Per Agreement between SMCCD & CSEA-Local 36, Art. 12.15, ratified 10.12.2011
WHO IS ELIGIBLE FOR CLASSIFIED EMPLOYEE WELFARE FUND?
To qualify you must meet the following criteria:
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. AND
- Employees Health Reimbursement Arrangement (HRA) funds provided in Sec. 12.14 of the District-CSEA Collective Bargaining Agreement must be exhausted.
Eligible out-of-pocket medical expenses incurred under a non-PERSCare plan but would have been covered by PERSCare. The District’s obligation for reimbursement shall be limited to the amount in the fund.
WHEN CAN I SUBMIT A CLAIM FOR REIMBURSEMENT?
Claims for reimbursement shall be made at the end of each calendar year and made no later than March 1 of each year.
||January 1, 2015 - December 31, 2015
||January 1, 2016 - March 1, 2016|
||January 1, 2016 - December 31, 2016
||January 1, 2017 - March 1, 2017|
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.
HOW DO I APPLY FOR A REIMBURSEMENT?
If you meet the eligibility requirements, please complete the following steps:
The following documentation must be submitted to substantiate the out-of-pocket expenses and that such expenses were paid. Documentation includes:
- Explanation of Benefits (EOB) statement from insurance carrier**; AND
- Itemized statement from your provider that indicates the name of provider, patient name, cost, date of service, description of service, and your amount paid to provider OR Proof of Payment Receipt – receipt of out-of-pocket expenses you paid to the provider**.
Step 3: Submit Claim Form, Comparison Chart, Worksheet and Supporting Documentation to the Office of Human Resources. 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.
- Claims submitted before the appropriate claim period shall be returned to claimant.
- Claims submitted after the appropriate claim period shall be denied.
Submit Claim Form and Supporting Documentation To:
Office of Human Resources
By Mail - 1900 Pico Blvd., Santa Monica, CA 90405
In-Person – 2714 Pico Blvd. 2nd Floor, Santa Monica, CA 90405
Claims for the 2014 Plan Year will be accepted during the following period only:
Claims Period for the 2014 Plan Year is closed.
**Note: You must submit a claim form by March 1st in order for your claim to be considered for reimbursement. If supporting documentation (EOBs and/or itemized statement/proof of payment) is missing from your claim, you have until June 1st to submit the missing supporting documentation.
WHEN WILL I RECEIVE MY REIMBURSEMENT?
Claimant will be notified of decision by Office of Human Resources by July 1st following the claim period in which the reimbursement claim was submitted. Notification shall be sent to claimant by email 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.
If you need assistance completing the forms, or if you have any questions, contact Lugina M. Rogers at ext.4060 or email@example.com.
NOTE: THIS INFORMATION IS SUBJECT TO CHANGE