Workers Comp Retirees Plan to Retire?

Provider Certification Form
(Confirming COSMETIC SERVICES were medically necessary)

Due to a recent IRS audit any cosmetic procedure that is NOT considered medically necessary will be subject to a 40% co-insurance processing charge that will allow the District to collect and remit the retiree share of Social Security and Medicare taxes along with State and Federal withholding taxes. Procedures that are certified as medically necessary will be exempt from taxation. The attached Provider Certification Form must be completed by your medical provider or the 40% charge will apply.