massachusetts mutual dependent care reimbursement account...

Massachusetts Mutual Dependent Care Reimbursement Account Plan Summary Plan Description

for Employees

Effective January 1, 2010

This Summary Plan Description (SPD), published in December 2010, takes the place of any SPDs and Summaries of Material Modifications (SMMs) previously issued to you describing your benefits.

MassMutual DCFSA – Employee December 2010 of 22

Table of Contents

Disclaimer ..................................................................................................................................................................3 Introduction ................................................................................................................................................................4 Eligibility....................................................................................................................................................................5 Enrollment ..................................................................................................................................................................7 Cost of Coverage ........................................................................................................................................................9 Contact Information..................................................................................................................................................10 How the Plan Works.................................................................................................................................................11 Filing for Reimbursement.........................................................................................................................................16 Appeals Procedures ..................................................................................................................................................18 About Your Coverage...............................................................................................................................................19 Plan Information.......................................................................................................................................................20 Dictionary Terms......................................................................................................................................................22


Disclaimer

This Summary Plan Description (SPD) provides details of the coverage available through The Massachusetts Mutual Dependent Care Reimbursement Account Plan (Dependent Care Flexible Spending Account or DCFSA). This SPD contains detailed and important information about the Plan; every attempt has been made to communicate this information clearly and in easily understandable terms. This SPD replaces and supersedes all previous SPD versions and Summaries of Material Modifications (SMMs).

Benefits are determined under the terms of the Plan in effect at the time you become eligible for the specific benefits. Benefits are based on current laws and regulations, which are subject to change. Massachusetts Mutual Life Insurance Company (“the Company” or “MassMutual”) reserves the right to modify, revoke, change, suspend or terminate any one or all plans, programs, policies, benefits or services described in this SPD or the underlying Plan documents at any time and from time to time, with or without notice. This SPD does not guarantee any particular benefit. Receipt of this SPD describing the Plan or option for which you are not eligible does not imply that you are eligible.

In the event of a discrepancy between descriptions in this SPD and information in relevant Plan documents, the Plan documents will govern.


Introduction

The Dependent Care Flexible Spending Account (DCFSA) allows you to be reimbursed with Before-Tax dollars for incurred dependent care expenses while you and your spouse (if you are married) work. Eligible dependent care expenses include expenses for child care or eldercare for your tax-dependent child(ren), parent(s) or disabled spouse. Keep in mind, all the money you contribute to a DCFSA in a calendar year must be used for eligible expenses incurred during that year, otherwise you forfeit it.

The DCFSA is not an Employee Retirement Income Security Act of 1974 (ERISA) benefit. The Plan is intended to be a non-discriminatory dependent care assistance program under the Internal Revenue Code (IRC) Section 129.

Be sure to read this SPD so you are aware of all Plan provisions, including who is eligible and how the Plan works. You must satisfy the requirements described in this SPD to be eligible to participate.


Eligibility

Eligible Participants

You are eligible for DCFSA coverage under the Plan if you are an employee regularly scheduled to work at least 20 hours per week for one of the following: • Babson Capital Management LLC • Centennial Asset Management Corp. • Cornerstone Real Estate Advisers LLC • HarbourView Asset Management, Corp. • Invicta Advisors LLC • Massachusetts Mutual Life Insurance Company • MassMutual International LLC • MML Investors Services, Inc. • OFI Institutional Asset Management, Inc. • OFI Private Investments, Inc.

ational, Ltd.

ces, Inc.

y, FSB

Management Corp.

Ineligible Individuals

• ntract with or employed by an agent, a formula general agent, or a general agent

s

• yee on the employment and payroll records of a participating

• OFI Trust Company • Oppenheimer Real Asset Management, Inc. • OppenheimerFunds Distributor, Inc. • OppenheimerFunds Intern• OppenheimerFunds, Inc. • Shareholder Financial Servi• Shareholder Services, Inc. • The MassMutual Trust Compan• Tremont Group Holdings, Inc. • Trinity Investment

You are not eligible for the Plan if you are: • Any employee not employed by one of the entities listed above; • An employee scheduled to work less than 20 hours per week; • broker or agency general manager; • Any employee otherwise excluded by the specific Plan terms;

