See IRS Publication 503 for more details.
2: Primary purpose must be custodial care, and not educational in nature. See IRS Publication 503 for more details.


Ineligible Dependent Day Care FSA Expenses
Note: If you pay for anything other than eligible expenses with your Dependent Day Care FSA, the
amount will be taxable, and you will be required to repay the amount or pay an additional tax penalty.
Below is a partial list of ineligible expenses. For more information, see your ERA Participant Guide at
https://partners.tasconline.com/ETFEmployee For the complete list of eligible and ineligible expenses, visit
www.IRS.gov and see IRS Publication 503.

• Child care while performing volunteer work
• Educational, learning, or study skills services
• Field trips or sleep-away camp
• Health care or expenses
• Household services (housekeeper, cook, etc.)

• Kindergarten/school tuition
• Meals, food or snacks
• Nursing home care for dependent adult(s)
• Summer school

TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 9




Qualified Dependents
Eligibility for the Dependent Day Care Flexible Spending Account (FSA) requires that certain criteria be met.
Dependent Day Care FSA expenses must be for the care of one or more qualifying individuals, defined as the
following:
• A dependent under the age of 13 and for whom a tax exemption can be claimed. Within 30 days of
dependent reaching age 13 (but no later) you may reduce the Dependent Day Care FSA annual election,
to reflect the total reimbursement or total contribution amount (whichever is greater).
• A spouse who is physically or mentally incapable of self-care, and lives with you for more than half the
year.
• A dependent who is physically or mentally incapable of self-care, for whom a tax exemption can be
claimed, and who lives with you for more than half the year.
• An elderly parent who lives with you at least half of the year. The care must be incurred while you (or
your spouse) are at work, looking for work, or attending school full-time. Care outside the home is eligible
if the dependent spends at least eight hours a day in your home.
• Note: Special rules apply to children of divorced or separated parents. See Additional Criteria for
Children of Divorced or Separated Parents.

Additional Criteria for Children of Divorced or Separated Parents
Even if you cannot claim your child as a tax exemption or tax dependent, he or she is treated as your qualifying
dependent if all of the following are true:
• The child is under age 13 and is not physically or mentally capable of self-care.
• One or both parents provide more than half of the child’s support for the year.
• Parents are divorced, legally separated, or lived apart at all times during the last six (6) months of the
calendar year.
• One or both parents has custody of the child for more than half the year.
• You are the parent with the higher adjusted gross income in a 50/50 custody arrangement.
• You are the child’s custodial parent, defined as the parent with custody for the greater portion of the
calendar year; OR if parents have equal custody (same number of nights), then the parent with the
higher adjusted gross income is the custodial parent.

Note: For a noncustodial parent, the child’s expenses are not eligible for the Dependent Day Care FSA, even if
said parent is financially responsible for providing the care, and even if said parent is entitled to claim the child
as a dependent.
• Only the custodial parent qualifies for the Dependent Day Care FSA for a taxable year.
• A noncustodial parent may not submit expenses for the portion of the year in which they have custody of
the child.

Important Care Provider Information
• All persons and organizations providing dependent care must be identified on IRS Form 2441.
• The provider name, address, and taxpayer identification number (or Social Security number) must be
included.
• If a center provides care for more than six (6) individuals, the center must comply with all state and local
regulations.
• Payments made to relatives who are not dependents can be included, but not to a dependent for whom you
can claim an exemption or for your child who is under age 19 at the end of the year (regardless of whether
he or she is your dependent).
• You may use IRS Form W-10 to request the required information from the care provider.


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 10
DEPENDENT DAY CARE FSA
ADDITIONAL INFORMATION




A Parking Account allows you to pay for eligible work-related parking expenses with pre-tax dollars.

What are the benefits? How does it work?
• Pre-tax contributions reduce your taxable
income.
• Easiest way to pay for eligible parking
expenses, with tax-free money.
• Your Parking Account funds become available
to you as payroll deductions are taken.
• Eligible for unlimited carryover, so there is
minimal “use-it-or-lose-it” risk.
• You can enroll or make changes to your account
at any time during the plan year.



