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May I submit claims for Over-the-Counter (OTC) medications?
Yes, under certain circumstances. Eligible expenses must alleviate or treat personal injuries or sickness. Expenditures merely benefit the general health of an individual are not covered.

Some examples are listed in the table below. This list is not all-inclusive and is meant to be a guide in determining what over-the-counter drugs are allowable in the benefit. All over-the-counter reimbursement items are subject to review by the plan and additional documentation (such as a doctor's note) may be required.

Who can seek reimbursement?
Section 152 of the code states: The taxpayer, spouse, or dependents are eligible.

What are the quantity limits?
Only amounts that can be used within the plan year by the taxpayer, spouse, or dependent are to be included.

Claims must be properly substantiated. What does this mean?
You must submit a complete and signed Flex Plan claim form with receipts attached.

You may also view the IRS information Revenue Rule 2003-102.

What is the best thing to submit to get reimbursed for orthodontic expenses?
Since you must have funds in your medical reimbursement account prior to receiving services, long-term orthodontic care payments must be reimbursed monthly, at the time you receive adjustments and/or orthodontic maintenance. However, if you have your orthodontist apportion your claim, you can receive full reimbursement of your out-of-pocket expenses when making a large down payment for these services. Please read below for an example of an apportioned orthodontic reimbursement request and present this to your orthodontist.

Example Regarding Orthodontic Expenses:
In October 1997, Sally contracts with her orthodontist to have the orthodontist work on her child's teeth. During the first visit (November) the child will be X-rayed and fitted for braces. During the second visit (December), the braces will be installed. During 15 subsequent monthly visits, the braces will be adjusted. Eventually (18 months after the first visit, if all goes as planned) the braces will be removed, and perhaps a retainer will be fitted for use thereafter. For these services, Sally pays $3,000 on the date of the first visit.

In the above example, it is clear that the entire $3,000 cannot be reimbursed as a calendar 1997 plan year expense, because in 1997 Sally's child was not provided with all the medical care that gave rise to the expense. So just how much of the $3,000 can be reimbursed as a calendar 1997 plan year expense? Sally needs to ask her orthodontist to apportion the $3,000 to the office visits her child makes over the contract's 18-month period. If the orthodontist estimates that one third of the total time that he or she will spend with the child (and one third of the expense for supplies) will occur during the first two visits (both in 1997), and that the remaining time and expenses will be spread evenly over the remaining months, then it seems reasonable that $1,000 of the $3,000 could be reimbursed as a 1997 expense, $1,500 as a 1998 expense (= 12 months X $2,000/16 remaining months), and $500 as a 1999 expense. The orthodontist's letter apportioning the expenses should be attached to the reimbursement request form submitted each month.

• Provide the Explanation of Benefits you receive from your medical plan rather than bills/statements from your provider’s office. For the Trust Plan this is the Green or Blue form you receive showing what the Plan has paid. (Placing these in date order is also helpful.)
  
• Call your pharmacy prior to mailing in a medical reimbursement claim and request a print out of all prescriptions purchased for your family rather than submitting individual prescription receipts. This may even save on postage!
  
• Try to wait at least three weeks before calling the Trust office to inquire as to the status of your Medical and Dependent Care reimbursement claim(s).

Please note:  On Tuesday the claims processed for the week are sent to the record keeper to request disbursement of funds. (Whenever possible, this is a good day to avoid calling the Trust office about Flex.)

Supplemental Workers Compensation

• You must provide proof of Workers' Compensation.
• For each week you receive Workers' Compensation you will receive $300 from your Wage Replacement Account, until your account is depleted.
• Within four weeks of the week that you meet the eligibility requirements, you should complete a claim form to receive benefits.  You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for supplemental compensation benefits in 2004, you must submit the completed claim form by January 15, 2005.

Supplemental Unemployment Compensation

• You must provide proof of unemployment payment (check stubs or statement from Unemployment office showing weeks paid).
• For each week you receive an unemployment check you will receive $300 from your Wage Replacement account, until your account is depleted.
• Within four weeks of the week that you meet the eligibility requirements, you should complete a claim form to receive benefits.  You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for supplemental unemployment benefits in 2004, you must submit the completed claim form by January 15, 2005.

Economic Dislocation Benefit

• Intend to travel to an IBEW Local Union headquartered outside the jurisdiction of the Union.
• If you are a member of Local 48, receive a travel letter.
• If you are not a member of Local 48, sign the out-of-work list. The Union will provide verification to the Administrator.
• Fill out a claim form.
• Submit your claim within four weeks of receiving travel letter or signing the books. You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for economic dislocation benefits in 2004, you must submit the completed claim form by January 15, 2005.
• 50% of your account balance will be paid out.

        Once your arrive in the new Local,

• Sign the out-of-work list.
• Fill out a claim form.
• The Local will provide verification that you are working in that jurisdiction.
• The remainder of your wage replacement account will be paid out.

Submit your claim within four weeks of signing the books. You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for economic dislocation benefits in 2004, you must submit the completed claim form by January 15, 2005.

How often can I transfer money from my Premium Reserve Account to the Medical and/or Dependent Care Account?
Open Election Periods are held Jan/Feb & Jul/Aug each year. Statements and Election forms are mailed out by January 31 and July 31. Please call the Trust office if you do not receive this information.

During the Open Election period, you can designate money to be placed monthly in Medical Reimbursement. At the same time, you can move any existing money in Premium Reserve into Medical Reimbursement and/or Dependent Care Reimbursement.