Proper documentation for Medical reimbursement

[Guest TrishL]

Hi all,

I'm new to HR and I have an employee that is turning in his Cafe Plan for Med reimbursment. One of his receipts is a statement from the Doctor's office that shows how much he paid but has a balance due. He wants to be reimbursed for the balance due portion. Is this ok?

Thanks in advance,

Trish in CO

[papogi]

As long as the balance is attributable to things which are reimbursable (i.e., the dates of service are within the flex plan year, the services are allowable medical expenses, the expenses are not payable under any regular medical coverage, and the patient is eligible under the flex plan), and this is documented in the claim papers you have in your hand, then this is reimbursable. To further illustrate, many flex claims are processed and paid based on the "employee responsibility" column found on Explanations of Benefits. This is OK, even though the doctor might not have gotten around to actually billing the patient, yet. Again, make sure this is not a carryover balance from a previous year, as these might be related to services rendered outside the current plan year.

[Guest JerseyGirl]

The IRS does not require that the bill be paid, only that the services have been rendered.

Here is a quick list of what is required as proper documentation for medical reimbursement:

The patient’s name (if the patient is not the participant, you need to know their relationship to the participant -- spouse, child, etc., and whether they are considered a legal dependent by the IRS); the name of the service provider; what type of treatment was rendered (not all procedures are considered medically necessary, and on some invoices, it can be hard to tell); the date the service was rendered; and what portion, if any, the participant’s insurance has paid. Note I did not say ‘will pay’. Very often the amount the doctor’s office estimates will be covered by insurance is off by large differences. If there is insurance involved and they have not yet paid their portion of the bill, you should really wait until you are given the EOB from the insurance carrier as part of the documentation to ascertain what the actual out-of-poceket expense is.

If the receipts being provided don’t supply all of this information, ask for more! It’s not that any of us want to keep an employee from their money, but it is our responsibility to keep the plan as a whole in compliance with the regulations.

Hope this helps!