• Use our tax-savings calculator or annual
expense estimate worksheet to help determine
how much you should contribute per year.
• Your annual contribution is deducted pre-tax
from your paycheck in equal amounts
throughout the plan year and deposited into
your TASC Account.
• Manage your account 24/7 via the TASC
Benefits mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee.

Enrollment Eligibility
• Most active state and UW employees, including limited term employees, are eligible to participate in a
Parking Account.
• Note: Spouses and dependent children are not eligible. If you park at your place of employment, your
deductions may already be taken pre-tax. These deductions are not reimbursable through this program.
• Note: Student Assistants who are classified as fellows, scholars, and trainees in the UW System, as well as
employees-in-training who are classified as grad intern/trainee or post-doc fellow/trainee, are not eligible.


Eligible Parking Expenses Parking Account Contribution Limit
Below is a partial list of eligible expenses that are
reimbursable through a Parking Account. For more
information, see your Employee Reimbursement Account
(ERA) Participant Guide. For the complete list of eligible
and ineligible expenses, visit www.IRS.gov and see IRS
Publication 5137.
2017 2016
Contribution Limit $255/month $255/month
Carryover Limit Unlimited Unlimited

This is the amount the Internal Revenue Service (IRS) allows to be
contributed to a Parking Account per month.
• Metered parking
• Daily/monthly parking fees for parking lots/ramps
• Park n’ ride lots
• Parking at mass transit facilities


Ineligible Parking Account Expenses
If you pay for anything other than eligible expenses with your parking and/or transit account(s), the amount
will be taxable, and you will be required to repay the amount or pay an additional tax penalty. Below is a partial
list of ineligible expenses. For more information, see your ERA Participant Guide. For the complete list of eligible and
ineligible expenses, visit www.IRS.gov and see IRS Publications 5137.

Note: If you park at your place of employment, your deductions may already be taken pre-tax. These deductions are
not eligible.


• Airline flights
• Bicycle-related expenses
• Expenses incurred traveling from an office to
business or client meetings
• Non-work related parking expenses
• Parking for business meetings

• Residential parking fees
• Tolls, gas, or other driving-related costs
• Transit costs reimbursed your employer
• Transit or parking expenses for spouses and
dependents
• Tunnel, bridge, or highway tolls (EZ Pass, etc.)

TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 11

HEALTH SAVINGS
ACCOUNT
Note: Parking and Transit are separate
benefits. Please choose the commuter
benefit(s) that best meets your needs.
PARKING
ACCOUNT




A Transit Account lets you use pre-tax dollars to pay for eligible mass transit expenses related to your
commute to and from work.

What are the benefits? How does it work?
• Pre-tax contributions reduce your taxable
income.
• Easiest way to pay for eligible transit expenses,
with tax-free money.
• Your Transit Account funds become available to
you as payroll deductions are taken.
• Eligible for unlimited carryover, so there is
minimal “use-it-or-lose-it” risk.
• You can enroll or make changes to your account
at any time during the plan year.


• Use our tax-savings calculator or annual expense
estimate worksheet to help determine how much
you should contribute per year.
• Your annual contribution is deducted pre-tax from
your paycheck in equal amounts throughout the
plan year and deposited into your TASC Account.
• Manage your account 24/7 via the TASC Benefits
mobile app or TASC Online account at
https://partners.tasconline.com/ETFEmployee.

Enrollment Eligibility
• Most active state and UW employees, including limited term employees, are eligible to participate in a
Transit Account.
• Note: Spouses and dependent children are not eligible. Employees who are also enrolled in a State of
Wisconsin pre-tax transit or vanpool program are not eligible.
• Note: Student Assistants who are classified as fellows, scholars, and trainees in the UW System, as well as
employees-in-training who are classified as grad intern/trainee or post-doc fellow/trainee, are not eligible.


