HCSO HRA Employee Resources

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How to File a Claim

The Health Care Security Ordinance (HCSO) is a San Francisco law that created an Employer Spending Requirement enforced by the Office of Labor Standards Enforcements. The Employer Spending Requirement requires Covered Employers to spend a minimum amount of money on Health Care Expenditures for their Covered Employees. Your employer is satisfying the HCSO requirement by supplying you with a HCSO Health Reimbursement Arrangement (HRA). For more information on your HCSO HRA, please see the Summary Plan Description.

HCSO GUIDELINES FOR SUBMISSION OF CLAIMS: The IRS provides the following guidance:

Medical Reimbursement

When receipts are submitted to BeneFLEX, they must show the following information:

  1. Who rendered the service (name and address)
  2. What type of service rendered
  3. Date service was provided, not a billing or due date
  4. Amount of charge

NOTE: In order to process your claim all 4 pieces of information must be on each receipt. This includes receipts for orthodontic services.

  • Canceled checks and credit card slips are not allowable receipts.
  • Any amount claimed which is a ‘Previous Balance’, ‘Balance Forward’, etc. cannot be paid unless the information stated in items 1-4 above is shown on the receipt.
  • Receipts must show all expenses incurred. Any over-payment, pre-payment, etc., for which no services are listed, cannot be reimbursed.
  • BeneFLEX cannot reimburse for any medical expenses incurred before activation in the HCSO HRA plan.
  • Over the Counter (OTC) drugs – Partial listing online at beneflexhr.com
    • When and Who Sold the product (date, name and address)?
    • Type of OTC purchased. *Must show product or brand name
    • Amount of charge

* If the receipt does not show the name of the product, you can write the product name on the receipt. You must have the cashier verify by signing their name.

FOR YOUR REFERENCE

  • To ensure timely reimbursement, all claims must be faxed to (314) 909-6983 or mailed to 10805 Sunset Office Drive, Suite 401 St. Louis, MO 63127 and received no later than 1:00 p.m. (PST) Tuesday for Thursday processing.
  • If you fax your claim, keep a copy of the confirmation statement in case BeneFLEX does not receive your paperwork.
  • If you terminate employment, check your SPD to see the Grace Period and run-out period you have available to use and file claims for your HCSO funds.
  • Please itemize the expenses on your claim form.
  • You can contact BeneFLEX HR Resources, Inc. by e-mail at info@beneflexhr.com or by calling (800) 631-3539 for questions regarding your plan.

Resources

HCSO  HRA – English

HCSO HRA Employee Overview

HCSO HRA Full Medical Spend Down Eligible Expense List

Dental/Vision/LTC Eligible Expense List

How to File a Claim

HCSO HRA Claim Form

HCSO HRA Direct Depostit Form

HRA Employee Waiver Form

 

HCSO  HRA – Spanish

HCSO HRA Employee Overview -Spanish

Dental/Vision/LTC Eligible Expense List – Spanish

HCSO HRA Full Medical Spend Down Eligible Expense List – Spanish

HCSO HRA Claim Form – Spanish

HCSO HRA Direct Deposit Form – Spanish

HRA Employee Waiver Form – Spanish