You may submit a claim for reimbursement whenever your eligible out-of-pocket medical and dental expenses total a minimum of $25.

Your expenses must be incurred between your effective date of coverage and March 15 of the following year. An expense is incurred when you receive the treatment or service or purchase the supply, not when you receive the bill or make payment.

The deadline for submitting claims for expenses incurred through March 15 is March 31. For expenses incurred between January 1 and March 15, any remaining balance from your prior year contributions are automatically drawn down before deductions are made against your current contributions.

Your claim form must include the following information:

• Employee ID
• Dates of service
• Amount claimed for reimbursement
• Description of the expense
• Information on the person for whom services were provided
• Your signature certifying:
• The expenses were incurred and qualify for reimbursement, and
• The expenses are not for general health or cosmetic purposes, and
• The expenses have not been and will not be reimbursed from another source
• Photocopies of acceptable documentation of expenses; this includes:
  
  • Explanation of Benefits statement from your medical or dental carrier
  • Statement from your provider of service
  • Fully itemized bills
  • Prescription drug receipts
  • Dated cash register receipts with the prescription number or eligible over-the counter expense
  • Listing of prescriptions purchased from your pharmacy
  • Written statement on the claim form for your mileage or parking

Claim forms received by Employee Benefits by noon on Wednesdays are typically reimbursed within two weeks. If you are enrolled in payroll direct deposit, your reimbursement will be deposited into that same bank account. You will receive an e-mail indicating the date that deposit was made. If you are not enrolled in payroll direct deposit, a check will be mailed to your home address. You may view your account balance and reimbursement statements at Employee Self-Service.

Eligible expenses are reimbursed for the amount submitted up to your authorized annual deduction. If the reimbursement amount is less than $25, payment will be issued at the end of the next calendar quarter.