Eligible Transit Expenses Transit Account Contribution Limit
Transit Accounts help pay expenses related to your
work commute. Below is a partial list of eligible
expenses that are reimbursable through a Transit
Account. For more information, see your Employee
Reimbursement Account (ERA) Participant Guide. For
the complete list of eligible and ineligible expenses,
visit www.IRS.gov and see IRS Publication 5137.

2017 2016
Contribution Limit $130/month $130/month
Carryover Limit Unlimited Unlimited
This is the amount the Internal Revenue Service (IRS) allows to be
contributed to a Transit Account per month. Contributions of $130 are pre-
tax State and Federal. Employees may contribute up to $255; however
contributions between $130 and $255 would be pre-tax Federal and post-
tax State.
• Bus passes
• Subway vouchers,
passes or tokens
• Vanpooling fees
• Train vouchers,
passes or tokens

Ineligible Transit Account Expenses
If you pay for anything other than eligible expenses with your parking and/or transit account(s), the amount
will be taxable, and you will be required to repay the amount or pay an additional tax penalty. Below is a partial
list of ineligible expenses. For more information, see your ERA Participant Guide. For the complete list of eligible and
ineligible expenses, visit www.IRS.gov and see IRS Publications 5137. Note: If you park at your place of
employment, your deductions may already be taken pre-tax. These deductions are not eligible.


• Airline flights
• Bicycle-related expenses
• Expenses incurred in traveling from an office to
business or client meetings
• Non-work related transportation or parking
expenses
• Parking for business meetings

• Residential parking fees
• Tolls, gas, or other driving-related costs
• Transit costs reimbursed your employer
• Transit or parking expenses for spouses and
dependents
• Tunnel, bridge, or highway tolls (EZ Pass, etc.)

TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 12

HEALTH SAVINGS
ACCOUNT
Note: Transit and Parking are separate benefits. Please
choose the commuter benefit(s) that best meets your needs.
TRANSIT ACCOUNT




Annual It’s Your Choice Open Enrollment Period: October 2 – 27, 2017
2018 Benefit Period: January 1 – December 31, 2018
Enroll During It’s Your Choice
• Visit www.etf.wi.gov/IYC2018 for It’s Your Choice
Open enrollment information.
• You have three ways to enroll during the It’s Your
Choice Open Enrollment Period:
o Online
o Paper
o Telephone
• You can request a paper application from your
payroll or benefits office, or download a copy from
the TASC or ETF website.
• Your election will be effective January 1, 2018.
• Note: If you are already enrolled in an Employee
Reimbursement Account (ERA), you must
re-enroll each year to continue participation.
Enrollments do not carry forward from year to year.

State of Wisconsin & STAR State Employees
• State of Wisconsin, Courts, and Legislature
employees who are paid through the STAR System
should log in to STAR at https://ess.wi.gov to make all
benefits elections during the annual It’s Your Choice
period. Contact your agency payroll and benefits staff
with any enrollment questions.
UW System Employees
• Enrollments are done directly through the UW, not
the TASC portal/website.
• UW System employees should refer to
www.wisconsin.edu/ohrwd/benefits or contact your
UW institution human resources department for
enrollment instructions for 2017.
If You Are a Newly Hired Employee WEDC Employees
• If you are electing to enroll in an ERA, you must
enroll within 30 days of your date of hire (in an
eligible position), or first eligible appointment.
• Coverage will be effective on the first of the month on
or following your eligibility date.
• For more information and enrollment instructions,
contact your human resources/benefits office.
• Enrollments are done directly through WEDC, not the
TASC portal/website.
• WEDC employees should refer to
OneLogin>Kronos>My Account>My Benefits>
Review/Select Benefits or contact WEDC human
resources for enrollment instructions for the 2018
plan year.

