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TITLE 34PUBLIC FINANCE
PART 4EMPLOYEES RETIREMENT SYSTEM OF TEXAS
CHAPTER 85FLEXIBLE BENEFITS
RULE §85.9Payment of Claims from Reimbursement Accounts

(a) Claim for reimbursement.

  (1) Claims for reimbursement of expenses incurred during an eligible employee's period of coverage in the plan year may be submitted at any time during the plan year, but not later than December 31 following the close of the plan year.

  (2) Claims shall be paid to the extent of available flexible benefit dollars allocable to the applicable type of expenses and shall only be paid out of flexible benefit dollars for the plan year, in which the expense was incurred. The TPA shall compare the participant's available balance and the amount of the expense to make certain that claims are paid according to the provisions of the Code and these rules.

  (3) Expenses incurred prior to becoming a participant or after the last day of a plan year, shall not be covered by this plan. A terminated participant may continue to file claims for eligible expenses incurred during the employee's period of coverage within the plan year, if applicable, to exhaust reimbursement account balances no later than December 31 following the close of the plan year.

  (4) Claims shall be submitted in a manner prescribed by the Employees Retirement System of Texas or its designee, accompanied by such bills, receipts or other proof of incurring the expense as the plan administrator or its designee may require.

  (5) A claim form must be submitted each time reimbursement or payment is requested, unless using the debit card.

  (6) The dependent care and health care reimbursement accounts are separate accounts, and funds from one account may not be used to reimburse expenses of the other account.

(b) Debit Card transactions.

  (1) Debit card payments for eligible expenses incurred during a participant's period of coverage in the plan year may occur at any time during the plan year.

  (2) Transactions shall be processed to the extent of available flexible benefit dollars allocable to the applicable type of expenses and shall only be paid out of flexible benefit dollars for the plan year in which the expense was incurred. The TPA shall compare the participant's available balance and the amount of the expense to make certain that claims are paid according to the provisions of the Code and these rules.

  (3) Expenses incurred prior to becoming a participant shall not be covered by this plan. Expenses incurred by a participant may be covered only in the plan year in which the expense is actually incurred. Upon a participant's termination, the debit card will be automatically deactivated. Paper claims may be filed for eligible expenses incurred during the participant's period of coverage within the plan year in which he was a participant. All claims for reimbursement from account balances must be filed no later than December 31 immediately following the close of the plan year.

  (4) Participants may be required to submit bills, receipts or other proof of incurring the expense as the plan administrator or its designee may require.

  (5) Reimbursements or payments made using the debit card may require additional supporting documentation as may be requested by the plan administrator or its designee, and the participant must maintain his own records to substantiate the eligibility of all expenses for individual income tax purposes, if necessary.

(c) Reimbursement of claims to participants.

  (1) Payment of eligible expenses shall be made directly to the participant by the plan administrator or its designee unless payment for dependent or health care expenses is made directly to the applicable provider through use of a debit card, other similar technology, or other means approved by the plan administrator.

  (2) The plan administrator may establish or waive the minimum payment as deemed necessary.

  (3) Reimbursements to participants or dependent care providers shall be made at least once each month.

  (4) Dependent care reimbursement shall at no time exceed the greater of the balance of the participant's account for the plan year at the time of the reimbursement, or an amount equal to the monthly salary reduction amount.

  (5) Health care reimbursement shall at no time exceed the eligible employee's election for the eligible period of coverage in the plan year.

(d) Participant's responsibility.

  (1) An employee or former employee will be held liable for any overpayments of benefits as a participant in the reimbursement accounts. The method of repayment shall be determined by the plan administrator or its designee, and until full restitution is made by the participant, no further claims payment from any TexFlex accounts will be made to the participant by the plan administrator or its designee.

  (2) A health care reimbursement account participant who has insufficient funds during the plan year is liable for the monthly health care election amount and must pay for it with after-tax dollars, unless as described in §85.3(b)(3)(D) of this title (relating to Eligibility and Participation). Should the participant fail to contribute to the account with after-tax dollars, upon the participant's return to active duty, payroll deduction will be required to recover the election amounts due.


Source Note: The provisions of this §85.9 adopted to be effective August 12, 1988, 13 TexReg 3754; amended to be effective September 1, 1990, 15 TexReg 4646; amended to be effective September 1, 1991, 16 TexReg 3779; amended to be effective September 1, 1992, 17 TexReg 2874; amended to be effective September 1, 1998, 23 TexReg 4571; amended to be effective March 26, 2000, 25 TexReg 2400; amended to be effective September 27, 2000, 25 TexReg 9639; amended to be effective September 13, 2001, 26 TexReg 6962; amended to be effective July 17, 2003, 28 TexReg 5539; amended to be effective December 31, 2003, 28 TexReg 11625; amended to be effective May 29, 2005, 30 TexReg3022;amended to be effective September 15, 2005, 30 TexReg 5809; amended to be effective June 10, 2014, 39 TexReg 4486; amended to be effective March 14, 2016, 41 TexReg 1860

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