Dependent Care Account

Set aside tax-free money for daycare and dependent care services

Use the below information to determine if a Dependent Care Account (DCA) is right for you and how to best take advantage of an DCA account.

How It Works

When you enroll in a Dependent Care Account (DCA) you get to experience tax savings on expenses like daycare, elderly care, summer day camp, preschool, and other services that allow you to work full time.

The Value & Perks

• Save On Eligible Expenses: You can use a DCA to pay for qualifying expenses such as daycare, summer day care, elder care, before and after school programs, and pre-school.

• Keep More Money: The funds are taken out of your paycheck "pre-tax" (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. Let’s say you earn $40,000 a year and contribute $1,500 to an DCA; so, only $38,500 of your income gets taxed. That means you are increasing your take-home pay simply by participating!

• Easy Spending and Account Management: You will receive an Ameriflex Debit Mastercard linked to your DCA. You can use your card for eligible purchases everywhere Mastercard is accepted. Account information can be securely accessed 24/7 online and through the mobile app.

Eligible DCA Expenses

The IRS determines what expenses are eligible under a DCA. Below are some examples of common eligible expenses:

For a full list of eligible expenses, go to myameriflex.com/eligibleexpenses.

Online Account Instructions

How to Access Your Ameriflex Account: Go to MyAmeriflex.com and click “Login” from the upper right hand corner. When prompted, select “Participant.”

How to Register Online For Your Ameriflex Spending Account: Click the register button atop the right corner of the home screen.

1.As the primary account holder, enter your personal information.

• Choose a unique User ID and create a password (if you are told that your username is invalid or already taken, you must select another).

• Enter your first and last name.

• Enter your email address.

• Enter your Employee ID, which in most cases, will be the account holder’s Social Security Number(no dashes or spaces needed).

2.Check the box if you accept the terms of use.

3.Click 'register'. This process may take a few seconds. Do not click your browser’s back button or refresh the page.

4.Last, you must complete your Secure Authentication setup. Implemented to protect your privacy and help us prevent fraudulent activity, setup is quick and easy. After the registration form is successfully completed, you will be prompted to complete the secure authentication setup process:

Step 1: Select a Security Question option, and type in a corresponding answer.

Step 2: Repeat for the following three Security Questions, then click next.

Step 3: Verify your email address, and then click next.

Step 4: Verify and submit setup information,

5.The registration process is complete! Should you receive an information error message that does not easily guide you through the information correction process, please feel free to contact our dedicated Member Services Team at 888.868.FLEX (3539).

Want to Manage Your Account on the go?

Download the MyAmeriflex mobile app, available through the App Store or Google Play.

Your credentials for the MyAmeriflex Portal and the MyAmeriflex Mobile App are the same; there is no need for separate login information!

Delta Dental PPO plus Premier™ Summary of Dental Plan Benefits For Group# 10129-1000, 1099 Chapel Hill-Carrboro City Schools

This Summary of Dental Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your Delta Dental plan, including information about plan exclusions and limitations. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's Maximum Approved Fee for each service and it may vary due to the Dentist's network participation.*

Control Plan – Delta Dental of North Carolina

Policy Year – September 1 through August 31

Covered Services –

*When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference.

The explanation and sample calculation of how these services will be paid can be found in Section VI – How Payment is Made in your Certificate.

 Oral exams (including evaluations by a specialist) are payable twice per benefit year.

 Two prophylaxes (cleanings) and/or up to four periodontal maintenance are payable per benefit year, not to exceed a total of four procedures in any benefit year.

 People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment.

 Fluoride treatments are payable twice per benefit year for people age 15 and under.

 Benefits for space maintainers are unlimited for people age 18 and under.

 Bitewing X-rays are payable once per Benefit Year and full mouth X-rays (which include bitewing X-rays) or a panorex are payable once in any five-year period.

 Four periapical X-rays are payable in any period of 12 consecutive months. Occlusal X-rays are payable twice in any 12-month period. Extraoral X-rays are payable once in any 6-month period.

 Genetic test for susceptibility to disease are payable once per lifetime for people age 18 and older.

 Sealants are payable once per tooth per three-year period for permanent molars for people age 15 and under. The surface must be free from decay and restorations.

 Composite resin (white) restorations are payable on posterior teeth.

 Localized delivery of chemotherapeutic agents is payable once per tooth in any twelve-month period.

 Full and complete dentures, and services related to dentures are not Covered Services.

 Implants and implant related services are not Covered Services.

 Crowns over implants and their related services are not Covered Services.

 Therapeutic parenteral drugs are a Covered Service.

Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet.

Maximum Payment – $1,250 per person limited to $3,000 per family per Policy Year on all services.

Deductible – $50 Deductible per person total per Policy Year limited to a maximum Deductible of $150 per family per Policy Year. The Deductible does not apply to diagnostic and preventive services, brush biopsy, genetic testing, bitewing X-rays, and sealants.

Waiting Period – Enrollees who are eligible for Benefits are covered on the first of the month following the date of hire. Eligible People – All employees of the Contractor working at least 30 hours per week, who choose the dental plan and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees, if applicable. The Subscriber pays the full cost of this plan.

Also eligible are your Spouse and your Children to the end of the month in which they turn 26, including your Children who are married, who no longer live with you, who are not your Dependents for Federal income tax purposes, and/or who are not permanently disabled.

Enrollees and their Dependents choosing either dental plan are required to remain enrolled for a period of 12 months. Should an Enrollee or Dependent choose to drop dental coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. Dependents may enroll if the Enrollee is enrolled (excluding COBRA) and must be enrolled in the same plan as the Enrollee. An election may be revoked or changed at any time if such change is the result of a qualifying event as defined under Internal Revenue Code Section 125.

