PRIME Participant Forms
These forms may be opened and filled out using the participant’s computer, then printed out for signature. Fields within the same form will also populate automatically for your convenience.
Frequently Asked Questions for PRIME Participants
What is a PRIME plan?
PRIME plan stands for Post/Pre Retirement Incurred Medical Expense Plan. A PRIME plan is an employer-sponsored trust that allows an employer to fund employee and retiree medical benefits on an entirely tax-free basis. The plan is designed to help governmental employers meet the challenges of providing medical benefits for employees and retirees.
What is the legal basis for the PRIME plan?
The PRIME Plan is based on Internal Revenue Code (the “Code”) provisions and Internal Revenue Service (“IRS”) rulings. The IRS has ruled that nonprofit organizations, including government employers, can establish funds, which are deemed to be an “integral part” of the organization. The IRS has determined that providing welfare benefits to employees or retirees qualifies as an “integral part” of government activities. Because providing welfare benefits is an integral part of the government’s activities, the trust used to fund the welfare benefits is also tax-exempt. The Code and Regulations provide that employees / retirees may receive employer paid health benefits on a tax-free basis.
Are plan participants subject to income taxes on employer contributions or benefit payments from the trust?
No – All employer contributions and benefit payments from the trust are contributed and received on a tax-free basis. In addition, any trust earnings accumulate and are distributed tax free as well for all “qualified” benefit payments.
What medical expenses qualify for reimbursement?
Trust participants and their qualified beneficiaries are reimbursed for all qualified medical expenses under IRS Code section 213(d).These expenses include:
- Health Insurance Premiums
- Medicare Supplemental Insurance
- Out-of-Pocket Medical Expenses (deductibles & co-pays)
- Prescription Drugs & Prescribed Over the Counter Medications
- Dental Insurance & Expenses
- Long-Term Care Insurance
- Vision Insurance & Expenses
How can I receive a reimbursement for a qualified medical expense?
In order to receive a reimbursement for a qualified medical expense, you must complete the Medical Expense Reimbursement Claim Form and attach copies of your bills or receipts.
How long does it take to receive a reimbursement?
Please allow up to 30 days for a reimbursement.
Can I have my reimbursement direct deposited into my bank?
Yes. The ACH Direct Deposit Authorization Agreement Form is included with the Medical Expense Reimbursement Claim Form. For your security, and to assure an accurate transfer of funds, complete the entire form in a legible manner and attach a voided check where indicated. The routing and account numbers on this form must be identical to the routing and account numbers on your voided check. The payer name on the voided check must match the plan participant’s name. If a voided check is not available, or if the account number or routing number provided on this form is different than on the voided check, include a letter from the bank or financial institution on their letterhead. Have the letter signed by an authorized representative of the bank and indicate the name of the account holder and provide the routing and account numbers to be used by Pelion Benefits, Inc. for ACH purposes.
What if I have more bills than the balance in my PRIME account?
Go ahead and submit bills even if they total more money than what is in your account. We will process your request until the money in your account is depleted.
What is the difference between a Non-Recurring Health Insurance Premium and a Recurring Health Insurance Premium on the Medical Expense Reimbursement Claim Form?
A Non-Recurring Health Insurance Premium is a onetime premium, such as an annual payment. Recurring Health Insurance Premiums are equal payments paid in intervals such as monthly. If your health insurance premium is recurring, you must identify the remaining payments at that rate under the Benefit Distribution Codes section of the form.
Must I send the original bills or receipts or are copies acceptable?
We will accept copies of bills or receipts.
Can I fax the completed Medical Expense Reimbursement Claim Form and my bills or receipts?
Yes. Our fax number is 919-942-2804.
Can I complete the form on my computer?
The Medical Expense Reimbursement Claim Form is formatted to be completed on your computer using Acrobat Reader. Complete the form, print it, sign it, then either mail or fax the form with copies of your bills or receipts.
How often will I receive a statement of my account?
For most plans, statements are mailed out quarterly at the end of each calendar quarter.
Can I view my statement online?
Yes. Statements are available anytime online.
To see my account online, what is my user ID and password? Can I change my password? How often is the website updated?
To login to your account, from our home page select Participant Login. Please contact our office directly if your Human Resource department has not provided your login information. Once you login, you can perform many functions such as changing your password, updating your personal information, checking your investment elections and tracking transaction history. For most plans, our website is updated daily.
Is there a minimum dollar amount for a reimbursement?
Yes. Please submit for reimbursement when your bills or receipts total $200 or more.
Can I roll over my PRIME account?
Can I take out a loan against my PRIME account?
What happens to my benefits if I die?
On the enrollment form you filled out, you indicated your qualified dependents and the percentage to which you want your benefits applied. Dependents of a participant who are covered under the plan at the participant’s death may continue to receive reimbursements from the participant’s account balance. If there are no living qualified dependents at the time of the participant’s death, the benefits shall be forfeited and revert to the employer. A qualified dependent is a spouse or a dependent who is 25 years old or less and receives more than 50% support for the year from the plan participant. To change your qualified dependents or the percentage to which you want your benefits applied, you must complete a new enrollment form. Some plans do not allow for beneficiaries so refer to your plan’s documents.
What types of investments are available to invest my PRIME account?
Funds shall be invested in a guaranteed fixed interest-bearing instrument. Participants shall not be permitted to direct the investment of their accounts in accordance with the Trust Agreement.
How can I update my personal information such as my address, e-mail or phone number?
Login to your account on our website and select the Personal Profile tab. Make the changes and submit.
Can I check the status of my claim online? Can I see past claims that I have submitted online?
You can view a current or past claim online by searching the transaction history. Login to your account, click on the “Transactions” tab at the top of the screen, then click on the “Transaction History” tab on the left side of the screen. You will then need to enter a range of dates where it says “Show account history from:”. Enter the dates for the time period you want to check on (or click on the dates on the popup calendars). All transactions for that time period will be listed. Please note that the date of the transaction is the date processing begins. Usually your claim is paid out about a week to ten days after the date showing in the transaction history.