REQUEST FOR REIMBURSEMENT INSTRUCTIONS
Please complete the Request for Reimbursement Form in its entirety, use our secure on-line portal, or our SABCFLEX mobile app for smart phones, to submit your claim. Incomplete forms will delay the processing of your request. Expense’s that incur in separate plan years must be accompanied by a separate request form. All expenses must have INCURRED (date services provided, not paid) within your plans coverage period and after your effective date in the plan. Add all receipts and write the amount in the appropriate space. If faxing or mailing please Copy all smaller receipts onto an 8.5 x 11 sheet of paper for scanning purposes. Do not complete separate forms for each receipt, statements, and/or insurance explanation of benefits, only for separate Plan Years.
With SABC’s express service, requests may be faxed, mailed, submitted securely online, mobile app or you may bring them to our office. Checks are processed between 8am-4pm. All mailed requests will processed the day it is received. In normal circumstances, faxed or emailed claims, received after 2pm, will be processed the following business day. Claims may be delayed if it is not legible or if further information is needed.
DEPENDENT CARE(DC): All DC receipts must have the following information: Care providers tax identification number or social security number, child(ren) name, date of birth, and/or age, amount of expense and date of service, not date paid. Note: Book, activity feeds, and meals not included in tuition, overnight camps and other incidental fees, ARE NOT REIMBURSABLE.
UNREIMBURSED MEDICAL(URM): All URM receipts must have the following information: A medical provider’s name & address, date of service (not date paid), type of service/expense and cost of expense(s). NOTE: Statements with a Balance Forward or Previous Balance that do not include the date and type of service are NOT REIMBURSABLE.
Medical expenses must have patients name. Prescription drugs must include the name of the drug and RX number on the receipt, along with the information indicated above.
IMPORTANT: All claims must be filed with your insurance carrier first. To claim your expenses, an Explanation of Benefits from your insurance carrier is preferred and may be required. The amount you pay your provider at the time of service is not necessarily the amount you will ultimately owe. Your insurance carrier will reduce your out of pocket cost, through network discounts and other predetermined agreements, and a credit will appear on your account.
All documentation must originate from a third party provider.
HEALTH REIMBURSEMENT ARRANGEMENT(HRA): If you are claiming expenses under your employers HRA, you must submit a copy of your Explanation of Benefits (EOB), provided by your insurance carrier and complete the claim form, provided by your employer. If your plan allows for reimbursement of dental or vision, your receipts must be in the form of an EOB, or contain the following information; Date of Service, Medical Providers name and address, type of service and cost of service after insurance, if applicable.
IMPORTANT: You can only be reimbursed for out of pocket expenses once. If your out of pocket expenses have been reimbursed by one type of arrangement (i.e. HRA or HSA) they can not be reimbursed by any other type of arrangement (i.e. URM). Your plan may specify which spending arrangement must pay first. Please refer to your summary plan description (SPD) for further information. If you and/or spouse or dependents are covered by a Health Savings Account (HSA), coverage under your (URM) will be restricted to dental and vision.
If reimbursed by check, claims must exceed $15.00 before reimbursement will be made. Final claims less than $15.00 and more than $1.00 will be reimbursed at the end of the plan year. Only eligible expenses, not reimbursable by insurance and/or any other third party, are reimbursable through other arrangements.
