Spouse Insurance Reimbursement Plan
If a subsidy is available for your spouse's premiums and/or claims:
Premiums are reimbursed once a month. A signed Premium Reimbursement Affidavit is required in order to be reimbursed. If there is a change in premium, please complete a Premium Reimbursement Affidavit and return to Marnie Lalor in Human Resources. The plan will reimburse in-network deductibles, coinsurance and copays based on District 155's in-network benefits. Claims are reimbursed twice a month. Submit a copy of the Explanation of Benefits (EOB) from your spouse's insurance plan indicating how the claim was processed. The EOB, accompanied by a claim form is required for payment. (Claim Form can be found below)
Should there be a change in your spouse's employment, insurance company, medical benefits, and/or contributions, you must notify the District within 31 days.
Want to receive premium and claim reimbursements faster? Complete the DIRECT DEPOSIT form, attach a voided check and mail it to Group Administrators at the address is on the form. All premium and claim reimbursements will be deposited directly into your checking account. No more waiting for reimbursement checks in the mail!
Group Administrators Home Page
D155 Spousal Insurance Reimbursement Plan Contact Info and Forms
Customer Service
(847) 519-1880
CLAIM OFFICE
Group Administrators, Ltd.
ATTN: FSA Administrators
20 N Martingale Rd., Suite 290
Schaumburg, IL 60173
contactus@groupadministrators.com
Tel: (847) 519-1880
Fax: (847) 519-1979
Spousal Affidavit
Spouse Insurance Reimbursement Claim Form
Web Access Instructions