Common use of Claims Substantiation Clause in Contracts

Claims Substantiation. The Plan Administrator may require the Participant to furnish a bill, receipt, cancelled check, or other written evidence or certification of payment or of obligation to pay Health Care Expenses. The Provider will reimburse the Participant from the general assets of the Sponsors for expenses that it determines are Health Care Expenses up to the balance in the Participant’s HRA Account at such intervals as the Plan Administrator may deem appropriate (but not less frequently than quarterly). The Plan Administrator reserves the right to verify to its satisfaction all claimed Health Care Expenses prior to reimbursement. Each request for reimbursement shall include the following information: (1) the amount of the Health Care Expense for which reimbursement is requested; (2) the date the Health Care Expense was incurred; (3) a brief description and the purpose of the Health Care Expense; (4) the name of the person for whom the Health Care Expense was incurred and, if such person is not the Participant requesting reimbursement, the relationship of the person to such Participant; (5) the name of the person, organization or other provider to whom the Health Care Expense was or is to be paid; (6) a statement that the Participant has not been and will not be reimbursed for the Health Care Expense by insurance or otherwise, and has not been allowed a deduction in a prior year (and will not claim a tax deduction) for such Health Care Expense under Code Section 213; and (7) A written bill from an independent third party stating that the Health Care Expense has been incurred and the amount of such expense and, at the discretion of the Plan Administrator, a receipt showing payment has been made. Expenses eligible for coverage under any medical, HMO, dental, or vision care plans in which the Participant or his or her Dependents are enrolled must be submitted first to all appropriate claims administrators for such plans before submitting the expenses to the Provider for reimbursement under the Plan. A Participant who is entitled to payment or reimbursement under a health care reimbursement account in a cafeteria plan under Code Section 125 must receive his or her maximum annual reimbursement under the health care reimbursement account in the cafeteria plan before he or she is entitled to any reimbursement under this Plan. Claims will be paid in the order in which they are filed with the Provider and will be charged to the HRA Account of the Participant who submits the claim. The Plan Administrator may establish such other rules as it deems desirable regarding the frequency of reimbursement of expenses, the minimum dollar amount that may be requested for reimbursement and the maximum amount available for reimbursement during any single month.

Claims Substantiation. The Plan Administrator may require the Participant to furnish a billxxxx, receipt, cancelled check, or other written evidence or certification of payment or of obligation to pay Health Care Expenses. The Provider Claims Administrator will reimburse the Participant from the general assets of the Sponsors Company for expenses that it determines are Health Care Expenses up to the balance in the Participant’s HRA Account at such intervals as the Plan Administrator may deem appropriate (but not less frequently than quarterly). The Plan Administrator reserves the right to verify to its satisfaction all claimed Health Care Expenses prior to reimbursement. Each Unless a Health Care Expense satisfies the Claims Administrator’s procedures for automatic substantiation pursuant to the requirements of Code Section 213(d), each request for reimbursement shall include the following information: (1) the amount of the Health Care Expense for which reimbursement is requested; (2) the date the Health Care Expense was incurred; (3) a brief description and the purpose of the Health Care Expense; (4) the name of the person for whom the Health Care Expense was incurred and, if such person is not the Participant requesting reimbursement, the relationship of the person to such Participant; (5) the name of the person, organization or other health care provider to whom the Health Care Expense was or is to be paid; (6) a statement that the Participant has not been and will not be reimbursed for the Health Care Expense by insurance or otherwise, and has not been allowed a deduction in a prior year (and will not claim a tax deduction) for such Health Care Expense under Code Section 213; and (7) A written bill xxxx from an independent third party stating that the Health Care Expense has been incurred and the amount of such expense and, at the discretion of the Plan Administrator, a receipt showing payment has been made. Expenses eligible for coverage under any medical, HMO, dental, or vision care plans in which the Participant or his or her Dependents are enrolled must be submitted first to all appropriate claims administrators for such plans before submitting the expenses to the Provider Claims Administrator for reimbursement under the Plan. A Participant who is entitled to payment or reimbursement under a health care reimbursement flexible spending account in a cafeteria plan under Code Section 125 must receive his or her maximum annual reimbursement under the health care reimbursement flexible spending account in the cafeteria plan before he or she is entitled to any reimbursement under this Plan. Claims will be paid in the order in which they are filed with the Provider and will be charged to the HRA Account of the Participant who submits the claim. The Plan Administrator may establish such other rules as it deems desirable regarding the frequency of reimbursement of expenses, the minimum dollar amount that may be requested for reimbursement and the maximum amount available for reimbursement during any single month.