Coordination of Benefits – If you and your Spouse are both eligible to enroll in This Plan as Enrollees, you may be enrolled together on one application or separately on individual applications, but not both. Your Dependent Children may only be enrolled on one application. Delta Dental will not coordinate Benefits between your coverage and your Spouse's coverage if you and your Spouse are both covered as Enrollees under This Plan.

Benefits will cease If an employee resigns on the 1st-15th of the month then their dental benefits end that month. However, if they resign on the 16th or later in the month, then their dental benefits end on the last date of the following month.

Customer Service Toll-Free Number: 800-662-8856 (TTY users call 711) https://www.DeltaDentalNC.com

March 22, 2022

Delta Dental PPO plus Premier™ Summary of Dental Plan Benefits For Group# 10129-2000, 2099 Chapel Hill-Carrboro City Schools

This Summary of Dental Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your Delta Dental plan, including information about plan exclusions and limitations. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's Maximum Approved Fee for each service and it may vary due to the Dentist's network participation.*

Control Plan – Delta Dental of North Carolina

Policy Year – September 1 through August 31

Covered Services –

Children through age 18 and under

Children through age 18 and under

Children through age 18 and under

*When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference.

The explanation and sample calculation of how these services will be paid can be found in Section VI – How Payment is Made in your Certificate.

 Oral exams (including evaluations by a specialist) are payable twice per benefit year.

 Two prophylaxes (cleanings) and/or up to four periodontal maintenance are payable per benefit year, not to exceed a total of four procedures in any benefit year.

 People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment.

 Fluoride treatments are payable twice per benefit year for people age 15 and under.

 Benefits for space maintainers are unlimited for people age 18 and under.

 Bitewing X-rays are payable once per Benefit Year and full mouth X-rays (which include bitewing X-rays) or a panoorex are payable once in any five-year period.

 Extra-oral posterior dental X-rays are Covered Services.

 Genetic test for susceptibility to disease are payable once per lifetime for people age 18 and older. Accession of tissue is a Covered Service.

 Sealants are payable once per tooth per three-year period for permanent molars for people age 15 and under. The surface must be free from decay and restorations.

 Crowns, inlays and onlays are payable once per tooth in any seven-year period. Veneers are payable on incisors and cuspids once per tooth per seven-year period for people age 16 and older. Stainless steel crowns are payable once in any three-year period for people age 18 and under.

 Composite resin (white) restorations are payable on posterior teeth.

 Inlays (any material) are Covered Services.

 Packet Not Reviewed!

 Therapeutic pulpotomy (excluding final restoration) is a Covered Service for people age 18 and under.

 Localized delivery of chemotherapeutic agents is payable once per tooth in any twelve-month period.

 Vestibuloplasty, oroantral fistula closure, removal of lateral exostosis (maxilla or mandible), frenulectomy and frenuloplasty are Covered Services.

 Full and partial dentures are payable once in any seven-year period. Rebase and reline of dentures, and tissue conditioning are payable once in any three-year period. Adjustments are payable once in any 12-month period.

 Bridges are payable once in any seven-year period.

 Implants are payable once per tooth in any seven-year period. Implant related services are Covered Services.

 Crowns over implants are payable once per tooth in any seven-year period. Services related to crowns over implants are Covered Services.

 Therapeutic parenteral drugs are a Covered Service.

Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet.

Maximum Payment – $1,250 per person limited to $3,000 per family per Policy Year on all services, except cephalometric films, photos, diagnostic casts, and orthodontic services. $1,000 per person total per lifetime on cephalometric films, photos, diagnostic casts, and orthodontic services.

Payment for Orthodontic Service – When orthodontic treatment begins, your Dentist will submit a payment plan to Delta Dental based upon your projected course of treatment. In accordance with the agreed upon payment plan, Delta Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. Delta Dental will make additional payments as follows: Delta Dental will pay 50% of the per monthly fee charged by your Dentist based upon the agreed upon payment plan provided by your Dentist to Delta Dental.

Deductible – $50 Deductible per person total per Policy Year limited to a maximum Deductible of $150 per family per Policy Year. The Deductible does not apply to diagnostic and preventive services, brush biopsy, genetic testing, X-rays, and sealants, cephalometric films, photos, diagnostic casts, and orthodontic services.

Waiting Period – Enrollees who are eligible for Benefits are covered on the first of the month following the date of hire. Eligible People – All employees of the Contractor working at least 30 hours per week, who choose the dental plan and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees, if applicable. The Subscriber pays the full cost of this plan.

Also eligible are your Spouse and your Children to the end of the month in which they turn 26, including your Children who are married, who no longer live with you, who are not your Dependents for Federal income tax purposes, and/or who are not permanently disabled.

Enrollees and their Dependents choosing either dental plan are required to remain enrolled for a period of 12 months. Should an Enrollee or Dependent choose to drop dental coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. Dependents may enroll if the Enrollee is enrolled (excluding COBRA) and must be enrolled in the same plan as the Enrollee. An election may be revoked or changed at any time if such change is the result of a qualifying event as defined under Internal Revenue Code Section 125.

Coordination of Benefits – If you and your Spouse are both eligible to enroll in This Plan as Enrollees, you may be enrolled together on one application or separately on individual applications, but not both. Your Dependent Children may only be enrolled on one application. Delta Dental will not coordinate Benefits between your coverage and your Spouse's coverage if you and your Spouse are both covered as Enrollees under This Plan.

Benefits will cease If an employee resigns on the 1st-15th of the month then their dental benefits end that month. However, if they resign on the 16th or later in the month, then their dental benefits end on the last date of the following month.