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Indiana State Budget Agency

SBA > Retirement Medical Benefits > Frequently Asked Questions about the Retirement Medical Benefits Plan > Reimbursement Claims Reimbursement Claims

Q. What expenses are eligible for reimbursement under the Plan?

A. Qualifying Expenses include:  premiums under an insurance policy for group or individual coverage of the Qualified Retiree and/or his or her Covered Dependents including medical, dental, vision, tax-qualified long-term care (subject to the limitations in Code Section 213(d) (10)) and Medicare supplement policies, the State’s Medicare complementary policy and coverage of the Qualified Retiree and/or his or her Covered Dependents under Medicare Part B and Medicare Part D.

(See Section 3.7 of the Plan document)

Q. What expenses will not be treated as Qualified Expenses under the Plan?

A. (1) expenses paid, reimbursed or reimbursable by any insurance, accident, health or worker’s compensation plan, (2) expenses paid, reimbursed or reimbursable Code Section 125 Flexible Benefits Plan, (3) expenses incurred while the individual is neither a Qualified Retiree nor a Covered Dependent, or (4) the individual is not legally obligated to pay.

(See Section 3.7)

Q. My insurance plan also provides non-health related benefits, such as discounts on certain consumer products and services. Are those premiums eligible?

A. No. Reimbursement only covers premiums for sickness, accident, hospitalization and medical expenses. Thus, Expenses for the purchase of a policy, plan or program providing coverage for expenses in addition to medical care (as defined in Code Section 213(d)), will be Qualifying Expenses only to the extent that such expenses are directly related to the cost of the medical care component of the policy, plan or program.

(See Section 3.8)

Q. Can I go head submit the reimbursement claim prior to receiving the service?

A. No, services and payments must be incurred before they are eligible to be reimbursed.

(See Section 4.1)

Q. How and when may I receive reimbursement for Qualified Expenses?

A. To receive reimbursement for Qualified Expenses you must send a copy of the proper documentation of your Qualified Expense along with a signed claim form to Key Benefit Administrators (KBA) to the address or to the fax number listed below no later than 90 days after the end of the Plan Year in which the expenses were incurred. Proper documentation includes a bill or receipt showing the type of insurance, the name of the provider, the name of the Qualified Retiree and/or the spouse or Covered Dependent, the month(s) covered, the amount of the premium and proof of payment.

FlexPro Key Benefit Administrators
P.O. Box 55210
Indianapolis, IN  46205
Fax #:  866-241-1488

Reimbursements will be issued on a weekly basis. Checks will be mailed directly to the Qualified Retiree’s home. (It is important that you notify KBA immediately if your address changes.)  You may also elect to receive reimbursements via direct deposit.

Q. What should be included with my claim?

A. Proper documentation includes a bill or receipt showing the type of insurance, the name of the provider, the name of the Qualified Retiree and/or the spouse or Covered Dependent, the month(s) covered, the amount of the premium and proof of payment.

Q. What qualifies as proof of insurance?

A. If Retired, and have Medicare A or B:

  • Send in the annual letter received from Social Security Administration which indicates the payments being taken from your monthly check.

If 65 or older and have a Supplemental Policy:

  • Send a copy of the summary page indicating the cost and type of coverage (dental, vision, etc.)

If retired and not eligible yet for Medicare:

  • Send a copy of summary page indicating the monthly cost and type of coverage.

If Still Working at Another Employer or Spouse Is Still Working With Group Coverage:

  • Have employer provide a statement indicating the premiums are not paid with pre-tax dollars.
  • Each month send a copy of the paycheck stub for the month a reimbursement is requested.

Q. What qualifies as proof of payment?

A.

  • Cancelled Check
  • Bank Statement
  • Credit Card Statement
  • Receipt for Cash Tendered for Payment
  • Statement from Insurance Carrier showing proof of payment

Q. What happens to the funds in my account if I am a retired participant and I do not submit any reimbursement claims for 6 months, a year, 5 years, or even longer?

A. The funds will remain in your account until you and your spouse and/or eligible dependents are deceased. The state’s third party administrator may contact you to ensure you are still alive, but the funds may be used at any time.

(See Section 2.4)

Q. My spouse has health insurance through his/her employer. The premiums are paid post tax. Is this eligible for reimbursement from the Plan if I am a retired participant?

A. Yes. Attached is an opinion letter from Krieg DeVault, LLC (our legal counsel) regarding this matter.