Current through Register Vol. 24-18, September 15, 2024
(1)
What type of medical premiums are
available for reimbursement for a LEOFF Plan 2 member who is catastrophically
disabled in the line of duty?
(a) LEOFF
Plan 2 members who are catastrophically disabled in the line of duty are
eligible for reimbursement of medical premiums.
(i) For members who are not eligible for
medicare, DRS will pay for the member, spouse, state-registered domestic
partner, and eligible dependents:
(A)
Employer-provided medical insurance;
(B) Medical insurance offered under the
federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA);
or
(C) Other medical premiums,
which could include vision and dental, not to exceed the COBRA amount. DRS will
not pay for separate supplemental plans for vision, dental, and
prescriptions.
(ii) For
members who are eligible for medicare, DRS will pay medicare Part A and
B.
(b) LEOFF Plan 2
members who are catastrophically disabled are eligible for reimbursement for
medical insurance premiums paid after June 30, 2013.
(2)
What if I am eligible for medicare
coverage? If you or your spouse become eligible for medicare coverage,
you must notify DRS when you become eligible. To remain eligible for the
reimbursement payment, you must enroll in and maintain enrollment in medicare
Part B. At that point, DRS will only reimburse for medicare Part A and B. DRS
will not reimburse for any medicare supplemental or prescription
plans.
(3)
How do I apply for
medical premium reimbursements? To receive medical premium
reimbursements, you must first complete a request for medical reimbursement
form and provide proof of medical insurance coverage and premium payment to
DRS.
(4)
What is acceptable
as proof of insurance coverage? DRS will accept these documents as proof
of insurance coverage:
(a) Invoice from
insurance provider.
(b) Certificate
from insurance provider.
(c)
Invoice from medicare.
(d) Social
Security Form SSA-1099.
(5)
What is acceptable as proof of
premium payment? DRS will accept these documents as proof of payment:
(a) Letter from the Social Security
Administration showing your medicare deduction from your monthly
benefit;
(b) Bank or credit card
statement showing insurance payment that is supported by other documentation
showing this is for medical insurance;
(c) Receipt from insurance provider;
or
(d) Copies of both sides of
cashed checks.
(6)
What if my premiums are deducted from my DRS benefit or my spouse's
payroll checks? DRS will accept these documents as proof of both
insurance coverage and premium payment:
(a)
Premium deduction authorization from your insurance provider, if premium
payments are being paid directly from DRS.
(b) Copy of spouse's or partner's pay stub
showing insurance deduction amount.
(7)
When is documentation
required?
(a) You must provide proof of
insurance coverage and premium payments at the time you apply for
reimbursement. After you are enrolled in the reimbursement program, you must
submit this form each time DRS requests, at a minimum twice a year, along with
requested documentation.
(b) DRS
will reach out to each retiree receiving medical reimbursement payments, and
retirees will have 90 days from the date of the letter to provide proof of
premium payment. DRS will provide notifications of the 90-day window to ensure
that retirees are aware of the requirement to reapply and supply
proof.
(c) After 90 days, DRS will
suspend reimbursement until proof of insurance coverage and premium payments
have been received for each missed period. After DRS receives supporting
information, DRS will reinstate reimbursement payments for the month(s) that
documentation supports were paid.
(d) Any adjustment in or cancellation of
medical premiums paid by retirees may result in an overpayment of the
reimbursement paid to the retiree, so changes should be reported to DRS when
they occur.
