Section Saf-C 7803.03 - Application Requirements(a) The applicant shall complete and submit the "Application for Medical Evaluation Reimbursement" for dated 12/2020.(b) The applicant shall include the following documentation with the "Application for Medical Evaluation Reimbursement" form: (1) A completed and signed copy of the "Occupational Health Provider Verification" form, date 12/2020; and(2) A legible itemized paid receipt from the occupational healthcare provider.(c) The above documentation shall be submitted to the division within 60 days of the date of the medic examination.(d) If the medical examination occurred after July 17, 2019 but prior to the effective date of this chapter the above documentation shall be submitted no later than 60 days after the effective date of this chapter.(e) Notwithstanding any rule to the contrary, applicants shall apply for reimbursement of medic examinations during the state fiscal year with termination of reimbursement for eligible costs at the end of t fiscal year on June 30.N.H. Admin. Code § Saf-C 7803.03
Derived from Volume XLI Number 6, Filed February 11, 2021, Proposed by #13161, Effective 1/21/2021, Expires 1/21/2031.