Flexible Spending Accounts

Introduction

Flexible Spending Accounts (FSAs) allow you to use tax-free dollars to pay eligible expenses by contributing a portion of your pay to a special account(s) that you use to pay for eligible out-of-pocket expenses. This arrangement helps you save Social Security and income taxes on the amount of your contributions.

The Health Care Flexible Spending Account allows you to pay for out-of-pocket health care expenses you expect during the year, such as contact lenses and solutions or medical expenses not fully covered by the Medical Plan, Prescription Drug Plan, Dental Plan, or Vision Plan. The Health Care Flexible Spending Account is part of the Health Care Program.

The Dependent Care Flexible Spending Account covers dependent care expenses that allow you to work. Covered expenses include day care for children or a disabled spouse or parent (see "Eligible Dependents" for details).

None of the terms and conditions contained in the official plan documents are changed by anything in this summary plan description (SPD). If there is a disagreement between this SPD and the plan documents, the plan documents will govern. If you wish to see or receive a copy of the plan documents, contact your local HR representative or contact the Plan Administrator at:

Plan Administrator
Attention: Benefits Department
Alliance Coal, LLC
PO Box 1950
Tulsa, OK 74101-1950

FSA Tax Savings

FSAs reduce your taxes because contributions are made with pre-tax dollars – that is, the money is taken out of your pay before Social Security, federal, and (in most cases) state and local taxes are calculated.

When you have an eligible out-of-pocket expense, you are reimbursed from your account – and the reimbursement is not taxable.

Because you pay with pre-tax dollars, your taxes are reduced and your spendable income can increase.

For example, if your combined tax rate is 25%, and you contribute $1,000 to an FSA, you save $250 in taxes.

Another way to think about this $1,000 contribution is that instead of receiving $750 in take-home pay ($1,000 - $250 taxes), you have the full $1,000 available to pay for expenses you expect to pay for out of your pocket.

How to Participate

For information about eligibility, see "Eligibility and Enrollment" in the Health Care Program Participation section.

To participate in one or both FSAs as a newly eligible employee, and for each new calendar year that you wish to participate, you must make a new election using the Flexible Spending Account Enrollment Form. FSA elections do not automatically renew each year. Regardless of whether you make a new election, any carryover amount (as described below) will be available for the new year.

You determine the portion of your pay you want to contribute to either or both FSAs. It is very important that you estimate your eligible expenses carefully when deciding how much to contribute; this is because the Internal Revenue Service requires that you forfeit any money not used for eligible expenses during the year, except as provided under "Carryover" in the "Health Care Flexible Spending Account Benefits" section below.

Your election will remain in effect for the entire year unless you have a qualified change in status that will permit an FSA election change.

Navia Benefits Card 

If you elect to participate in one or both FSAs, you have the option of using a debit card from Navia. This convenient option allows you to swipe the card at the pharmacy or other providers that accept MasterCard. The money will be withdrawn from your Health Care FSA or Dependent Care FSA, as applicable depending on the type of expense.

In most cases, your Navia Benefits Card transactions will not require the submission of receipts. For example, you will generally not need to submit a receipt for copays or prescriptions. However, you should still save your receipts in case it is necessary to substantiate the expense or confirm that it is eligible for reimbursement under IRS rules.

In some cases, it will not be possible for Navia to auto-verify that your transaction is for an eligible expense. In that case, Navia will email you a documentation request notice for the charges that need substantiation. Upon receiving this notice, you will need to substantiate the expense in the manner described in the email. If you are required to provide substantiation for an expense and fail to do so, or if it is determined that an expense was ineligible for payment, you will be required to repay the amount of the expense. If you do not make the repayment, your employer can withhold the amount involved from your paycheck or your right to payment of future claims will be reduced. Also, you will lose the right to use the card.

For more information about using the Navia Benefits Card, visit CoalBenefits.com/fsa.

Receiving Reimbursement

In addition to the option to use the Navia Benefits Card, if you elect to participate in one or both FSAs, you can request reimbursement for your eligible expenses.

1. When you incur an expense that is eligible for payment, you submit a request to the claims administrator using the Navia Benefits Solutions, Inc. (Navia) online employee portal or mobile app, or an FSA Claim Form. You must include a receipt, statement, or bill from an independent third party stating that the expense has been incurred and the date and amount of such expense.
2. For eligible expenses incurred during the calendar year in which you elect to participate, you will have until March 31 of the following year to submit a claim for reimbursement. You will be notified in writing if any claim for benefits is denied.
   
   Please note that it is not necessary that you have actually paid an amount due for an eligible expense — only that you have incurred the expense, and that it is not being paid for or reimbursed from any other source. The only exception is that orthodontia claims are reimbursable based on date of payment.

You may receive reimbursement by either:

• Direct deposit into your checking or savings account (if you elect this option online or have submitted a Direct Deposit Authorization Form); or
• Check mailed to your home address on record.

Generally, the claims are reimbursed within two weeks after they are received by the claims administrator.

Eligible expenses must have been incurred (or paid, for orthodontia claims) during the calendar year. Based on IRS regulations, you may not be reimbursed for any expenses incurred:

• Before the calendar year begins,
• Before your Salary Redirection Agreement becomes effective,
• After the close of the calendar year (except as permitted under the carryover rules),
• After a separation from service (except as allowed under continuation coverage under COBRA), or
• Before the health care service is actually rendered (even if your doctor requires that an expense be paid in advance).

Failure to submit the required forms could result in your reimbursement being delayed and/or denied.

Forfeited Amounts

You will not be entitled to receive any direct or indirect payment of any amount that represents the difference between the actual eligible expenses you have been reimbursed and the annual benefit level you have elected and paid for except as provided under "Carryover" in the "Health Care Flexible Spending Account Benefits" section below.

Any amount forfeited will be retained by the Plan Administrator and used to offset reasonable administrative expenses.

Service Center Provided by the Claims Administrator

Navia offers you an online portal and mobile app. Use them to view your FSA balance and account activity, as well as to file claims, check on claims status, and download forms. Navia Customer Service is also available to answer questions about your account or benefits.  

You can contact Navia:

• By phone: (800) 669-3539 between 7:00 a.m. and 7:00 p.m. CT on regular business days
• By email: Claims@NaviaBenefits.com
• By fax: (866) 831-6222