Annuity & Savings Plan

Hardship Distribution and Supporting Documentation

  I. Medical

Medical expenses for you, your spouse or your dependents may qualify for hardship distribution. Generally any medical expenses that are considered by the IRS to be a deductible medical expense will qualify for a hardship distribution. Complete the Worksheet for Hardship Withdrawal for Medical Expenses

A. You may receive a hardship distribution for the following items:

• Operations/treatment affecting any part of the body
• Obstetrical expenses
• Therapy
• X-ray treatments
• Hospital services
• Nursing services
• Medical services
• Laboratory services
• Surgical services
• Dental services
• Diagnostic services
• Healing services
• Medicine and drugs, if legally procured
• Artificial teeth
• Artificial limbs
• Ambulance hire
• Lodging (while away from home primarily for and essential to medical care,
  limited to $50 per night)
• Transportation for and essential to receipt of medical care
• Eyeglasses
• Seeing eye dog
• Wheelchair
• Crutches
• Inclinator
• Air conditioner, detachable from property and purchased only for the use of
  a sick person
• Capital expenditures, operation and maintenance for permanent improvement or
  betterment of the property advised by a physician (example, an elevator
  for an afflicted individual), limited to the difference between the
  increase in property value due to the improvement and the cost of
  installing the improvement.
• Attendance at a special school for a mentally or physically handicapped individual
• Qualified long-term care services defined as:  necessary diagnostic, preventative,
  therapeutic, curing, treating, mitigating, and rehabilitative services,
  and maintenance or personal care services, that are required by a
  chronically ill person as certified by a healthcare practitioner. An
  individual is “chronically ill” if he/she is unable to perform at least
  2 activities of daily living (e.g., eating, toileting, transferring,
  bathing, dressing, and continence); or requires substantial supervision
  to protect the individual’s health and safety due to severe cognitive impairment.
• Premium payments under a qualified long-term care insurance contract. The
  payment of these premiums is limited to the following amounts:

Age before the Close of the Taxable Year	The Annual Limitation is:
40 or less	$200
More than 40 but not more than 50	$375
More than 50 but not more than 60	$750
More than 60 but not more than 70	$2,000
More than 70	$2,500

Indexing: For any taxable year after 2009, each of the above dollar amounts shall be increased by the medical care cost adjustment (as prescribed by the Treasury Secretary) each calendar year. Any increase that is not a multiple of 10, shall be rounded to the nearest multiple of 10.

• Medical insurance premiums
• Cobra premiums

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B. You cannot receive a hardship distribution for the following Medical Care Expenses:

• Amounts expensed for illegal operations/treatments
• Toiletries, cosmetics, or sundry items
• Expenditures beneficial to the general health (i.e., vacations, hot tub, swimming pool)
• Capital expenditures, in general, except as described in “A” above.
• Insurance policies providing indemnity against loss of income or for loss of life, limb, sight
• Expenses for surgery solely for cosmetic reasons.

C. Documentation - If you request a hardship distribution for medical expenses, you must have documentation to support your request. HRSA-ILA requires that this documentation be attached to your application. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

1. Some Medical Care Expenses are paid for by your insurance company. Others are not.For the portion of those Medical Care Expenses that your insurance company will not pay (unreimbursed qualifying Medical Care expenses):

• Bill for service
• Explanation of Benefits for each bill submitted indicating:
• Service rendered that qualifies as a Medical Care expense
• Date of such service
• Amount of coverage paid
• Amount currently owed
• If you cannot produce an Explanation of Benefits, you must obtain a copy from the insurance company. If the company cannot provide a copy, you may obtain a copy of the medical history with respect to the service rendered, including any amount paid by the insurance company.

2. Some Medical Care Expenses will not be covered at all by your insurance company. For qualifying Medical Care expenses for treatment not covered by the Participant’s insurance policy:

• Explanation of Benefits evidencing a denial of coverage; or
• A letter from the insurance company stating that no Explanation of Benefits is available.

3. If you are required to prepay certain Medical Care Expenses at the time you receive treatment:

• Estimate of the cost for the procedure from the insurance company
• Letter from the medical professional stating that payment is required either in advance or at the time of the procedure.

4.   If you will be paying for your Medical Care Expenses in installments:

• Explanation of Benefits evidencing the service rendered and that the lifetime maximum permitted by the insurance company has been reached.
• A current bill showing the remaining amount to be paid.

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Click Here to access complete request package for a hardship withdrawal for
unreimbursed medical expenses.

Medical Care | Home Purchase | Burial Expenses | Education Expenses | Eviction or Forclosure | Casualty Repair