A person formerly under co

An agent, general agent, formula general agent, sales manager,

or broker who is placed on the Company’s payroll during a transition period in which there is no general agent in the agency office;

• A person under contract with or employed by a general agent or by an agent of such general agent in salesupport, including, but not necessarily limited to, secretaries and development and district office clerks;A person who is not recorded as an emploemployer, including anyone who is subsequently reclassified by a court of law or regulatory body as a common law employee of that company;


• A person who performs services for an employee as an independent contractor, under an employee leasing

• • scheduled to work fewer than 20 hours per week except during a period in which he or

rarily working an increased schedule, such as school

• loyee of the Company; or al employee of MassMutual International LLC who is regularly assigned to a worksite ed States.

•

• A qualifying child or relative (such as a spouse or parent) who is physically or mentally incapable of self-care

income must be less than the dependency exemption amount ($3,650 for 2010).

your child as a dependent on your tax return. If either parent can claim a child as a dependent under the rules for ld ion.

For more information on eligible dependents, see Internal Revenue Service (IRS) Publication 503. You can obtain a copy of this publication by calling the IRS at 800-829-1040 or by viewing it online at www.irs.gov

arrangement, or any other non-employee or non-payroll classification; An Information Security Organization (ISO) Academy, intern or school-to-work employee; An employee regularlyshe is a trainee, in a company training program or tempobreaks and vacations; A retired agent or retired emp

• Any foreign nationoutside of the Unit

Eligible Dependents

Your eligible dependent is your tax-code dependent who is any of the following: Your qualifying child unde r age 13 who lives with you for more than half of the taxable year;

• Your spouse if he or she is physically or mentally incapable of self-care and lives with you for more than half of the taxable year; or

and lives with you for more than half of the taxable year. Note: For a qualifying relative, the individual’s gross

MassMutual reserves the right to verify a dependent’s eligibility status for Plan coverage at any time, or from time to time.

If you are divorced or legally separated, your child may be considered your dependent even if you do not claim

divorced or separated parents, each parent can include the dependent care expenses he or she pays for the chieven if an exemption for the child is claimed by the other parent. Contact your tax advisor for more informat

.


www.irs.gov

Enrollment

Enrolling in the Plan

You have 30 days from your date of hire to enroll in the Plan. Note: If you are hired after Annual Benefits Enrollment, you may not be eligible to participate in the current Plan Year, but you may enroll for the next Plan Year.

If you do not elect to participate, you will not be covered under the Plan. However, as long as you remain eligible, you will have the opportunity to enroll in DCFSA coverage during the Annual Benefits Enrollment period each fall for coverage effective the first of the following year.

In addition, if you have a Qualified Change in Status, you may be eligible to change coverage during the Plan Year. You must contact MassMutual Benefits (or OFI Human Resources for OppenheimerFunds, Inc. Participants) within 30 days of your qualified event to make changes to your coverage; see the Qualified Change in Status section for details.

When Participation Begins

Initial Eligibility

Your DCFSA coverage is effective as of your date of hire, provided you enroll within 30 days. Your contributions are taken from your first paycheck following enrollment and will continue through the calendar year.

Annual Benefits Enrollment

You may elect DCFSA coverage once a year during Annual Benefits Enrollment (or you may be able to change your DCFSA election when you have a Qualified Change in Status; see the Qualified Change in Status section).

During the Annual Benefits Enrollment period, you may elect coverage.

Any changes you make during Annual Benefits Enrollment become effective on the first day of the next calendar year. If you do not make any changes to your DCFSA coverage during Annual Benefits Enrollment, you will not be enrolled in the DCFSA for the following year. The DCFSA is an election that you are required to make on an annual basis.

Qualified Change in Status

Any change to your DCFSA due to a Qualified Change in Status must be consistent with and due to the Qualified Change in Status. If you have a Qualified Change in Status, you can change the amount of your contribution or you may be able to enroll if you previously waived coverage. You must make any changes and provide documentation within 30 days of your Qualified Change in Status.


Qualified Changes in Status include: • A change in the number of your dependents, due to birth, death, adoption, placement for adoption, addition of

a foster child or child for whom you have become a legal guardian; • Your covered dependent becoming ineligible (e.g., if you child turns age 13); • Most changes in your legal marital status, such as marriage, the death of a spouse, divorce or legal separation; • Your spouse’s plan having a different coverage period (e.g., his or her plan year runs from July 1 - June 30

rather than MassMutual’s Plan Year, which is January 1 - December 31); • Your spouse or your qualifying relative gaining or losing employment.

