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SMC|Human Resources|Human Resources Department|Faculty Association Supplemental Benefits Guidelines

Faculty Association Supplemental Benefits Guidelines

 

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GUIDELINES for Completing the Supplemental Benefit Reimbursement Claim Form for Faculty

 

Source: Agreement between Santa Monica College Faculty Association and Santa Monica Community College District, Article 10.2
Effective Dates: January 01 - December 31, 2013
 
 WHO IS ELIGIBLE FOR A REIMBURSEMENT?    
 
 
Ø  Any faculty member who switches coverage from PERSCare to PERS Choice during the 2012 open enrollment period;
Ø  Any faculty member who had PERSCare in 2012 and switches to PERS Choice in a subsequent year;
Ø  Any faculty member who had PERS Choice in 2012;
Ø  Any retired faculty member receiving early retiree supplemental benefits as of January 01, 2013.
 
WHAT IS ELIGIBLE FOR REIMBURSEMENT?   
           
           
Ø  The District shall reimburse the faculty member for out-of-pocket expenses in any calendar year in excess of $250.00; expenses incurred by the faculty member and his/her eligible dependents must result from exceeding a maximum coverage level imposed by PERS Choice that is more restrictive than that provided under PERSCare.
 
Ø  The District shall be liable only for the amount that would have been incurred had the services been provided under the PERSCare plan and by an in-network PPO provider.
 
Ø  Eligible out-of-pocket medical expenses* are
Expenses incurred as out-of-pocket expenses under PERS Choice but would have been covered by PERSCare;
 
Ø  Eligible out-of-pocket expenses can be found on the “Comparison of PERSCare and PERS Choice” charts for both Medicare and Non-Medicare expenses.
 
          
 
​ ​WHAT IS NOT ELIGIBLE FOR REIMBURSEMENT?   
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​Ø  Copayments

Ø  Deductibles
Ø  Out-of-pocket maximums
Ø  Where services are provided by a non-PPO provider, the District shall be liable for only that portion that would have been paid had the service been provided by a PPO provider in the PERS plan.
 
 
 
IS THERE A MAXIMUM REIMBURSEMENT?   
 
 
Ø  Yes. The maximum amount varies depending on the category of expenditure.*
Ø   Coverage differences between PERS plans may be found in the Health Benefit Summary for the calendar year in question on the SMC  Human Resources website, Medical Plans (PPO Plans).
 
 
*These categories may change in future years as determined by PERS.
 
HOW DO I GET A REIMBURSEMENT?   
 
 
Ø  Step 1:
  • Use the Comparison of PERSCare vs PERS Choice 2013 Plans (see under FORMS, below) to determine whether an expense is eligible for reimbursement.
  • Claim Form must be submitted to the Office of Human Resources no later than one (1) calendar year following the date expenditure was paid for by the eligible faculty member and/or eligible dependents.
FORMS
 
CLAIM FORM:

COMPARISONS OF CARE vs CHOICE:

For Active Employees (non-Medicare):

For Retirees (Medicare): 

MISCELLANEOUS:

 
Ø  Step 2:
Submit Claim Form and supporting documents to:
Office of Human Resources, 1900 Pico Blvd., Santa Monica, CA 90405, or by hand delivery to 2714 Pico Blvd., 2nd Floor, Santa Monica, CA 90405.
 
Ø  Step 3:
Claimant shall be notified via email of decision by Office of Human Resources. If there is no email address available, notification shall be sent by U.S. Mail to address on claim form.
 
Ø  Step 4:
Payment will be issued by the District to the faculty member and mailed to the address on the claim form.
 
 
 

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Office of Human Resources
 
By Mail:
1900 Pico Blvd., Santa Monica, CA 90405
 
In-Person Delivery:
2714 Pico Blvd., 2nd Floor
Santa Monica, CA 90405
 
310-434-4415