Medical Reimbursement Frequently Asked Questions**

I elected Medical Reimbursement during my company's open enrollment period. How soon after I enroll in my company's Cafeteria Plan am I able to submit claims for reimbursement?
You may begin using your benefits the first day of the Plan Year. The claims you submit must have a date of service equal to or after the first date of the Plan Year. Immediate funding for this account is the responsibility of your Employer. This is the risk your employer has accepted when offering this type of benefit plan to you.

What expenses are considered eligible under the Medical Reimbursement Plan? Where do I find this information?
Some of the expenses that are reimbursable under your Medical Reimbursement Plan include, but are not limited to, office visit co-payments, medical deductibles, co-insurance amounts, eye care and dental charges. For a listing of all eligible expenses under the Medical Reimbursement Plan, please visit www.irs.gov and print Publication 502.

Can I hold my receipts and file just before the end of the Plan Year? Also, how do I know when the Plan Year begins and ends?
While we do not recommend it, some participants retain their eligible receipts for Medical Reimbursement and file at the end of their Plan Year. You also have a 90-day extension after your Plan Year ends to get all your information to us. But remember, only those receipts received in our office by close of business on the 90th day will be considered for reimbursement.
Your Employer’s Plan Year is a 12 month period. Most begin in January and end in December, similar to the calendar year. BUT, your Employer may have a different beginning and ending month for your company’s Plan Year. You can always contact Ameritas Customer Service to determine the beginning and ending date of your Company’s Plan Year.

I overestimated my expenses for the year. I will have a balance in my account at the end of the year. Will those funds be returned to me?
Your Employer should have made it very clear during the Open Enrollment process that all funds remaining in the Medical Reimbursement account after the Plan Year ends, are returned to the Employer to offset the administrative costs of maintaining the plan in compliance with the IRS “use it or lose it” rule. It is for this reason that participants in the plan should always be certain that the amount they allocate for their account be slightly lower than what will actually be spent during the Plan Year.

I have enrolled in my company’s Medical Reimbursement plan for the 2nd year. Last year I would receive my reimbursements within a week after submitting my receipts. This year it is taking much longer. At one point, it was as long as 30 days. What has changed?
Different factors can delay the process of expense reimbursement. The two biggest delays occur when -

Your company is renewing their business with Ameritas. Until all information requested for renewal is submitted to our office, we cannot go forward with the process. Quickly returning enrollment material to your Benefits Office will certainly speed up the process.

There are discrepancies in the monthly statement. The Ameritas Section 125 Administration staff must reconcile your company’s monthly statement to assure that the information and funds your Employer is sending matches the current information in our system. Additional information, incorrect dollar amounts and other statement discrepancies will delay the posting of funds and subsequently slow down the reimbursement process. Your Employer and Ameritas understand that this money is extremely important to you. We thank you for your patience and ask that you remember that this is a temporary situation.

What is the definition of Over the Counter (OTC) Expenses and what items can I be reimbursed for?
Over the Counter (OTC) Expenses are those expenses that are incurred for “medical care”. Medical care is defined by the IRS as:
"for the diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting any structure or function of the body"

OTC Expenses may include items such as antacids, allergy medications, pain relievers, and cold medications. Any items that are used to maintain your general health or well being are not eligible expenses (i.e., vitamins).

See the next question on what type of information is required to submit an OTC expense.

What type of information must be provided for Over-the-Counter (OTC) drugs?
Although the IRS Ruling expands the definition of medical care, it does not change the minimum substantiation requirements for accident and health plans, including Health FSA’s. Participants must provide a receipt or other document from the third party provider (e.g., the grocery store, the pharmacy, etc.) that identifies the following:

• the date the expense was incurred
• the specific OTC drug that was purchased
• the amount of the drug

Many receipts from the grocery store or pharmacy will not identify the OTC item (e.g., it might just indicate “pharmacy”, “drug”, “H&B Supply”) by name. The identification of the OTC drug or item is necessary for the administrator to make a determination that the OTC item is for “medical care”. Self-certification by the participant that the OTC drug or item was purchased to treat a specific medical condition is, in and of itself, insufficient to satisfy the substantiation rules.

I am unhappy with the way my Medical Reimbursement claims are being processed. Receipts that I thought were considered eligible are being denied by LifeRe. What steps can I take to have my account reviewed?
Your first step should be to contact Ameritas Customer Service (800 229-1024 or 210 357-1010 local). A Customer Service Representative (CSR) will have your file reviewed by the Section 125 Claims Processing Department. Be certain to inform the CSR what claims payments/denials you are disputing and if necessary, fax any additional supporting documentation.

If the claim remains denied, additional appeals must be done in writing. All appeals are addressed to the attention of the Claims Director and mailed to Ameritas Group, P.O. Box 786010, San Antonio, TX 78278-6010. Your appeal must be submitted during the plan year in which the claim was incurred. If your appeal is submitted during the 90 day extension period (after end of plan year), the final decision must be reached before the 90th day. An extremely important point to consider, if you wait until the end of the plan year to file your claims.