If you enroll in the Health Care FSA and participate in any of the following plan options, your FSA claim forms will automatically be filed for you:

• A Blue Cross Blue Shield PPO with Express Scripts prescription drug coverage
• Lumenos HRA Plan
• Aetna EPO
• Delta Dental PPO Plans

With automatic claims reimbursement, the carrier** will submit claims on your behalf for amounts that apply to your medical (including Express Scripts prescription drugs) and/or dental plan deductibles and coinsurance. Benesyst (the FSA claims administrator) will then automatically reimbursement you through your FSA.

You are automatically enrolled in this feature. To opt out of automatic claims reimbursement, you must call the NGBC.

**Automatic claims submission does not apply to expenses incurred through ValueOptions, any HMO, some EPOs, Vision Service Plan (VSP), and CIGNA Dental.