Page 7 - Guide
P. 7
2017 BENEFITS ENROLLMENT
Deductible Reimbursement Program
Deductible Reimbursement Program
The deductible reimbursement program is designed to assist you with the cost of a higher deductible plan. This
program will reimburse you for a portion of the deductible amount met by you or a dependent. Reimbursements
will be made after you provide your explanation of beneits (EOB) and the HRA reimbursement forms to
Human Resources. You must also complete a HIPAA authorization form.
Individual Deductible
$4,000 Deductible with $2,500 Deductible Reimbursement—In-Network Only
You are responsible for $1,500 of the $4,000 individual annual deductible. Upon meeting the irst $1,500 of the
annual deductible, you will become eligible to ile reimbursements for charges incurred over the $1,500 up to
$2,500 from ALCO. You will be responsible to provide veriication in the form of an explanation of beneits (EOB) to
Human Resources to receive your deductible reimbursement of up to $2,500 in the 2017 plan year .
Family Deductible
$8,000 Deductible with $5,000 Deductible Reimbursement—In-Network Only
Each member in your family has an individual deductible which, in combination, equals the total family
deductible . No family will have to incur more than the $8,000 deductible ($4,000 per individual in the family) .
Once the family deductibles total $8,000, family members will not have to pay any more toward a deductible for
in network services and the insurance pays 90% coinsurance up to the out-of-pocket maximum .
Families which have more than one individual meet the deductible will be eligible for a total deductible
reimbursement of $5,000 . Please refer to the example below .
At the point in which you, or any family members combined meet your deductible responsibility of $1,500,
you will be eligible to ile reimbursements for charges incurred over $1,500 up to $5,000 from Alco. You will be
responsible to provide veriication in the form of an explanation of beneits (EOB) and HRA reimbursement form to
Human Resources to receive your deductible reimbursement of up to $5,000 in the 2017 plan year ($5,000 family
maximum reimbursement) .
Note: if you experience a service which requires payment of your entire deductible prior to receiving services, your inancial
obligation will be the entire deductible; ALCO will then reimburse you your portion of the deductible after being presented with
an EOB .
ALCO MANAGEMENT 7
Deductible Reimbursement Program
Deductible Reimbursement Program
The deductible reimbursement program is designed to assist you with the cost of a higher deductible plan. This
program will reimburse you for a portion of the deductible amount met by you or a dependent. Reimbursements
will be made after you provide your explanation of beneits (EOB) and the HRA reimbursement forms to
Human Resources. You must also complete a HIPAA authorization form.
Individual Deductible
$4,000 Deductible with $2,500 Deductible Reimbursement—In-Network Only
You are responsible for $1,500 of the $4,000 individual annual deductible. Upon meeting the irst $1,500 of the
annual deductible, you will become eligible to ile reimbursements for charges incurred over the $1,500 up to
$2,500 from ALCO. You will be responsible to provide veriication in the form of an explanation of beneits (EOB) to
Human Resources to receive your deductible reimbursement of up to $2,500 in the 2017 plan year .
Family Deductible
$8,000 Deductible with $5,000 Deductible Reimbursement—In-Network Only
Each member in your family has an individual deductible which, in combination, equals the total family
deductible . No family will have to incur more than the $8,000 deductible ($4,000 per individual in the family) .
Once the family deductibles total $8,000, family members will not have to pay any more toward a deductible for
in network services and the insurance pays 90% coinsurance up to the out-of-pocket maximum .
Families which have more than one individual meet the deductible will be eligible for a total deductible
reimbursement of $5,000 . Please refer to the example below .
At the point in which you, or any family members combined meet your deductible responsibility of $1,500,
you will be eligible to ile reimbursements for charges incurred over $1,500 up to $5,000 from Alco. You will be
responsible to provide veriication in the form of an explanation of beneits (EOB) and HRA reimbursement form to
Human Resources to receive your deductible reimbursement of up to $5,000 in the 2017 plan year ($5,000 family
maximum reimbursement) .
Note: if you experience a service which requires payment of your entire deductible prior to receiving services, your inancial
obligation will be the entire deductible; ALCO will then reimburse you your portion of the deductible after being presented with
an EOB .
ALCO MANAGEMENT 7
