(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 and employer contributions, if applicable,
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.
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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; amended to be effective September 8, 2020, 45 TexReg 6240 |