CCP 12-13-2004 - Laserfiche WebLink

Home Browse Search

Citv of Arden Hills Summary Plan Description In the case of health care reimbursement coverage, your Period of Coverage will end as of the . end of the month of the qualifying event (or, if you are a terminated employee, your last continuation period) for which you pay for coverage. For. example, if Johnson's employment terminates on.Septembet21l\nd he has paid for health eare reimbursement coverage through September and elects not to pay foreontinuation coverage with after-tax dollars (see Continuation Coverage), his Period of Coverage wOilldeuda.sof the end of September. Asa result, he would not be entitled to reimbursement for expenses incurred in October through December ofthat year. This would be true even if Johnson had elected $1,200 of coverage during the Plan Year and, throughSeptember,had paid $900 forthebenefjt. If Jolmson elected..to .payforcontinuation coverage on an afterctax . basis, he. would ext.end. his Period of Coverage and therefore expenses incurre4duringthiscontinuation period would be eligibleforreimbursement. (These results can differsgmewhatif you take a "family or lUedjcal leave,"your health care reimbursement. coverage tenninates, and you later reinstate the coverage. See LEAVES OF<ABSENCES AND FAMILY OR MEDIQAL LEAVES,) . .... ... 3. When is an Expense "Incurred"? A health care expense or dependent care expense is incurred when the health care or dependent care-giving rise to the expense is provided. The date of billing or payment is irrelevant. ;f'otexample, ifJoneSvisits his dentist on Deeember15,2004, is billed for the dentaLs5rviceson January 5,2005, and pays the bill on January 14, 2005,Joneswillhayeincurred the expense on December 15, 2004. . gOnsequently, the expense would beeligibleforreimbursenlen.t tmder Jones' health care reimbursement coverage for 2004, bi:lt not WIder hii coverage for 2005. . 4. How Do I Claim Reimbursement Benefits? If you have elected reimbursement coverage, you may c1ain1 reimbursement for eligible health care and/or dependent care expenses until February IS after the close of the Plan Year. Benefits are paid at least bi-weekly throughout the Plan Year. Your claim must total $10.00 before you can submit your claim for reimbursement. This minimum requirement does nol apply to claims filed on or after December 31" for the Plan Year just ended. To be reimbursed you must follow these simple steps: . When you enroll, you will receive a Reimbursement Claim Form along with an envelope that you will use to submit your first expenses to the Acclaim Benefits Flexible Spending Account Department. Please note: the form allows you to list several expenses on one form, if desired. . Attach a copy of your bill or receipt or other satisfactory third party documentation of the amount of the expense, the date(s) the expense was incurred (a canceled check is not sufficient) to the Reimbursement Claim Form. . Complete the form in its entirety. Then sign and date the form. (Your signature is certification that each expense is eligible for reimbursement under the Plan, that it has not been previously reimbursed under the Plan, that it is not reimbursable from any other source (M., insurance), and that you will not also claim it as a deduction or credit on your income . tax retum.) SPD-6