Who is Eligible:
· Full time employees
· Eligible dependents
Benefit Defined: Your Health Expense Reimbursement Benefit can be used for reimbursement of prescription drug copayments, health insurance copayments and a Heart, Lung and Body scan. This benefit has been developed to meet Affordable Care Act requirements.
- The benefit shall be $200.00 per calendar year, effective January of each calendar year.
- All prescription drug, health insurance and Heart, Lung and Body scan copayment claims shall be processed as part of this benefit.
- This benefit may not used to be paid for individual insurance.
Benefits are not payable for Individual Insurance. In no event are premiums for individual health insurance a permissible plan benefit, whether purchased in the individual insurance market or in a Health Insurance Marketplace.
Reimbursement of Claims. To receive reimbursement from eligible expenses you incur on or after January 1st - December 31st of the calendar year, you will need to complete a claim form and send it to the Union office along with all supporting documentation that will verify the claim. No reimbursement will be made without, at a minimum, (1) a copy of your most recent pay stub indicating a year to date payment of the Health Insurance Premium totaling at least $200 (2) a written statement of an independent third-party such as an EOB from you stating that the expense had been incurred and the amount of the expense and (3) a written statement and documentation (e.g. pharmacy receipts or printouts with relevant information) from the participant that the expense has not been reimbursed and is not reimbursable under another plan coverage. No reimbursement of eligible health care expenses shall be made if such expenses have been reimbursed by any other health care insurance, provider or entity.
Claims can be submitted only ONCE A YEAR at any time after the maximum expense amount ($200) but in no event later than January 15th of the following year in which the claim was incurred.
Exclusions and Limitations:
1. This benefit does not apply to costs covered or reimbursed by your or your spouse’s health insurance or other similar benefit plan.
2. Claims from non-physician providers, physical therapy, emergency room services, procedures performed at a hospital, x-rays and dental co-payments are not eligible.
3. Deductible and co-insurance payments are not eligible.
4. Co-pay expenses in excess of the calendar year maximum.
5. If the husband and wife are both eligible employees, the claims must be submitted together.