Per Agreement between Santa Monica College Faculty Association and Santa Monica Community College District, Article 10.2
Who is Eligible for the Faculty Association Supplemental Benefits Fund?
- Any faculty member who switches coverage from PERSCare to PERSChoice during the 2012 open enrollment period;
- Any faculty member who had PERSCare in 2012 and switches to PERSChoice in a subsequent year;
- Any faculty member who had PERSChoice in 2012;
- Any retired faculty member receiving early retiree supplemental benefits as of January 1, 2013.
Review the Faculty Association Supplemental Benefits Presentation and Article 10.2 for additional information.
What Expenses Are Eligible For Reimbursement?
Eligible expenses are out-of-pocket medical expenses incurred under PERSChoice but would have been covered by PERSCare. The categories of expenditures* are as follows:
2017 Plan Year
- Home Health Care
- Occupational Therapy
- Physical Therapy
- Skilled Nursing Care and Rehabilitation Care
2018 Plan Year
- Home Health Care
- Occupational Therapy
- Physical Therapy
- Skilled Nursing Care and Rehabiltation Care
*These categories may change in future years as determined by CalPERS.
Review the Comparison of PERSCare vs. PERSChoice Plans charts for eligible benefit services and reimbursement amounts for both Medicare and Non-Medicare expenses.
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.
What is Not Eligible for Reimbursement?
- Copayments
- Deductibles
- Out-of-pocket maximums
- 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?
Yes. The maximum amount payable varies depending on the category of expenditure.
The District shall reimburse the faculty member for eligible 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 PERSChoice that is more restrictive than that provided under PERSCare.
How Do I Get a Reimbursement?
Step 1: Complete the Faculty Association Supplemental Benefit Reimbursement Claim Form
Complete the Comparison of PERSCare vs. PERSChoice Plans (see FORMS below) to assist you in determining what expenses are eligible for reimbursement.
- Claim Form must be submitted to the Office of Human Resources no later than one (1) calendar year following the date of service for an eligible faculty member and/or eligible dependents.
Note: If a faculty member is incapacitated and unable to file a claim timely, a request for an extension may be granted up to two (2) calendar years following the date of service.
Forms and Documents
| Form | 2017 Plan Year | 2018 Plan Year |
|---|---|---|
| Claim Form | 2017 Faculty Association Supplemental Benefit Reimbursement Claim Form | 2018 Faculty Association Supplemental Benefit Reimbursement Claim Form |
| Comparison Chart (Active Employees) | 2017 Comparison of PERSCare vs. PERSChoice | 2018 Comparison of PERSCare vs. PERSChoice |
| Comparison Chart (Retirees) | 2017 Comparison of PERSCare vs. PERSChoice Medicare Coverage | 2018 Comparison of PERSCare vs. PERSChoice Medicare Coverage |
Step 2: Submit Supporting Documentation
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.
The FA Voluntary Medical Expense Reimbursement Worksheet can assist you with organizing your expenses. Note: This form is optional and does not need to be submitted with your claim.
Step 3: Return Claim Form and Supporting Documentation to:
Office of Human Resources
By Mail - 1900 Pico Blvd., San Monica, CA 90405
In-Person - 2714 Pico Blvd. 2nd Floor, Santa Monica, CA 90405
When Will I Receive My Reimbursement?
Claimant shall be notified via email of decision by Office of Human Resources. Notification shall be sent to claimant by email if an email address was submitted on claim form. If there is no email address available, notification shall be sent by US Mail to address on claim form.
Payment will be issued by the District to the faculty member and mailed to the address on the claim form.
If you need assistance completing the forms, or if you have any questions, contact Lugina M. Rogers at ext. 4060 or rogers_lugina@smc.edu.
Note: This information is subject to change.
Rev: 06.07.19