If you decrease your DCFSA contributions due to a Qualified Change in Status, you cannot decrease your contributions below the annual contribution minimum of $120 or below the amount you have already contributed and received as reimbursement. If you increase your contributions, you can contribute up to the annual contribution maximum amount (see the Contribution Amounts section for details).

A situation where you may wish to stop your DCFSA contributions, for example, would be if your spouse decided to stay home with your child and you no longer have eligible day care costs. Conversely, if you adopt a child, you may wish to increase your DCFSA contributions to accommodate the added day care costs you may incur for this adopted child.

Changes you make due to a Qualified Change in Status become effective as of the date of your Qualified Change in Status, provided you notify MassMutual Benefits (or OFI Human Resources for OppenheimerFunds, Inc. Participants) and provide documentation within 30 days of the event.


Cost of Coverage

The DCFSA is a reimbursement plan; you elect a pre-tax amount you want to contribute to the Plan; then as you incur eligible dependent care expenses, you submit a form and documentation for reimbursement, up to your annual election amount. The Company pays administrative fees for this benefit from Plan forfeitures and out of the general assets of the Company, and also funds any deficits from general assets.


Contact Information

Resource Participant Web Site Telephone Benefit Concepts, Inc. (FSA Administrator)

www.avantserve.com 866-629-6350 Fax for Claim Submission: 866-629-6390

MassMutual Benefits

Web site: https://mmfgonline.massmutual.comE-mail: [email protected]

866-662-6448 or Ext. 46169, on business days, 1 – 5 p.m., ET

OppenheimerFunds, Inc. To view BenefitsChoice, go to OPNet, click on HR for Policies, select BenefitsChoice for Procedures & Benefits Web site: http://opnet/departments/hr contacts/learningdev/hrportal/Index.htmlE-mail: [email protected]

303-768-3111


http://www.avantserve.com/

https://mmfgonline.massmutual.com/

mailto:[email protected]

http://opnet/departments/hr_contacts/learningdev/hrportal/Index.html

mailto:[email protected]

How the Plan Works

Plan Benefit

You may use the Plan to reimburse eligible dependent care expenses you incur for an eligible dependent during the period of coverage. Your eligible dependents are your tax-dependent: • Child(ren); • Parent(s); and/or • Disabled spouse.

If your spouse is not employed, dependent care expenses will not be eligible for reimbursement, unless your spouse is actively seeking employment, a full-time student or physically or mentally incapable of self-care.

Child(ren) of Divorced or Separated Parents: If you are divorced or legally separated, your child may be considered your dependent even if you do not claim your child as a dependent on your tax return. If either parent can claim a child as a dependent under the rules for divorced or separated parents, either parent can be reimbursed for eligible expenses he or she pays for the child even if an exemption for the child is claimed by the other parent. Contact your tax advisor for more information.

Eligible Expenses

Eligible expenses are those expenses that would generally be eligible deductions on your tax return that are not reimbursed by any other source. Following is a partial list of examples of reimbursable dependent care expenses. For a complete list of rules and reimbursable expenses, see IRS Publication 503. To receive a copy of this publication, call the IRS at 800-829-1040 or to view it, log on to www.irs.gov.

For your dependent child under age 13 for whom you are entitled to take a tax exemption under IRC Section 151(c): • A babysitter or housekeeper who provides dependent care (includes taxes paid on their wages). The person

providing the care cannot be someone you claim as a dependent, a child of yours under age 19, a spouse or an ex-spouse. The services can be provided either inside or outside your home. If they are provided outside of your home, a “qualifying individual” must spend at least eight hours a day in your home.

• A day-care center, nursery school or pre-school. • An after-school program or summer day camp, including specialty camps (soccer, computer, music, etc). • A dependent care center (if the center cares for more than six people, it must comply with all state and local

laws). • Amounts paid to an au pair to care for a child. • Agency fees, application fees and deposits that are not directly for the care of the individual, but are required

expenses to obtain care. However, if the care is ultimately not provided, then these expenses will not be considered work-related.