If You Have Experienced a Qualifying Life Change Event
• If you experience a qualified life change event, such as a marriage or divorce, birth or adoption of a child, a
change in employment status, or another qualified life change event, you may have the opportunity to enroll or
change your coverage outside of the open enrollment period.
• There are various rules related to life change events. You must enroll or make changes within 30 days from the
date of the qualifying event.
• Contact your human resources/benefit office for more information on qualifying life change events to see what
your options are, how to enroll, and how to make a change.

Following Enrollment
Once you have enrolled in the ERA, TASC will send these items to you:
ERA Welcome Brochure
• The ERA Welcome Brochure will provide you with
information on how to manage your ERA.
• Follow the instructions to set-up your TASC Online
account.
o Note: Don’t forget to update your TASC Online
username and password!
• Use your online account to check your balance, submit
claims, and manage your notifications.

TASC Card
• Your TASC Card allows you to conveniently pay for
eligible expenses.
• Be sure to review the Cardholder Agreement affixed to
the card.
• Note: If you are a current TASC participant, you will not
be issued a new TASC Card. You will continue to use
your current TASC Card.


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 13

HOW TO ENROLL

Enroll with TASC Online
1. Determine desired annual contribution amount.
a. See page 15 of this ERA Enrollment Brochure for the
ERA Annual Expense Estimate Worksheet.
2. Go to the TASC Online website:
http://partners.tasconline.com/ETFemployee
a. If you are a new TASC Participant, enter a
temporary TASC username and password. This is
your first initial, last name, date of birth (mmddyy),
and the last four digits of your Social Security
Number (SSN).
• For example: JSmith0101771234
b. If you are a current TASC participant, enter your
current TASC username and password.
• If you do not remember your username or
password, click Forgot Username or
Password and follow the reset steps
provided.
2. Once logged in to your TASC Online Account, click
Enroll Now.
3. In the Enrollment pop-up menu, select the radial
button which correlates to the plan type in which you
wish to enroll – HSA or ERA.
a. To enroll in any of the ERA programs, select the
second radial button.
b. Note: There are only two radial button options. All
five ERA program offerings correlate to the second
radial button.
c. If you are planning to enroll in the HSA, you will need
to repeat the enrollment process from this screen
forward.
4. Review plan details and ERA qualifications to ensure
you are eligible for an ERA.
a. Note: If you are enrolled in a High-Deductible Health
Plan (HDHP), you are not eligible for the Health Care
Flexible Spending Account (FSA). See the Health
Savings Account (HSA) Enrollment Brochure or
Limited Purpose Flexible Spending Account (LPFSA)
information on pages 6 and 7 for benefit options.
5. When you are ready to continue, click Begin Your
Enrollment Now in the upper right corner.
6. Enter your information.
a. We recommend adding your personal email address.
b. Click Continue.
7. If applicable, add your dependent(s).
a. Enter the name(s) of your dependent(s).
b. Click Add Dependent.
c. Your dependent(s) will be displayed on the Eligible
Dependents list.
d. Click Continue.
8. Review the plan rules.
a. Check the acknowledgement box indicating that
you have read the plan rules and agree to them.
b. Note: You must do this for every plan, even for
plans in which you are not enrolled.
c. Click Continue.
9. Enter your election amount.
a. Enter your desired election amount for the ERA
program in which you are enrolling.
• Annual election: Health Care FSA, Limited
Purpose FSA, and Dependent Day Care
FSA.
• Monthly election: Parking Account and
Transit Account.
b. It is your responsibility to ensure your contributions
do not exceed the IRS maximum annual limits.
c. Click Continue.
10. Select your reimbursement Payment Method.
a. You will automatically be enrolled to receive a TASC
Card (aka Benny Debit Card).
b. Select your preferred method to receive
reimbursements for claims filed online.
c. If you elect direct deposit, you will need to enter your
bank information.
d. Click Continue.
11. Verify, submit, and print.
a. Carefully review each section on the Enrollment
Verification page and verify that your enrollment
information is correct.
b. If any changes are required, click Edit Information.
c. When you have verified that everything is correct,
print a copy of the Enrollment Verification page for
your records.
d. Click Submit to complete your enrollment.
12. Check your email for an enrollment confirmation
message from TASC.
TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 14
Reminder: If you are a UW System employee,
a WEDC employee, or a State of Wisconsin,
Courts, or Legislature employee paid through
the STAR system, do not enroll via TASC
Online or by phone. See the prior page for
enrollment details.





