• Reimbursement Benefit Overview
• What Types of Expenses Qualify?
• When Do I Become Eligible for the Reimbursement Benefit?
• How Do I Submit a Qualified Medical Expense for Reimbursement?
• Is There a Time Limit for Submission of Qualified Medical Expenses?
• What Are the General Rules for Reimbursement of Long-Term Care Services?
• What Are the General Rules for Reimbursement of Long-Term Care Insurance Premiums?

Please note that the descriptions provided above are not comprehensive and additional restrictions or limitations may apply.

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When Do I Become Eligible for the Reimbursement Benefit?
You become eligible when you meet one of the following criteria:

• You are immediately eligible for the Reimbursement Benefit upon the earlier of:
  • The date the you cease employment (either Terminated or Retired) with your employer after attaining "Retirement Eligibility¹," as defined by your institution, or
  • The later of the date you turn age 55 or cease to be employed (either Terminate or Retire) by your employer.

• If you cease to be employed by your Employer prior to attaining age 55 and the aggregate balance of your Employee After-Tax Contribution Account and Employer-Contribution Account (determined after application of the forfeiture rules) does not exceed $5,000, you will be immediately eligible for reimbursement of Qualified Medical Expenses payable from your Health Accounts for you, your Spouse (or Dependent Domestic Partner²), Dependent Children, and/or Dependent Relatives. View definitions of the different types of eligible dependents.

• If you, your Spouse (or Dependent Domestic Partner)², Dependent Child, or Dependent Relative incurs Terminal Illness or Injury Expenses, those expenses can be reimbursed from your Accounts. "Terminal Illness or Injury Expenses" refers to Qualified Medical Expenses (QMEs) of the terminally ill or injured individual which are incurred:
  • Within one year prior to the date of the individual's death; or
  • Within one year prior to, or at any time following, the date of certification by the individual's physician that the individual has suffered an illness or injury expected to result in such individual's death within five (5) years of the date of certification.

  QMEs do not include expenses incurred prior to the date you became a Participant in the Emeriti Program.

• If you submit valid evidence of Qualified Medical Expenses incurred by you, your Spouse (or Dependent Domestic Partner)², Dependent Children, and/or Dependent Relatives during a single 12-month period, and those expenses exceed $15,000 in the aggregate, then the Plan will reimburse you for the portion of those QMEs that exceed $15,000 (Catastrophic Protection). QMEs do not include expenses incurred prior to the date you became a Participant in the Emeriti Program.

• If you die, your Spouse (or Dependent Domestic Partner)², Dependent Children, and Dependent Relatives will each be immediately eligible for reimbursement of Qualified Medical Expenses payable from the balances in your Employer-Contribution Account (determined after application of the forfeiture rules) and Employee After-Tax Contribution Account.

• When a division of assets occurs due to a Domestic Relations Order, and if the alternate account holder is not a Participant under the Emeriti Plan, the alternate account holder is immediately and only entitled to Reimbursement Benefits paid from the alternate account holder’s separate account. With respect to these Reimbursement Benefits, the alternate account holder may submit claims for reimbursement of Qualified Medical Expenses incurred by the alternate account holder and his or her Spouse (or Dependent Domestic Partner), Dependent Children, and/or Dependent Relatives. The alternate account holder may not make contributions to his or her Account(s).

  ¹ Retirement Eligibility varies by plan. For more information, see the Your Plan Highlights sheet or your Plan's Emeriti Summary Plan Description, or call 1-866-EMERITI.

  ² Domestic partners' coverage is only available if elected by your institution. If you have a non-dependent domestic partner, you cannot use your Emeriti Health Account to pay for the health insurance or qualified medical expenses. Insurance premiums must be paid each month via electronic transfer from other assets.

  This is general information regarding eligibility; please refer to your institution's Emeriti Summary Plan Description for complete details under your Plan.

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  How Do I Submit a Qualified Medical Expense for Reimbursement?
  After you have incurred an eligible expense that is not otherwise covered by a medical, dental, vision, or other health plan, and which has not been previously reimbursed, you must fill out a QME Claim Form and return it along with the bill documenting the expense to Acclaris Inc. at the address given on the form. You will be reimbursed for eligible expenses out of your Health Account assets. You will need to make sure there are enough funds in your Health Accounts to cover these payments.

  *Please note that the fee is waived for the first four submissions (consisting of as many receipts as you wish) in a calendar year. Thereafter, there is a fee of $6 for each subsequent submission during the rest of the calendar year. So if you submit your expenses once per quarter, you will have no added cost for the Reimbursement Benefit.

  Is There a Time Limit for Submission of Qualified Medical Expenses?
  Once you incur a qualified medical expense, that expense must be submitted for reimbursement within 12 months following the end of the calendar year in which the expense was incurred.

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  What Are the General Rules for Reimbursement of Long-Term Care Services?
  The Emeriti Health Accounts may be used to reimburse expenses for qualified long-term care services provided to the employee or an eligible dependent (for example, an elderly parent enrolled as a Dependent Relative under the Plan), unless they are otherwise reimbursed by insurance or another reimbursement plan. Long-term care services are qualified if they are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative services, or “maintenance or personal care services,” which are required by a “chronically ill individual” and which are provided pursuant to a plan of care prescribed by a licensed health care practitioner. Expenses incurred at facilities, such as nursing homes, can qualify as long-term care expenses, subject to the relationship requirements discussed below.
  

  • A “chronically ill individual” is one who has been certified within the last 12 months by a licensed health care practitioner as:
    
    • Unable to perform without substantial assistance at least two activities of daily living (eating, toileting, transferring, bathing, dressing, or continence) for a period of at least 90 days due to a loss of functional capacity.
    • Having a level of disability similar to the level of disability described in clause or,
    • Requiring substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairment.

  • The term “maintenance or personal care services” means care given with the primary purpose of providing needed assistance with any of the disabilities causing the individual to be considered a “chronically ill individual” — i.e., eating, toileting, transferring, bathing, dressing, or continence — including protecting the individual from threats to health and safety due to severe cognitive impairment.

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  What Are the General Rules for Reimbursement of Long-Term Care Insurance Premiums?
  The Emeriti Health Accounts may be used to reimburse premiums paid for qualified long-term care insurance. The insurance contract is qualified if:

  1. It provides coverage only for qualified long-term care services (discussed above: note that it may provide payments on a per diem or other basis regardless of the actual expenses an insured incurs during the period to which the payments relate).

  2. it does not pay or reimburse expenses for services or items provided under Medicare (or that would be provided by Medicare but for application of a deductible or coinsurance amount), except for expenses reimbursable by Medicare only as a secondary payer (and the contract may provide benefits that coordinate with Medicare)

  3. it is guaranteed renewable;

  4. it does not have a cash surrender value or other financial provision that may be paid, assigned, pledged as collateral for a loan, or borrowed by the policyholder; and

  5. it provides that all refunds of premiums and all policyholder dividends or similar amounts arising under the contract will be applied either to reduce future premiums or to increase benefits under the contract (except that it may provide a refund when the insured dies or the contract is cancelled).