The HRA Program

The Mission Valley Power Health Reimbursement Arrangement (HRA) is integrated with and is a part of your Employer’s health plan. The HRA plan provides eligible employees of Mission Valley Power (MVP) and any subsidiary or division designated by MVP as a participating employer with reimbursements of qualifying medical expenses. Currently, MVP is the only employer participating in the Plan.

The rules and operation of the Plan are described in the Summary Plan Description (“SPD”) as clearly as possible with minimal use of the technical terms appearing in the official legal documents (including applicable insurance contracts). However, the official legal documents remain the final authority and, in the event of a conflict with this SPD, shall govern in all cases. A copy of this document is provided under the Forms and Documents tab. You are encouraged to read the SPD carefully. If you have any questions about the benefits provided under the Plan, you should contact your employer.

You are eligible for the Plan if you are classified as either a regular full-time permanent, bargaining unit employee enrolled in your Employer’s health plan option that relates to this HRA. After ten years of continuous service with MVP, to the extent required by federal law, employees leaving MVP employment shall be allowed to take their HRA account with them (portability). Except as provided by law, employees leaving prior to ten years of service shall have no rights to take with them or access their HRA account balance after leaving MVP.

Eligible Employees will be automatically enrolled in the HRA on the date you are eligible for your Employer’s Health Plan that relates to this HRA.

You are not eligible to participate in the Plan if you don’t meet the eligibility requirements stated above.

The Plan allows you to be reimbursed for Qualifying Medical Expenses. Qualifying Medical Expenses include the following, as determined by the Claims Administrator (unless excluded below)

• Any expense that qualifies as a medical expense under Section 213(d) of the Internal Revenue Code for yourself and your eligible spouse and dependents; and
• “Eligible” medical expenses, included but not limited to deductible or co-insurance requirements under the health plan, that qualify as medical expenses under Section 213(d) of the Internal Revenue Code but are not paid by MVP’s health plan;
• Any premiums (or premium equivalents) for retiree health insurance or retiree health coverage that is paid for by you after-tax.

Qualifying Medical Expenses do not include the following –

• Any expense paid by another health plan (up to the dollar amount paid by the other health plan);
• Any expenses for over the counter medicines or drugs, unless you have a written prescription for such medicine or drug. Contact the Claims Administrator for additional information;
• Any expenses incurred before you begin to participate in the Plan;
• Any medical, dental or vision insurance premium (or premium equivalent) to the extent that you have paid for or could have paid for such premium (or premium equivalent) on a pre-tax basis through a Code Section 125 cafeteria plan;
• Any employee medical, dental or vision insurance premium (or premium equivalent) relating to coverage in a Mission Valley plan; and
• Any expenses or insurance premiums (or premium equivalents) for a domestic partner and his/her children, unless such individuals are your federal tax dependents.

Please keep in mind the following special rules regarding reimbursements and your Plan HRA Account –

• You must file any claims for eligible expenses by May 31st of the year following the year in which the eligible expense was incurred. Claims filed after May 31st of the year following the year in which the expense was incurred will not be paid. The May 31st deadline may be revised in the future by the Plan Administrator by communicating to Plan participants a different deadline date.
• Eligible expenses incurred for yourself may be reimbursed from the HRA Account. Expenses incurred for your spouse, your child or other dependent will only be reimbursed if your spouse, child or other dependent satisfies the provisions to be eligible for the Plan. Expenses for your domestic partner and your partner's children are not eligible for reimbursement from your HRA Account, unless they are considered your tax dependents for federal income tax purposes.

Participants will be provided with a debit card by the Claims Administrator to pay for Qualifying Medical Expenses. Any debit card shall be subject to the debit card’s terms of use and any other requirements established by the Claims Administrator for this purpose. If a debit card is used to pay for an expense that is not a Qualifying Medical Expense, the Claims Administrator shall apply correction procedures as set forth in guidance under Section 125 of the Internal Revenue Code.

Any credits to the HRA Account will be reduced by Qualifying Medical Expenses that are properly reimbursed from the Plan participant’s HRA Account either by using the debit card assigned to them or through manual reimbursements. HRA Account credits will also be reduced by the administrative fees paid by Mission Valley Power to the Claims Administrator for processing claims and contributions under the Plan. These fees will be withdrawn from HRA Accounts on a monthly basis. Plan participants can contact the Company or the Plan Administrator to obtain the current amount of the fees.

Unused amounts from the prior calendar year may be carried forward to subsequent calendar years. You may not be reimbursed for an amount of eligible expenses that is greater than your HRA Account balance at the time the reimbursement is to be made.

After your Plan eligibility terminates, no additional amounts will be credited to your HRA Account, with respect to periods after your termination. However, a contribution may be made to your HRA Account after termination of employment if the contribution is required by the applicable collective bargaining agreement. You can continue to use the funds accumulated in your HRA account until all funds have been depleted.

Reimbursement Requests

You are encouraged to use your Debit Card to pay for qualified medical expenses but if you cannot, you may submit requests for a manual reimbursement of expenses you have incurred. The form is provided for you below. You must include substantiation documentation along with the form in order to be reimbursed. This includes an Explanation of Benefits from the insurance provider or detailed statements from the medical provider showing credits/adjustments from insurance. Please note that payment receipts cannot be submitted for reimbursement as they do not contain the information needed to determine that insurance has paid the covered portion. If the request qualifies as a benefit or expense that the Plan has agreed to pay, you will receive a reimbursement payment soon thereafter. Remember, reimbursements made from the Plan are generally not subject to federal income tax or withholding. Nor are they subject to Social Security taxes. You will not receive a 1099 and you cannot claim any expense paid with HRA money on your taxes as a medical expense.
Reimbursement Request Form

Forms and Documents

Annuity Application
Death Benefit Application
Enrollment Form
Statement of Retirement
Annuity Plan Summary Plan Description
Restated Plan Document

All forms and applications with the requested documentation can be submitted in one of the following ways: Todos los formularios y solicitudes con la documentación solicitada se pueden presentar de una de las siguientes formas:
Faxed to (801) 975-1342 Attn: UTL Annuity
Enviado por fax a: (801) 975-1342 Attn: UTL Annuity
Emailed to UTLMAILROOM@COMPUSYSUT.COM
Enviado por correo electrónico a: UTLMAILROOM@COMPUSYSUT.COM
Mailed to: PO Box 26237, Salt Lake City, UT 84126
Enviado por correo a: PO Box 26237, Salt Lake City, UT 84126
Hand/Overnight Delivery: 1293 West 2200 South, Suite A, Salt Lake City, Utah 84130
Entrega en mano/express: 1293 West 2200 South, Suite A, Salt Lake City, Utah 84130

Contact Us

CompuSys of Ut. Inc.
1293 West 2200 South Ste A
Salt Lake City, UT 84119
Toll-Free (800) 928-1001
Fax (801) 975-1342

Important Links

IRS Publication 502: Medical and Dental Expenses
Health Reimbursement Arrangement Reimbursement Form
Consumer Portal
FSA Store