Haw. Code R. § 14-52-52 - Processing and payment of claims

(a) Claims shall be processed on a semi-monthly basis and subject to the approval of the director or third-party administrator in accordance with the Code and other applicable state laws.

(b) If a participant's claim is approved, the participant shall be reimbursed the approved amount. Participants shall only be entitled to be reimbursed from:

(1) The remaining balance in the participant's dependent care expense reimbursement spending account; or

(2) The total amount specified in the compensation reduction agreement for the participant's medical expense reimbursement spending account less any prior reimbursements for that plan year.

(c) Upon approval, the third-party administrator shall:

(1) Deposit the reimbursement amount into the participant's checking or savings account; or

(2) Issue a check in the reimbursement amount and mail the check to the participant's last known address on file with the third-party administrator,

(d) If the participant's claim is rejected for any reason, the third-party administrator shall notify the participant in writing within two business days of the rejection, clearly explaining the basis for the rejection and informing the participant of the appeal procedure set forth in section 14-52-53.

(e) If a claim is authorized for an amount different from the request for reimbursement, the third-party administrator shall provide the participant written notification of the reason within five business days of the authorization and shall inform the participant of the appeal procedure set forth in section 14-52-53.

Notes

Haw. Code R. § 14-52-52

[Eff SEP 13 1999] (Auth: HRS § 78-61) (Imp: HRS § 78-61) [Am and comp 12/2/2021] (Auth: HRS § 78-30) (Imp: HRS § 78-30)