• Fees for transportation provided by the dependent care provider.


http://www.irs.gov/

For your dependent qualifying relative (e.g., spouse or parent) who is physically or mentally incapable of caring for himself or herself and for whom you are entitled to take a tax exemption under IRC Section 151(c): • Charges from an adult day care center; • Charges from an adult private sitter, nanny or home-care companion; and • Housekeeping charges as long as the qualifying relative is cared for in your home. (Housekeeping services

are ordinary and usual services done in and around your home that are necessary to run your home. They include the services of a housekeeper, maid or cook. However, they do not include the services of a chauffeur, bartender or gardener.)

For a complete list of rules and reimbursable expenses, see IRS Publication 503. To receive a copy of this publication, call the IRS at 800-829-1040 or to view it, log on to www.irs.gov. In addition, information can be accessed on Benefit Concepts’ Web site: www.avantserve.com. (Benefit Concepts, Inc. (BCI) administers MassMutual’s FSAs.)

Eligible Provider

You may use any care provider you choose; however, the care provider must meet the business and licensing requirements of your state. For example, day care providers who care for six or more children must meet state and local regulations and/or licensing.

The services may be as informal as care provided by your neighbor, as long as the neighbor claims the money received for services as income when determining their taxes at the end of the year. When you submit your expenses for reimbursement and when you file your federal tax return, you must provide: • The social security number for individual dependent care providers; and • The taxpayer identification number for care centers and schools.

Ineligible Expenses

You cannot be reimbursed for expenses: • That are not spent to allow you, and your spouse (if married), to work or look for work; • That are payable under any other benefit plan; • For services that occurred before or after your participation in the Plan; or • That are in excess of the amount allocated, or that exceed your or your spouse’s earned income for the year.

Here are some examples of expenses that are not eligible for reimbursement: • Charges from unlicensed dependent care providers if there are more than six children being cared for;

t care location; rten or a higher grade;

es;

• r e tax return);

• Nursing home charges; • Expenses for transportation to and from a dependen• Expenses to attend kinderga• Food or clothing expenses; • Overnight camp expens• Educational expenses, • Entertainment expenses;

Expenses for services provided by your child who is under age 19 or by a person for whom you (or youspouse, if married) are entitled to a personal exemption deduction on your federal incom


http://www.irs.gov/


• Expenses that you deduct or for which you take a tax credit on your income tax return; Expense• s for services provided by your spouse or a person you claim as a dependent on your income tax

idential institution;

enses

to www.irs.gov

return; • Expenses that are not work-related; • Expenses for services that occurred in another Plan Year; • Expenses for care provided in a full-time res• Expenses for anyone who is not eligible; or • Expenses for which you claim the tax credit.

All submitted expenses will be reviewed according to IRS regulations. For a complete list of rules and expthat are not reimbursable, see IRS Publication 503. To receive a copy of this publication, call the IRS at 800-829-1040, or to view it, log on . In addition, information is available at www.avantserve.com.

l x

rn, or if you are single and file a head-of-

• • s working during any month he or

she is a full-time student or is physically or mentally not able to care for himself or herself; see IRS

If you become eligible for the DCFSA during the Plan Year, you may still contribute up to the maximum

igible dependent’s health-care expenses. Similarly, any money you set aside in your Health- reimburse any dependent care expenses. Note: You cannot transfer money between

provided the type of change is consistent with and due to the Qualified Change in Status. You

can contribute up to the maximum contribution amount allowed for the Plan Year; see the Qualified Change in

Contribution Amounts

You may elect to contribute at least $120 per year, up to a certain annual maximum into a DCFSA. Your annuama imum is the LEAST of the following amounts: • $5,000 per year if you are married and file a joint income tax retu

household tax return; • $2,500 per year if you are married and file a separate tax return;

Your earned income; or Your spouse’s earned income, if you are married (your spouse is treated a

Publication 503 for a definition of “deemed income” in these instances).

contribution amount allowed per year.

The DCFSA and the Health-Care FSA are separate. Money you set aside in your DCFSA cannot be used to pay for your or your elCare FSA cannot be used tothe two accounts.

Changes in Contributions

Generally, if you experience a Qualified Change in Status, you may make changes to your contributions duringthe Plan Year,

Status section.

