6.1 Health Reimbursement Arrangement
The Southern California IBEW-NECA Health Plan's Health Reimbursement Arrangement (HRA) provides Eligible Participants with a source of pre-tax Contributions to pay eligible medical expenses.
When you work under a Collective Bargaining Agreement (or certain other agreements) that requires HRA Contributions, your Employer will make pre-tax Contributions on your behalf into your HRA account. You may use these pre-tax funds to pay eligible medical expenses for you and your eligible dependents.
When you retire and begin Retiree Health Plan coverage, you will continue to have access to the funds in your HRA account, provided you maintain your Retiree Health Plan coverage.
All HRA Contributions are assets of the Trust Fund. You may use the funds in your HRA account to pay eligible medical expenses, but you are not vested in any Contributions made into your HRA account. In addition, the Board of Trustees retains the right to change the HRA's rules or to terminate HRA benefits.
6.1.1 Eligible Expenses
The funds in your HRA account may be used on behalf of you and your covered Spouse to pay eligible medical expenses. Eligible expenses are defined under Section 213 of the Internal Revenue Code. Some eligible medical expenses include:
- Retiree Health Plan self-pay premiums;
- COBRA premiums;
- Co-payments, co-insurance and deductibles;
- Expenses that exceed medical, hospital, dental or vision plan limits;
- Non-prescription drugs prescribed by a physician;
- Dental expenses, including orthodontia;
- Vision care expenses, including eye exams, glasses and contact lenses;
- Transportation expenses related to medical care;
- Hearing aids;
- Chiropractic care;
- Durable medical equipment;
- Crutches; and
Some examples of ineligible expenses are:
- Cosmetic services, including hair restoration and hair transplants;
- Weight loss programs, unless medically necessary;
- Fees for exercise or health clubs, unless medically necessary;
- Expenses that are reimbursed or subject to reimbursement by any other source, such as an insurance policy, an employer, Medicare or any other government health program;
- Medical expenses that are experimental or not medically necessary; and
- Expenses claimed on an income tax return;
- Expenses incurred outside of the allowable claims timeframe (see Article 6.1.3: Applicable Time Periods for HRA Claims).
6.1.2 Using the Funds in Your HRA Account
There are four ways to use the funds in your HRA account:
- Debit Card. All HRA-Eligible Participants receive a debit card that may be used for eligible medical expenses. You simply swipe your debit card at the time of purchase and the purchase is paid for using the funds in your HRA account. The card cannot be used for non-eligible expenses.
- Online Portal (Payments). If you have an upcoming medical bill, including your Retiree Health Plan self-pay premium, you can submit your invoice via the HRA's online portal (scibewneca.lh1ondemand.com) and request that payment be made to the vendor. Payment must be for the full amount of the bill. Partial payments are not allowed.
If you do not have enough funds in your HRA account to pay a medical bill, you can pay the bill out of pocket and request a partial reimbursement. If additional funds are later contributed into your HRA account, you may re-submit the claim for additional reimbursement.
- Online Portal (Reimbursements). You can request a full or partial reimbursement from your HRA account. Simply submit the receipt associated with an eligible medical expense through the HRA's online portal (scibewneca.lh1ondemand.com) and you will receive a reimbursement check up to the amount of available funds in your HRA account.
- File a Paper Claim. You can send in a paper claim requesting a reimbursement from your HRA account. The HRA Reimbursement Claim form is available on www.coastbenefits.com. Mail or fax your completed claim form and receipts to:
3444 Camino del Rio North, Suite 101
San Diego, CA 92108
Toll-Free Phone: (844) 739-7956
Toll-Free Fax: (877) 501-1015
Along with the HRA Reimbursement Claim Form, you must provide supporting documentation describing the expenses and proving that you or your Spouse paid the expenses. Supporting documentation may include the following:
- An itemized bill describing the services provided, the person to whom the services were provided, the date of service, and the charged amount;
- An Explanation of Benefits (EOB); or
- A receipt showing proof of payment.
Do not send your HRA claims to the Administrative Office. HRA claims are processed by Coast Benefits, the third-party administrator for HRA benefits.
You cannot request a payment or reimbursement check for less than $25. You may submit claims that are less than $25, but a reimbursement will not be processed until you have submitted claims totaling at least $25.
Debit card transactions can be used to pay eligible medical expenses that are less than $25.
6.1.3 Applicable Time Periods for HRA Claims
You cannot use the funds in your HRA account for any medical expense incurred by you or your eligible spouse:
- Prior to September 1, 2017 (the date the HRA went into effect); or
- During any period when you were not covered under the Active Health Plan (including COBRA coverage) or the Retiree Health Plan; or
- Prior to the date of your initial HRA Contribution.
When your Active Health Plan coverage ends, you may use the funds in your HRA account to pay COBRA premiums or Retiree Health Plan self-pay premiums.
6.1.4 Spousal Rights
If your Spouse ceases to be an eligible dependent (because of a divorce or otherwise), they lose all rights to HRA reimbursement and may not access the funds in your HRA account.
If you die while covered under the Retiree Health Plan, your covered Spouse will continue to have access to the funds in your HRA account for as long as your Spouse remains covered under the Retiree Health Plan.
The funds in your HRA account will be permanently forfeited if any of the following occur:
- Your Retiree Health Plan coverage is terminated because you engaged in Non-Covered Electrical Employment (see Article 3.7.2: Non-Covered Electrical Employment on page 19);
- You are an owner of a company in the Electrical Industry which is not signatory to a CBA of an IBEW Local having jurisdiction of the work;
- You die with no Eligible Spouse; and
- You are not covered under the Active Health Plan or the Retiree Health Plan for a period of 60 or more consecutive months.