The Plan sets out the terms and conditions to which both parties are agreed upon. The Plan is of great benefit to both the Corporation and the Participant because it is the central part of the health benefit plan maintained by the Corporation for the benefit of its employees as well as an assurance that the Participant's health is safeguarded.
The first step in having a Medical Expense Reimbursement and Disability Benefits Plan is to institute and draw up the rationale of the plan. The rationale behind the Plan is to repay the participants of the Plan all expenses incurred by them for medical care. The Plan can also include the spouse and dependents that are not being reimbursed under another Plan of the Corporation or from other insurance policies. In addition, Participants under the Plan may avail benefits for wages lost consequent to absence from work due to work-related and non-work-related personal injuries and sickness.
Having established the Plan, the Corporation may fund it through insurance policies or from the assets of the Corporation. This document (the Plan) is the fulcrum around which much of the reimbursement process revolves. By completing this document, the preliminary process of obtaining compensation is set into motion.
Besides setting into motion the reimbursement procedure, this document is of great importance in excluding ambiguity and misunderstanding of the terminology used. All terms are defined clearly and conditions explained without any failing. The reimbursement of medical expenses clause will state the exact method followed by the Corporation when paying out the medical and disability expenses as incurred by the Participant. The exact status of the Participant is arrived at, at that point of time when the expense was incurred. In addition, the Plan also sets out in writing what, if any, is the maximum limit to reimbursing the expenses incurred by the Participant.
The Plan is also clear as to what procedure is followed in case of disability. The disability benefits that it pays to the Participant are subject to the terms spelt out in the Plan. Wages lost as a result of disability are reimbursed according to the Wage Continuation clause wherein all the formalities are set out. In case of partial disability too, there is a separate clause stating the period for which the reimbursement is to be made.
In addition, the Plan also specifies the person responsible for administrating the reimbursements. This administrator may be a person or persons designated by the Board of Directors of the Corporation.
The claims procedure may include some of the following:
* Filing of Claim
* Notifying the claimant of the decision
* Review process
Finally, the Plan will specify any restrictions upon the Participant, changes to the Plan and also what the gender of the Participant is.