When Contributions Are Credited

Your contributions will be deducted from each pay statement and credited to your DCFSA.

Only the amount already deposited to your DCFSA is available for reimbursement. For example, if your annuacontribution is $5,000 ($416.68 per month), and you submit $450 in eligible expenses on Janua

l ry 31, you would

be reimbursed for only $416.68, which is the amount you contributed in January. The rest of the expense, if it t of $25, would be reimbursed as your deductions continue. meets the minimum reimbursemen


www.irs.gov

www.avantserve.com

Determining Your Contribution

Since you will lose any amount you do not use, you should estimate your eligible expenses carefully before deciding on an amount to contribute. Use the Benefit Concepts DCFSA calculator to estimate how much to elto contribute to your DCFSA, which is available

ect online at www.benefitconcepts.com/tools/payroll124.html. Tip:

ew he IRS provides information about the

ualifying expenses in IRS Publication 503. You can obtain a copy of this publication by 00-829-1040 or by viewing it online at www.irs.gov

Do not forget to consider any vacation time you spend with your dependent, and only include dependent care services you will receive during the Plan Year.

Remember: Your DCFSA contributions are deducted before applicable taxes are withheld. (If you reside in NJersey or Pennsylvania, contributions to your DCFSA are state-taxable.) Ttax deduction and qcalling the IRS at 8 .

Account Balance

Check your account balance frequently. You can visit BCI’s self-service Web site, www.avantserve.com, to viewyour account activity and current balance. Or, you can call BCI to obtain your current balance. Check your

ll know how much of your annual contribution remains available. In addition to u can also view reimbursements that were made and when they were made.

receive the

lances in your DCFSA after the 90th day following the close of the used to offset the administrative expenses of the Plan.

oth the DCFSA and the federal tax credit, provided you do not claim the same expenses for both. If you use both the DCFSA and the federal tax credit, be sure to reduce the tax credit by any amount contributed to the DCFSA.

account balance often so you wigetting your account balance, yo

Forfeit Unused Contributions

You have until the end of the 90th day (usually March 31) following the close of the Plan Year to request reimbursement for eligible expenses incurred during the Plan Year. You incur an expense when youservice and not when you are billed (or pay) for it. For example, a service rendered on December 31 this year and billed on February 3 next year is eligible to be reimbursed with funds DCFSA funds from this year.

Under this Plan, you will forfeit any unused baPlan Year. Forfeited balances, if any, will be

Dependent Care Tax Credit Versus DCFSA

The DCFSA is just one way to save on taxes for eligible dependent care expenses. The federal government also allows a tax credit for dependent care expenses when you file your income tax return.

You can use b



www.irs.gov

www.benefitconcepts.com/tools/payroll124.html

You may want to consult a tax specialist for more information about the advantages of a DCFSA versus those of the federal tax credit.

A federal tax exemption in the form of either a tax credit or “exclusion from gross income” using a DCFSA, is available for certain dependent care expenses. • If you choose the tax credit, you would claim your dependent care expenses on your federal tax return, which

would reduce the amount of taxes owed to the federal government by the amount of your claimed expenses (subject to limitations).

• If you choose to participate in the DCFSA, you would exclude from your gross income the amount of money you contribute to your DCFSA, subject to limitations.

Your unique situation determines which tax break is more beneficial for you. You may want to consider using the BCI tax calculator (www.benefitconcepts.com/tools/payroll124.html) to help determine which method would be best for you.


http://www.benefitconcepts.com/tools/payroll124.html

Filing for Reimbursement

How to File for Reimbursement

You pay your day care or eldercare provider first, and then complete a dependent care claim form. The dependent care claim form has a provider statement at the bottom of the form that can be used to substantiate the information contained on the claim form. This is the preferred method of substantiating the claim information. Otherwise, a statement from the provider showing the provider address, Tax Identification Number (TIN), date the service(s) was incurred, whom the expense was incurred by and the amount charged is necessary. This should mirror what appears on the claim form.

The claim form can be completed online at www.avantserve.com, After you log in; select Submit Claims and enter all your expenses on the form individually. Once you have entered all your expenses, click Submit and you will be prompted to review what you have entered; if everything is correct, click Continue. The next screen gives you the option of electronic submission or manual. Choose your method and follow the system prompts.

