2017 011 Ordinance - Laserfiche WebLink

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benefit shall be paid hereunder unless a Participant has first submitted a written claim for benefits to the Plan Administrator on a form specified by the Plan Administrator, and pursuant to the procedures set out in Section VIII, below. Upon receipt of a properly documented claim, the Employer shall pay the provider of medical services or the Participant the benefits provided under this Plan as soon as is administratively feasible. A Participant may submit a claim for reimbursement for an Eligible Medical or Prescription Expense arising during the Plan Year at any time during the period that begins when the expense is incurred, and ends ninety (90) days after the close of the Plan Year. 5.03. Required information Each Participants claim for benefits shall contain a written statement containing the following information: (a) the person or persons on whose behalf Eligible Medical or Prescription Expenses have been incurred; (b) the nature of the expenses so incurred; and (c) the amount of the requested reimbursement; - . (d) a statement that such expenses have not otherwise been paid through insurance or reimbursed from any other source. The above information can be provided by submitting a copy of the employer sponsored fully insured programs Explanation of Benefits Statement which provides detailed information of the specific claim for benefits. The Plan may require, in addition to the Explanation of Benefits Statement, a copy of the medical provider statement which corresponds to the claim for benefit request. 5.04. Termination of benefits A Participant, who is no longer eligible for coverage under this Plan, shall have the right to submit a claim for reimbursement for any Eligible Expense arising during the Coverage Period, incurred up to the date coverage ceases, at any time prior to the expiration of the 90-day period following the close of the Plan Year in which the expense arose, and to receive benefits hereunder. Ma~eld Village HRA Plan 0117.doc 8