10-10-2022 Council Packet - Laserfiche WebLink

Home Browse Search

© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 39 accordance with the standard rules described above in paragraphs (vii) and (viii). Note: If the over-the-counter medicine cannot be purchased with the electronic payment card, it may still be reimbursed using the manual reimbursement procedures described in paragraph (a) above. (10) You must pay back any improperly paid claims. If you are unable to provide adequate or timely substantiation as requested by the Claims Administrator within the applicable time period, the card will be turned off and you must repay the Plan for the unsubstantiated expense. The deadline for repaying the Plan is set forth in the Cardholder Agreement. If you do not repay the Plan within the applicable time period, then the amount of the improperly paid claim may be withheld from your pay (if allowed by applicable law) and/or offset against future eligible claims under the Health FSA. If the amount of the improperly paid claim is not collected in full as described herein, the remaining unpaid amount will be treated as an indebtedness to the Employer. (11) You can use either the payment card or the paper claims approach. You have the choice as to how to submit your eligible claims. If you elect not to use the electronic payment card, you may also submit claims under the paper claims approach discussed above. Claims for which the electronic payment card has been used cannot be submitted as paper claims. (12) Your use of the payment card is not a claim. The use of an electronic payment card does not constitute a “claim” under the claims procedures. 5.7 What limits apply to reimbursements under the Health FSA? You cannot be reimbursed for any expenses above the amount of your election. You also cannot be reimbursed for any expenses that were incurred before the effective date of the Health FSA, for any expenses incurred before you become a Participant in the Health FSA, or for any expenses incurred after you terminate employment or otherwise cease to be eligible for coverage under the Health FSA, unless coverage is continued. Please note that it is not necessary that you have actually paid an amount for that expense to be eligible for reimbursement. You only must have incurred the expense and not have been reimbursed or paid from another source. An expense i s "incurred" when the service which gives rise to the expense has been provided, not when you are billed or when you pay the expense. Special Rule: A special rule applies to expenses for orthodontia care. Such expenses may be reimbursed before the orthodontia care has been provided if you have actually paid the healthcare provider in advance in order to receive the services (e.g., an upfront payment required to receive services). 5.8 What is the Grace Period? “Grace Period” means the period beginning on January 1 and ending sixty (60) days later each Plan Year. Claims incurred during the Grace Period will be considered to have been incurred during both the preceding Plan Year and the current Plan Year. For example, a claim incurred on February 1, 2023 will be deemed to have been incurred during both the Plan Year running from January 1 through December 31, 2022, and the Plan Year running from January 1 through December 31, 2023.