Classified Staff Welfare Fund
Reimbursement Claims For Plan Year 2012
Per Agreement between SMCCD & CSEA-Local 36, Art. 12.15, ratified 10.12.2011
Who is eligible for a reimbursement?
Ø This fund shall be used for the sole purpose of providing reimbursement to unit members who changed health plans during the open enrollment period from October 10, 2011 to November 4, 2011, from a PERSCare Coverage plan to a non-PERSCare health care plan offered by the District and who incurred expenses for health care expenses for the employee or covered dependent that would have been covered by PERSCare and were not covered by the new insurance plan.
Ø HRA funds provided in Sec. 12.14 of the Collective Bargaining Agreement must be exhausted.
What is eligible for a reimbursement?
Ø Eligible out-of-pocket medical expenses incurred under a non-PERSCare plan but would have been covered by PERSCare.
Ø Is there a maximum amount that can be reimbursed?
The District’s obligation for reimbursement shall be limited to the amount in the fund.
Claims for reimbursement shall be made at the end of each calendar year and made no later than March 1 of each year starting in 2013. If the claims submitted exceed the amount of money in the fund, the available funds shall be distributed on a pro rata basis. Any decision to deny reimbursement shall be subject to the grievance process of Article 10.
Where can I find the forms that I need to submit a claim?
Ø Forms may be found in the section below titled, "How do I apply for a reimbursement?" or below:
Ø If you prefer to fill out the forms by hand, you may print them out from the link above, pick up the forms at the Office of Human Resources, or call 310-434-4415 and request the forms to be sent to you. Please note, if you fill out the forms by hand, you must include the dollar totals of each line item claimed.
Ø If you need assistance completing the forms, or if you have any questions, call the Office of Human Resources, 310-434-4415.
How do I apply for a reimbursement?
Please review the following presentation for additional information:
Ø Step 1:
Complete CLASSIFIED STAFF WELFARE FUND REIMBURSEMENT CLAIM FORM. See Instructions on Page 1 of the Claim Form.
You will require the Comparison of COMPARISON OF PERSCare vs PERS Choice 2012 PLANS to assist you in determining what expenses are eligible for reimbursement.
Ø Step 2:
§ Attach original itemized receipts, Explanation of Benefits (if applicable), etc.
Ø Step 3:
Submit Claim Documentation during the following claim periods:
NOTE: Deadline for claim submission extended to April 01, 2013 for 2012 Plan Year ONLY
· Plan Year 2012: For expenses incurred Jan.01-Dec.31, 2012, submit January 01-March 01, 2013
· Plan Year 2013: For expenses incurred Jan.01-Dec.31, 2013, submit January 01-March 01, 2014
· Plan Year 2014: For expenses incurred Jan.01-Dec.31, 2014, submit January 01-March 01, 2015
· Plan Year 2015: For expenses incurred Jan.01-Dec.31, 2015, submit January 01-March 01, 2016
· Plan Year 2016: For expenses incurred Jan.01-Dec.31, 2016, submit January 01-March 01, 2017
CLAIMS MUST BE SUBMITTED IN A TIMELY FASHION.
Claims submitted with postmark or date stamped by the Office of Human Resources within the appropriate claim period shall be accepted for reimbursement consideration.
v Claims submitted before the appropriate claim period shall be returned to claimant.
v Claims submitted after the appropriate claim period shall be denied.
Ø Step 4:
Notification of Reimbursement Decision
Claimant will be notified of decision by Office of Human Resources by July 01 following the claim period in which the reimbursement claim was submitted.
Method of Notification: An email shall be sent to claimant if an email address was submitted on claim form; if no email address was submitted a letter of notification will be sent via US Mail to address on form.
NOTE: THIS INFORMATION IS SUBJECT TO CHANGE.
If you have any questions, contact Laurie Heyman, ext. 4987 or email@example.com.