Ill. Admin. Code tit. 80 § 2120.525

Current through Register Vol. 48, No. 43, October 25, 2024

Section 2120.525 - Electronic Card Reimbursement Program

a) A Participant may elect to pay medical care expenses through the use of a stored value card (Card) provided by the Plan Administrator. The Card deducts funds directly from the Participant's medical care assistance account and avoids any up-front, out-of-pocket expenses for the Participant.

b) In order to be eligible for the Card, the Participant must agree to abide by the terms and conditions associated with the Card as established by the Plan Administrator and provided to the participant prior to enrollment, limitations as to Card usage and the Plan Administrator's right to withhold and offset payment for unsubstantiated expenses. The Participant must further certify that the Card will be used only for eligible medical care expenses.

c) Use of this Card is limited to payments for Medical Care Expenses.

d) The maximum reimbursable amount under the Card is the full amount of the Participant's contribution to the medical care assistance account for the Plan Year, less any previously submitted reimbursements.

e) The Participant must obtain a receipt or third party statement (i.e., explanation of benefits form or invoice) each time the Card is used. The receipt must be retained for 1 year following the end of the Plan Year in which the expense was incurred and must be available for presentation to the Plan Administrator upon request. At a minimum, the receipt must contain the following information:

1) the type of service provided (i.e., office visit; prescription; over-the-counter purchase);

2) the date the medical care was provided (i.e., when the expense was incurred);

3) the amount of the expense;

4) the provider's or vendor's name; and

5) the patient's name.

f) If the Participant fails to provide the requested documentation to the Plan Administrator within the requested time frame, the expenses will be deemed unsubstantiated and the Participant will be required to repay the unsubstantiated expenses. Repayments may be made by either:

1) submitting payment to reimburse the Plan for the cost of the unsubstantiated expense. Payment must be in the form of a check payable to the State of Illinois, submitted to the Plan Administrator; or

2) submitting other paper claims for the fiscal year with third-party receipts in amounts equal to, or greater than, the unsubstantiated expenses. These paper claims will automatically be substituted to offset the outstanding Card transactions.

g) Failure to submit requested documentation or provide payment for unsubstantiated expenses will result in suspension of the Card and termination of future use of the Card. Participants may be subject to involuntary withholding for the unsubstantiated expenses or outstanding transactions may be reported to the IRS as income and the Participant's W-2 form adjusted accordingly.

h) Participants may elect the Card at any time during the Plan Year. Cards are automatically suspended upon termination or cancellation of participation in the Plan.

Ill. Admin. Code tit. 80, § 2120.525

Amended at 37 Ill. Reg. 4241, effective March 22, 2013