AgdaPkt 2003-03-24 - Laserfiche WebLink

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(a.) E - ll 4.12 Maximum Benefits The maximum amount of benefits available to any Participant under this Plan shall be the amount determined by the Administrator to be available under the Premium Contribution Plan, plus such amounts as are separately allowable under the DCAP and MERP as adopted under the Plan. SECTION V - CLAIM PROCEDURES 5.1 Claims Procedures A Participant under the Dependent Care Assistance Plan or the Medical Expense Reimbursement Plan may apply to the City or designated plan administrator for reimbursement of eligible expenses by submitting an application in writing to the Administrator in such form and accompanied by any supporting documentation as the Administrator may prescribe, setting forth: (a) the amount, date and nature of the expense with respect to which a benefit is requested; (b) the name of the person, organization or entity (and social security or tax identification number for DCAP reimbursements only) providing the service of the incurred expense; (c) the name of the individual for whom the expense was incurred; (d) any other information as shall be requested by the Administrator. If any person eligible to receive benefits under the Plan or any person claiming to be eligible to receive benefits under the Plan believes he is entitled to benefits for an amount greater than those which he is receiving or has received, he may file a claim with the Administrator. Such a claim shall be in writing and state the nature of the claim, the facts supporting the claim, the amount claimed and the address of the claimant. The Administrator shall review the claim and notify the claimant of the decision with respect to the claim. If claimed benefits would be payable by an insurer under a contract of insurance or by a claims agent under a contract between such agent and the City, the Administrator may (a) refer the claim to representatives of such insurer or claims agent, as the case may be, for decision (such decision to be subject to the approval of the Administrator), or (b) to the extent he deems necessary or helpful in making his decision, consult with representatives of such insurer.