This worksheet is intended to assist you with the enrollment process by helping you calculate your applicable
expenses and determine which Employee Reimbursement Account (ERA) offerings are right for you. Enter your
expenses below and determine the appropriate amount(s) to contribute to your ERA Account(s).

Medical/Dental/Vision Reimbursement Account
Annual medical expenses, such as:
Deductibles and co-pays $ ______________
Physician visits $ ______________
Prescriptions $ ______________
Other:_______________________ $ ______________

Annual dental expenses, such as:
Deductibles and co-pays $ ______________
Routine check-ups $ ______________
Orthodontia $ ______________
Other:_______________________ $ ______________
Annual vision expenses, such as:
Exams $ ______________
Eyeglasses $ ______________
Contact lenses, solutions, cleaners $ ______________
Other:_______________________ $ ______________
Total Estimated
Medical/Dental/Vision Expenses:

$

_________________
Annual Amount
(Cannot exceed $2,600 IRS
maximum)

÷

_________________
# of Pay Periods**

= $

_________________
Per Pay Period

Dependent Day Care Reimbursement Account
Annual dependent day care expenses, such as:
Payment to dependent care facility or
individual

$

______________

Payment to other care providers $ ______________
Other:_______________________ $ ______________
Total Estimated
Dependent Day Care Expenses:

$

______________
Annual Amount
(Cannot exceed $5,000 IRS
maximum)

÷

______________
# of Pay Periods**

= $

______________
Per Pay Period

Parking & Transit Reimbursement Accounts
Annual parking and/or transit expenses, such as:
Parking fees for lots and/or ramps $ ______________
Bus/train passes or vouchers $ ______________
Vanpooling fees $ ______________
Other:_______________________ $ ______________
Total Estimated
Parking/Transit Expenses:

$

______________
Annual Amount*

÷

______________
# of Pay Periods**


= $

______________
Per Pay Period

*Cannot exceed IRS maximum $255/month ($3,060/year) for parking and $130/month ($1,560/year) for transit. Up to
$255/month ($3,060/year) is allowed for transit. Contributions between $130 and $255 are pre-tax Federal and post-tax State.
Total Per-Pay-Period Reduction $
Per Pay Period Add the total estimated medical/dental/vision expenses and the total dependent day care estimate.
**Biweekly: 24 pay periods | 12-Month: 12 pay periods | 9-Month: 9 pay periods


TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com 15
EMPLOYEE REIMBURSEMENT ACCOUNT
ANNUAL EXPENSE ESTIMATE WORKSHEET




TASC CARD
• Access your ERA funds wherever you are – just swipe to deduct
funds from your account.
• A great alternative to submitting paper requests for reimbursements.
• Automatic verification of most eligible expenses.

TASC Online Account
• Instant access to your account information and account balance 24/7.
• Easy access to your contribution and reimbursement histories.
• Access helpful online tools like tax savings calculators, health care
expense tables, and more.
• Self-service feature available, such as signing up for direct deposit,
ordering additional TASC cards, and managing your notifications.

TASC Benefits Mobile App
• Access your account information and account balance – no matter
where you are!
• Submit contribution and reimbursement requests by taking pictures of
your receipts with your mobile device camera.
• Download the TASC Mobile App is available for Apple and Android
phones – just search for “eflex Benefits” in the App Store or
Marketplace.








TASC Customer Care | Phone 844-786-3947 or 608-316-2408 | Email 1customercare@tasconline.com



HEALTH SAVINGS
ACCOUNT
TASC TOOLS
It’s Your Choice
Open Enrollment Period October 2 – 27, 2017


After enrollment, don’t forget to:
• Set-up your TASC Online
Account.
• Check your email for a link
to the ERA Welcome
Brochure.
• Check your mail for your
TASC Card and Cardholder
Agreement.

