Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)

7.9 Claims Procedures

No reimbursement of submitted claims will be made from a Participant's HRA Account unless aggregate eligible claims submitted provide for reimbursement of at least $25.00. Individual claims may be aggregated to meet the $25.00 minimum. An HRA Reimbursement Claim Form must be submitted to the Third Party Administrator selected by the Trust Fund that not only processes the claims received but also handles all non-eligibility based appeals related to specific claims. No claims are ever to be submitted to the Administrative Office other than disputes as to eligibility. Claim forms will be available from the Administrative Office or the Trust Funds website at and will require the Participant's certification that the expenses were not reimbursed, and are not reimbursable, by this or any other plan. Along with the HRA Reimbursement Claim Form, supporting documentation must be provided describing the expenses and proving that the Participant (or eligible spouse or other eligible dependents) paid the expenses. Supporting documentation may include the following:

  1. An itemized bill describing the services provided, the person to whom the services were provided, the date of service, and the charged amount.
  2. An Explanation of Benefits (EOB)
  3. A receipt showing proof of payment