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Application for Employee Discount

Application for Employee Discount

Lima Memorial Health System offers Associates and their dependents a discount off medical services received at LMHS. This discount is not reflected on the Explanation of Benefits (EOB) processed by Paramount. If you participate in the Flexible Spend Account (FSA) and / or Health Reimbursement Account (HRA) and submit an EOB for reimbursement, please be aware that you cannot claim reimbursement for dollars written off by the LMHS discount. IRS rules prohibit you from collecting FSA and / or HRA dollars for expenses that were waived by the discount. Doing so could result in you being held liable for back taxes and IRS penalties.

You will be asked to sign the Application below each time you request your hospital discount.

By signing this Application for the Employee Discount, I certify that I will only seek reimbursement from my Flexible Spending Account and / or Health Reimbursement Account for qualified expenses actually incurred. I will not request, or receive, reimbursement for any portion of my medical bill that is waived as a result of my LMHS Associate discount.

Form Submission

Please wait for the Thank You page to confirm your form has been submitted.

If you have any questions regarding FSA / HRA and IRS rules, please visit the Human Resources Department, or call 419-226-5089, prior to claiming reimbursement from your account. If you have a billing question, please call Patient Accounts at 567-242-0460.

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