Discrimination is Against the Law 45 C.F.R. § 92.8(b)(1) & (d)(1)
Total Administrative Services Corporation complies with applicable
Federal civil rights laws and does not discriminate on the basis of
race, color, national origin, age, disability, or sex. TASC does not
exclude people or treat them differently because of race, color,
national origin, age, disability, or sex.

TASC provides free aids and services to people with disabilities to
communicate effectively with us, such as qualified sign language
interpreters and written information in other formats.

TASC provides free language services to people whose primary
language is not English, such as qualified interpreters and
information written in other languages. If you need these services,
contact TASC’s Civil Rights Coordinator.

If you believe that TASC has failed to provide these services or
discriminated in another way on the basis of race, color, national
origin, age, disability, or sex, you can file a grievance with: Civil
Rights Coordinator, 2302 International Way, Madison, WI 53704;
Phone: 1-608-316-2408; Fax: 1-877-231-1287; Email:
CivilRightsCoordinator@tasconline.com.

You can file a grievance in person or by mail, fax, or email. If you
need help filing a grievance, TASC’s Civil Rights Coordinator is
available to help you.

You can also file a civil rights complaint with the U.S. Department of
Health and Human Services, Office for Civil Rights electronically
through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence
Avenue SW., Room 509F, HHH Building, Washington, DC 20201,
1-800-868-1019, 800-537-7697 (TDD).

Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.

ATENCIÓN: si habla español, tiene a su disposición servicios
gratuitos de asistencia lingüística. Llame al 1-608-316-2408.

LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus,
muaj kev pab dawb rau koj. Hu rau 1-877-533-5020 (TTY: 1-800-
947-3529).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致
電1-877-533-5020 (TTY: 1-800-833-7813).



ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos
sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-
533-5020 (TTY: 1-800-947-3529).

مقر) 877-533-5020-1 ةظوحلم: اذإ تنك ثدحتت ركذا ،ةغللا نإف تامدخ ةدعاسملا
ةیوغللا.(800-947-3529-1 :فتاھ مصلا مكبلاو رفاوتت كل ناجملاب. لصتا مقرب

ВНИМАНИЕ: Если вы говорите на русском языке, то вам
доступны бесплатные услуги перевода. Звоните 1-877-533-5020
(телетайп: 1-800-947-3529).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로
이용하실 수 있습니다. 1-877-533-5020 (TTY: 1-800-947-
3529).번으로 전화해 주십시오.

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ
miễn phí dành cho bạn. Gọi số 1-877-533-5020 (TTY: 1-800-947-
3529).

Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht,
kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die
englisch Schprooch. Ruf selli Nummer uff: Call 1-877-533-5020
(TTY: 1-800-947-3529).

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ

້ າພາສາ ລາວ, ການບ



ການຊ່ວຍເຫ

ຼື
ອດ້ານພາສາ,
ໂດຍບ

່ ເສັຽຄ່າ, ແມ່ນມ

ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-877-533-5020 (TTY: 1-
800-947-3529).

ATTENTION : Si vous parlez français, des services d'aide
linguistique vous sont proposés gratuitement. Appelez le 1-877-
533-5020 (ATS : 1-800-947-3529).

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej
pomocy językowej. Zadzwoń pod numer 1-877-533-5020 (TTY: 1-
800-947-3529).

ध्यान द
ें
: यदद आप ह िंदी बोलत ेह
ैं
तो आपके ललए म

फ्त म
ें
भाषा सहायता सेवाएं
उपलब्ध ह
ैं
। 1-877-533-5020 (TTY: 1-800-947-3529) पर कॉल कर
ें

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të
asistencës gjuhësore, pa pagesë. Telefononi në 1-877-533-5020
(TTY: 1-800-947-3529).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit
ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag
sa 1-877-533-5020 (TTY: 1-800-947-3529).