1. (a) Claim for reimbursement.

   1. (1) Claims for reimbursement of expenses incurred during an eligible employee's period of coverage in the plan year may be submitted at any time during the plan year, but not later than December 31 following the close of the plan year.
   2. (2) Claims shall be paid to the extent of available flexible benefit dollars allocable to the applicable type of expenses and shall only be paid out of flexible benefit dollars for the plan year in which the expense was incurred.
   3. (3) Expenses incurred prior to becoming a participant or after the last day of a plan year, August 31, shall not be covered by this plan. A terminated participant may continue to file claims for eligible expenses incurred during the employee's period of coverage within the plan year to exhaust reimbursement account balances no later than December 31 following the close of the plan year.
   4. (4) Claims shall be submitted on forms provided by the Employees Retirement System of Texas, accompanied by such bills, receipts, or other proof of incurring the expense as the plan administrator may require.
   5. (5) A claim form must be submitted each time reimbursement or payment is requested.
   6. (6) The dependent care and health care reimbursement accounts are separate accounts, and funds from one account may not be used to reimburse expenses of the other.

2. (b) Reimbursement of claims to participants.

   1. (1) Payment of eligible expenses shall be made directly to the participant by the plan administrator. A participant may request payment of a dependent care reimbursement plan claim be made directly to a child care provider.
   2. (2) The plan administrator may establish or waive the minimum payment as deemed necessary.
   3. (3) Reimbursements to participants or dependent care providers shall be made at least once each month.
   4. (4) Dependent care reimbursement shall at no time exceed the balance of the participant's account for the plan year, at the time of the reimbursement.
   5. (5) Health care reimbursement shall at no time exceed the eligible employee's election for the eligible period of coverage in the plan year.
3. (c) Statements. On or before January 31 of each year, the plan administrator or its agent shall furnish to each dependent care reimbursement plan participant a statement of account as of the end of the previous calendar year.

4. (d) Participant's responsibility.

   1. (1) An employee or former employee will be held liable for any overpayments of benefits as a participant in the reimbursement accounts. The method of repayment shall be determined by the plan administrator and until full restitution is made by the participant, no further claims payment from any TexFlex accounts will be made to the participant by the plan administrator.
   2. (2) A health care reimbursement account participant who goes on leave without pay or has insufficient funds during the plan year is liable for the monthly health care election amount and must pay for it with after-tax dollars, unless as described in §85.3(b)(3)(D) of this title (relating to Eligibility and Participation). Should the participant fail to contribute to the account with after-tax dollars, upon the participant's return to active duty, payroll deduction will be required to recover the election amounts due.

Source Note:The provisions of this §85.9 adopted to be effective August 12, 1988, 13 TexReg 3754; amended to be effective September 1, 1990, 15 TexReg 4646; amended to be effective September 1, 1991, 16 TexReg 3779; amended to be effective September 1, 1992, 17 TexReg 2874; amended to be effective September 1, 1998, 23 TexReg 4571.