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Important Program Rules
Here are some important rules about the reimbursement of the PacifiCare Deductible/Full Network plan annual inpatient hospital deductible.
- You must participate in the PacifiCare Deductible/Full Network plan (and have been a member as of January 1, 2007) in order to be reimbursed for your inpatient hospital deductible.
- A dependent child added after January 1, 2007, and subsequently hospitalized, is eligible for reimbursement of the inpatient hospital deductible.
- You will be reimbursed only if you become hospitalized and pay a portion or all of your inpatient hospital deductible. If you are not hospitalized, you will not receive a payment of any credits you’ve earned by participating in the health and wellness programs.
- Participants under age 18 who become hospitalized will be reimbursed for their inpatient hospital deductible regardless of whether they participate in the designated health and wellness programs. You or the participant must submit proof of payment of the participant’s inpatient hospital deductible within 365 days of the hospital discharge date.
- You earn credits and request reimbursement based on a “rolling” (continuous) 12-month period. A continuous 12-month period begins on the date you are discharged from the hospital and ends 364 days later. Your $1,500 inpatient hospital deductible is charged on a calendar year basis. (You pay the inpatient hospital deductible only once per calendar year, regardless of the number of times you are hospitalized.)
- You will be reimbursed up to the amount you have paid toward your deductible or the amount of credits earned, whichever is less. For example, if you’ve paid $600 toward your deductible but only have $500 in credits, you will be reimbursed $500.
- The maximum amount you will be reimbursed in any continuous 12-month period is $1,500.
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How to Get Reimbursed
If you (or your dependent) become hospitalized and pay a portion or all of your inpatient hospital deductible, be sure to keep your proof of payment. You will need it to request reimbursement. Examples of proof of payment include:
- A receipt
- A hospital bill showing the amount you paid toward your deductible
- An explanation of benefits showing the amount you paid toward your deductible.
You may begin the reimbursement process by downloading the Inpatient Hospital Deductible Reimbursement Request
Form. Complete the form and follow the instructions on the form for submission. You should receive your reimbursement check within three to four weeks of submitting your request.
You may also contact the VEBA Advocacy Programs office with any questions or to request a reimbursement form: (619) 278-0021 phone; (619) 278-0024 fax,
info@vebaonline.com.
Please note: If you participate in the Medical Group/ Hospital Utilization feature of the program, faxing your proof of payment showing the name of the hospital to which you were admitted also counts as documentation. If your proof of payment does not show the hospital to which you were admitted, you will need to submit other documentation to verify that you were admitted to the appropriate hospital in order to receive reimbursement.
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Program Summary and Reimbursement Request Form
Below are links to a one-page summary of the reimbursement program, as well as a receipt submission form when you need to request reimbursement.
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