M.J. Day – Reimbursement Claims

Claims Submission

To be reimbursed for your eligible expenses, you must complete a claim form and submit it to the Trust Fund Office within 12 months of the date the expense was incurred. The eligible expense cannot exceed your Account balance at the time reimbursement is requested.

Incurred expenses must total at least $100 before they can be submitted for reimbursement. You may include multiple Eligible Medical Care Expenses to be included in a claim in order to reach the $100 minimum. If your claim(s) do not meet or exceed the $100 limit, you may submit one claim per quarter.

Claim forms are available on this website and from the Trust Fund Office.

Substantiation

As part of the process to substantiate reimbursement for eligible expenses, you must submit a properly completed claim form with any required supporting documentation, in accordance with the Plan’s claim procedures as described in the Summary Plan Description / Plan Document. The claim for the eligible expenses must be incurred on or after the date your Account became effective and demonstrates that:

You have not been, and will not be, reimbursed for these expenses by any other health plan, insurance, or other source or entity;
You have not deducted, and will not deduct, any of the expenses reimbursed through the Plan on your individual income tax return; and
Premiums submitted for reimbursement were not made through salary reduction contributions under the terms of an IRC Section 125 Plan.

Along with the claim form, you must provide any of the following, as applicable:

Proof of the amount, the name of the covered person, date paid, and coverage period for other insurance premiums, such as a spouse’s group health coverage premiums, and verification that the premium was not paid or eligible for payment under an IRC Section 125 Plan.
Bills, invoices, or other statements from an independent third party showing that the Medical Care Expenses have been incurred and the amounts of such expenses, together with any additional documentation that the Trust Fund Office may request.
Any additional documentation requested by the Plan.

Where to File a Claim

To file a claim for reimbursement, send your completed claim form and supporting documentation to:

Michael J. Day Machinists Retiree Health Investment Plan
c/o Health Services & Benefit Administrators
4160 Dublin Boulevard, Suite 400
Dublin, CA 94568

Claims Decisions

Within 30 days of the date you submitted your claim and supporting documentation, you will either be reimbursed or provided with a notification that your claim has been denied. If additional time for reimbursement is needed, due to matters beyond the control of the Plan, you will be informed of the extension within this 30-day deadline. If additional information is needed before your claim can be processed, you will be notified within the 30-day period. You will then have up to 45 days to provide the requested information. After 45 days or the date information is received, whichever is earlier, the Plan will notify you of its decision within 15 days.

Denied Claims

If your claim is denied, the Plan will notify you within 30 days of the date the claim was submitted.