In the landscape of workers' compensation and insurance, the Saif Corporation F3135 form emerges as a cornerstone for employers seeking a unique avenue to manage costs associated with nondisabling claims. This enrollment form opens the door for employers to directly reimburse Saif Corporation for medical expenses tied to accepted nondisabling claims, up to a ceiling predefined by the Oregon Department of Consumer and Business Services. Despite its potential for cost savings on premiums, the program typically suits employers with an annual premium exceeding $15,000 due to the possible outweighing of reimbursement costs over premium savings. Delving deeper, the form lays the groundwork for participation criteria, highlighting that the decision to enroll is pivotal and entails a commitment until either party decides to terminate the agreement or coverage is discontinued. To facilitate this process, details regarding program enrollment, including the necessity of completing and returning the form to Saif, are stipulated, underlining the importance of employer engagement for successful participation. Additionally, the form addresses operational aspects such as reimbursement frequency, which varies based on the nature of the employer’s policy, establishing a structured framework for ongoing evaluation. For those navigating these waters, guidance and assistance are readily available through direct contact with Saif representatives, ensuring that employers are well-supported throughout their program participation.
Question | Answer |
---|---|
Form Name | Saif Corporation Form F3135 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | MEDFORD, NONDISABLING, notifies, PENDLETON |
w w w . saif . com
N on d isa b lin g Cla im s Re im b u r se m e n t Pr og r a m
En r ollm e n t For m
Em ploy er s m ay choose t o r eim bur se SAI F Cor porat ion for m edical ex penses on accept ed nondisabling claim s up t o t he m ax im um r eim bur sem ent am ount set by t he Or egon Depar t m ent of Consum er and Business Ser v ices. Reim bur sem ent of claim s is gener ally not r ecom m ended w her e t he em ploy er 's annual pr em ium is less t han $ 15,000, since t he
r eim bur sem ent claim cost s m ay ex ceed any pr em ium sav ings. For addit ional det ails about t his pr ogr am go t o sa if . com and click " I am an em ploy er . "
I f y ou choose t o enr oll in t his pr ogr am , y ou m ust com plet e t his for m and r et ur n it t o SAI F.
This r eim bur sem ent elect ion w ill r em ain in effect unt il SAI F r eceiv es y our w r it t en r equest t o end it or unt il y our cov er age is cancelled.
I f y ou hav e any quest ions or need assist ance, please cont act y our agent or SAI F r epr esent at iv e.
We elect t o par t icipat e in t he Nondisabling Claim s Reim bur sem ent pr ogr am effect iv e
_______________ and under st and t hat r eim bur sem ent is opt ional under t his pr ogr am .
The ev aluat ion fr equency for policies w it h a cash flow r et r ospect iv e r at ing plan w ill be quar t er ly . Policies w it h a guar ant eed cost or r egular r et rospect iv e r at ing plan m ust select a r eim bur sem ent fr equency .
Ev aluat ion fr equency for guar ant eed cost and r egular r et r ospect iv e r at ing plans:
Annual Quar t er ly
Account Nam e
Signat ur e of Aut hor ized Repr esent at iv e
Pr int ed Nam e |
|
Ret ur n for m t o: |
SAI F Cor por at ion |
|
400 High St r eet SE |
|
Salem , OR 97312 |
Policy Num ber
Dat e
Phone Num ber
F3135 |
5/ 13 |