If you are going to use RightFax, follow the manual process: • Print the documents, sign your forms and scan them along with your receipts. • Once you have a PDF, initiate RightFax:

o Enter Claim Review Department in the name field; o Enter 1-866-629-6390 in the fax # field; o Enter Benefit Concepts in the Company field; and ; o Attach the scanned PDF.

Note: Faxes with a cover page error out; so go to the Advanced Faxing Options tab and uncheck the box to Use cover sheet. Go back to the message tab and send the fax.

You have until the end of the 90th day (usually March 31) following the close of the Plan year to request reimbursement for eligible expenses incurred during the Plan year.

Note: • Claims and substantiation should not be submitted before the date the service(s) was incurred. • A paid receipt must contain the provider name, provider address, date(s) of service, whom the expense was

incurred by and the amount paid. • The substantiation should be included with the claim form.

A cancelled check with a statement is acceptable; however, a cancelled check alone is not acceptable. oo A copy of a contract is not acceptable.

• ncepts by: Submit the form and the substantiation to Benefit Cown on the claim form; or o Mail to the address sho

Fax to 866-629-6390. o

• Keep copies of the claim form and substantiation for your records.

The dependent care claim form can be downloaded from www.avantserve.com or you may call Benefit Concepts at 866-629-6350. You have until the end of the 90th day (usually March 31) following the close of the Plan Year to request reimbursement for eligible expenses incurred during the Plan Year.

Reimbursement requests must not be submitted until after the expense has been incurred. The IRS defines “incurred” as when the service was provided, not when you were billed, charged or paid for the service. For example, if your child’s day care provider bills you at the start of each month, you receive reimbursement from your DCFSA after you have received all day care services for that month, not when you paid that month’s bill.




Reimbursement Denial

If your claim for reimbursement is denied, in whole or in part, you will be notified, in writing, of the reason for the denial within 30 days of receipt of the claim. This period may be extended by the Plan for up to 15 days, if an extension is necessary due to matters beyond the control of the Plan. You will be notified in writing before the end of the 30-day period of the circumstances requiring the extension of time and the date the Plan expects to make a decision. If an extension is necessary because you did not submit information necessary to decide the claim, the notice will describe the information that is needed, and you will be given 45 days from the date you received the notice to provide the information.

If You Have a Question About the Denial

If you have a question about why the submitted expense was denied, Benefit Concepts customer service is available to help. You can call 866-629-6350 toll free and explain your concern to a member services representative. They will do their best to resolve the matter on your initial contact. If they need more time to review or investigate your concern, a representative will get back to you in three to five business days, if not sooner, depending on the research needed.

If you are not satisfied with the results of a coverage decision, you may start the two-step appeal process: first, you must request a review of your claim, and if still not satisfied, you may request an appeal.


Appeals Procedures

Claim Review

To request a claim review, you should notify Benefit Concepts. State why you disagree with how the claim was handled. Any request for a claim review must be made within 60 days of the date you receive notice that your claim was denied. The request for the review must include: • A copy of the denial; • Any additional documentation that supports the approval of the claim (such as: written comments, documents,

records, any other information you feel will support your claim); and • The specific reasons why you think the claim should be reconsidered and approved.

After the claim review, if your claim is denied, you can appeal the denial by initiating an appeal. An appeal must be made within 60 days after you receive the decision.

Appeal Procedure

If you are dissatisfied with the claim review decision, you may make an appeal to the Plan Administrative Committee. To initiate an appeal, follow the same process required for a claim review and send your written appeal to:

Plan Administrative Committee MassMutual Benefits 1295 State Street, F105 Springfield, MA 01111-0001

You will receive information about the final decision of reimbursement within 60 days of the date the Plan Administrative Committee receives the request. Decisions made by the Plan Administrative Committee are final and binding.

The Dependent Care Flexible Spending Plan is not covered by the Employee Retirement Income Security Act of 1974 (ERISA) and is not subject to the denied-claim appeals process mandated by ERISA.

Legal Action

You have the right to take legal action if you are not satisfied with the outcome of the appeal procedure. You may not initiate a legal action against the Plan until you have exhausted the claim review and claim appeal processes.

