Agenda - Council - 12/17/1991 - Laserfiche WebLink

Home

(iii) proof of payment. Depending on the type of claim, evidence of the claim may include a copy of an explanation of benefits from the administrator of a medical or dental plan, or a provider bill or statement or other similar information. (c) For eligible medical care expenses, claims will be reimbursed by the City up to the amount submitted not exceeding the amount elected on the participant's enrollment form for the Plan year regardless of the amount of employee contributions in the account on the subn~ttal date. (d) In the event that a participant ceases to be an employee with the City, the participant may still request reimbursement for qualifying expenses for the remainder of the Plan Year as long as the qualifying health care expenses were incurred within the same Plan Year. No reimbursement to a former employee, however, shall exceed the remaining balance, if any, in the former employee's Health Care and Insurance Reimbursement Account for the Plan Year in which the qualifying health care expenses under Sections 4.4 and 4.6 were incurred. (e) Upon presentation of a claim, a participant shall expressly represent that the item for which a claim is made is not subject to reimbursement under any policy described in paragraph 4.5. Section 4.5. Limitation on Benefits. Anything herein to the contrary notwithstanding, no benefits shall be paid under this Plan: (a) In the event and to the extent that such reimbursement or payment is covered under any insurance policy or policies, whether paid for by the City or the participant, or under any other health and accident plan by whomever maintained. In the event that there is such a policy or plan in effect providing for such reimbursement or payment, in whole or in part, then to the extent of the coverage under such policy or plan, the City shall be relieved of any liability hereunder. (b) To reimburse the participant for premiums paid for health coverage under a health plan maintained by the employer of the participant's spouse or dependent. Section 4.6. Disability Insurance Benefits. (a) Subject to limitations contained in other provisions of this Plan, and to the extent of the amount contained in the participant's Health Care and Insurance Reimbursement Account, a participant who incurs expenses for long term group disability insurance made available by the City to a participant shall be entitled to receive from the City full reimbursement under the terms of the Plan for the entire amount of such expenses incurred after the Effective Date of this Plan. An employee who becomes eligible after the Effective Date of this Plan may be enrolled on January 1. The City shall pay all qualifying disability insurance expenses incurred under this Section 4.6 pursuant to the procedures set forth under paragraphs (a) through (e) of Section 4.4. In the event that a participant ceases to be an employee, such former employee shall be reimbursed for such disability insurance expenses incurred under this Section 4.6 pursuant to the provisions and limitations of paragraph (d) of Section 4.4. (b) Subject to the entry date limitations of paragraph (a) above, a participant shall not be eligible for a disability insurance benefit under this Plan until the insurance contemplated by this Plan is actually obtained or made available by the City. 5 12/11/91