§ 5.37.160. Payments.

The County shall from time to time, upon request of a Participant made in writing not later than the end of the Run-Out Period, reimburse all or part of the Medical Expenses incurred by the Participant during such Year; provided, however, that:

A.

All such payment during or in respect of a particular Plan Year to the Participant's Health Care Spending Account shall be limited in the aggregate to (a) his Maximum Amount; plus (b) the Carryover Amount described in Section 5.37.160B, subject to the rules in Section 5. 37.160C.

B.

Subject to the rules in Section 5.37.160C below, amounts up to $500 that remain unused under the Health Care Spending Account with respect to one Plan Year are carried over to the next Plan Year. The carryover amount is the lesser of (a) any unused amounts from the immediately preceding Plan Year, or (b) $500 (the "Carryover Amount"). Any unused amount in the Health Care Spending Account in excess of the Carryover Amount that remains unused as of the last day of the Run-Out Period shall be forfeited.

C.

A Participant's unused balance under the Health Care Spending Account at the end of the prior Plan Year will be used either: (a) to reimburse expenses incurred during the prior Plan Year and submitted during the Run-Out Period that begins at the end of the prior Plan Year (thus retroactively reducing the unused amount as of the end of the prior Plan Year), or (b) to the extent of the Carryover Amount, for expenses that are incurred at any time during the current Plan Year. Any Carryover Amount used to reimburse a prior Plan Year's expense during the Run-Out Period will reduce the Carryover Amount that may be used for current Plan Year expenses, and any of the Carryover Amount used for current Plan Year expenses will reduce the amount available to reimburse the prior Plan Year's expenses during the applicable Run-Out Period. The Health Care Spending Account treats claims for Medical Expenses as reimbursed first from unused amounts credited for the current Plan Year and, only after exhausting such amounts, as reimbursed from the Carryover Amount. Any unused amounts from the prior Plan Year that are used to reimburse a current Plan Year expense: (a) reduce the amounts available to pay prior Plan Year expenses during the Run-Out Period; (b) are counted against the Carryover Amount; and (c) cannot exceed the Carryover Amount.

D.

Notwithstanding Section 5.37.155, a Participant in a Health Care Spending Account during one Plan Year who fails to enroll in the Health Care Spending Account for the following Plan Year on a timely basis will nevertheless have a Health Care Spending Account established for him for that following Plan Year to the extent of any Carryover Amount provided for in this Section 5.37.160.

E.

Payments hereunder may be made only upon such proof of the Medical Expenses in question as the County shall in its discretion require. It is not necessary that such Medical Expenses have been already paid by the Participant, his spouse or his dependents, but merely that, if not yet paid, there exists an obligation to pay them.

F.

Medical Expenses reimbursed by the Plan for a Plan Year must have been incurred during a period when the Participant (and Dependents) are covered by the Health Care Spending Account, as described in the Election Information and Materials, and submitted for reimbursement, with all required substantiation, before the end of the Run-Out Period. Accordingly, with regard to each Plan Year, the Plan will not reimburse any expenses incurred: (i) before the start of the Plan Year or, if later, before the date the Eligible Employee first becomes a Participant under Section 5.37.155; (ii) after the end of the Plan Year; (iii) after coverage terminates or while coverage is suspended as described in the Election Information and Materials, or (iv) that are not adequately substantiated before the end of the Run-Out Period.

(Ord. 2014-0008 § 33, 2014; Ord. 98-0076 § 31, 1998: Ord. 92-0013 § 5 (part), 1992.)