You cannot take legal action against the Plan more than six months following the decision of an appeal by the Plan Administrative Committee.


About Your Coverage

Coverage When You Are Not Working

Taking an approved leave of absence affects your DCFSA. If your absence is paid, coverage continues as if you were working. If your absence is unpaid, the cost for your coverage while on leave will be deducted when you return from your leave.

If You Leave the Company

DCFSA contributions stop when your employment ends. If, when you leave the Company, you have a DCFSA balance, you can submit for reimbursement for eligible expenses incurred through the end of the Plan Year. Contact Benefit Concepts for details.

If the Company Ends the Benefit

At this time, the Company expects to continue sponsoring the Plan. However, the Company reserves the right to terminate or amend the benefit plans, in whole or part, at any time, and from time to time without advance notice. This may result in modification or termination of benefits to Plan Participants.

When Coverage Ends

Your DCFSA coverage ends on the first of the following dates: • The date the Company terminates or amends the Plan eliminating coverage; • The date the Plan is discontinued; • The date you are no longer eligible to participate in the Plan; • The date your employment ends; • The date you retire; • The date of any fraud against the Plan; or • Your death.

You have until the end of the 90th day (usually March 31) following the close of the Plan Year to request reimbursement for eligible expenses incurred during the Plan Year.


Plan Information

Plan Name

Massachusetts Mutual Dependent Care Reimbursement Account Plan (this is not an ERISA-plan).

Plan Administrator

The Plan Administrator is the Plan Administrative Committee, which is appointed by MassMutual’s Chief Executive Officer. The Plan Administrative Committee has the authority to control and manage the operations and administration of the Plan. You can reach the Plan Administrative Committee at:

Massachusetts Mutual Life Insurance Company MassMutual Benefits 1295 State Street, F105 Springfield, MA 01111-0001 866-662-6448

Plan Sponsor

Massachusetts Mutual Life Insurance Company 1295 State Street, F105 Springfield, MA 01111-0001 866-662-6448

Employer Identification Number (EIN)

The EIN of Massachusetts Mutual Life Insurance Company is 04-1590850.

Plan Year

The Plan Year is January 1 through December 31.

Agent for Service of Legal Process

General Counsel of Massachusetts Mutual Life Insurance Company 1295 State Street Springfield, MA 01111-0001

If legal action is necessary to settle a claim, any action may also be served upon the Plan Administrator.

Plan Type and Funding

This Plan is a dependent care assistance program. You pay the cost through payroll deductions. Benefits are paid from general assets of the Company.


Claims Administrator

The claims administrator is Benefit Concepts, Inc. Refer to the Contact Information section for details.

Type of Administration

This Plan is administered by a third-party administrator. The third-party administrator is Benefit Concepts, Inc. (BCI). BCI administers the Plan on behalf of the Company and the Company, not BCI, is a fiduciary of the Plan. Refer to the Contact Information section for details.

Continuation of the Plan

Although MassMutual does not now intend to terminate the benefits described in this SPD, nevertheless it reserves the right to modify, revoke, change, suspend or terminate the Plan, policies, benefits or services described here or in the underlying Plan document at any time or from time to time, with or without notice.


Dictionary Terms

Annual Benefits Enrollment, Benefits Enrollment or Open Enrollment

The period each year designated by the Company when you may make changes to your benefit elections. Changes are effective the following January 1.

Before-Tax or Pre-Tax

Contributions taken before applicable federal, state and local taxes are withheld.

Effective Date

The date the coverage begins.

Member or Participant

A person enrolled in and covered by this Plan, including you and your eligible dependents.

Plan Year

January 1 - December 31.

Qualified Change in Status

The following changes: • A change in the number of your dependents, due to birth, death, adoption, placement for adoption, addition of

a foster child or child for whom you have become a legal guardian; • Your covered dependent becoming ineligible (e.g., if you child turns age 13); • Most changes in your legal marital status, such as marriage, the death of a spouse, divorce or legal separation; • Your spouse’s plan having a different coverage period (e.g., his or her plan year runs from July 1 - June 30

rather than MassMutual’s Plan Year, which is January 1 - December 31); • Your spouse or your qualifying relative gaining or losing employment.


massachusetts mutual dependent care reimbursement account...

Documents