Health Reimbursement Account

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Presentation transcript:

Health Reimbursement Account How to Use Your Benny Card Introduction Started using Benny Card in December 2014. Prior to that, we processed about 3000-4000 HRA claims per year. Since December 2014, we have processed about 30,000 claims through the new HRA system. We have had to make adjustments to procedures and resources. IBEW-NECA Benefits Administration Association - Proprietary

What is a Health Reimbursement Account (HRA)? A health reimbursement account is an employer-funded plan. Contributions are directed from the employee’s salary to the HRA account. Because these contributions are not actually received by the employee, these contributions are not considered as wages for federal income tax purposes. These HRA contributions are tax-free. The funds in the HRA account can be used only for eligible medical care expenses, either through reimbursement or through Benny Card transactions. If the Benny Card is used to pay for an ineligible expense, then the amount of the transaction must be paid back to your HRA account, or the transaction amount must be reported as income on a 1099-MISC. HRA – employer contributions HSA – employee contributions Difference between cards Substantiate – verify that it is HRA eligible or not Receipt – interchangeable with documentation which includes itemized statements from provider or EOBs IBEW-NECA Benefits Administration Association - Proprietary

IBEW-NECA Benefits Administration Association - Proprietary Valid Merchants Note: this does not automatically verify that the transaction is for an HRA-eligible expense No! When you use your Benny Card, the first step: the Benny Card can only be used at a valid merchant. This is for your protection, and also to allow NECA-IBEW to use the auto-substantiation options allowed by the IRS, which will ultimately help you by reducing the amount of paperwork that you have to provide to verify that an expense is HRA-eligible. IBEW-NECA Benefits Administration Association - Proprietary

Use the Benny Card for HRA-eligible expenses See page 59 of the SPD booklet, as well as on the HRA Participant Portal/Mobile App The HRA claim is for an HRA-eligible expense The HRA claim has not been previously reimbursed The HRA claim is not a duplicate of a claim which has already been submitted/reimbursed The HRA claim has processed through all applicable insurance The HRA claim is filed in a timely manner You must have the funds available in your HRA account to cover the debit transaction These terms and conditions were sent to you along with the Benny Card. They are standard terms and conditions as required by the IRS for Benny Card use. In the terms and conditions it states that you re-affirm that you are aware of these terms and conditions every time you use the Benny Card. Coordination of Benefits Year for timely filing IBEW-NECA Benefits Administration Association - Proprietary

Make a payment with your Benny Card Already processed by all applicable insurance Has not previously been reimbursed/paid Enough Funds You can use your Benny Card at a valid merchant by swiping the card at a point of sale device, to make a payment online, or over the phone. Your card arrives activated and using a PIN is not necessary. Some merchants use zip-code validation so if your card is declined and you know it is active, ask what zip code they are using and ensure it is the one we have in our system. Reminder: every time you use your Benny Card, you are reaffirming that you are abiding by the terms and conditions that you received with the card. This includes: This claim is for an HRA-eligible expense All applicable insurance has been applied to this claim This claim is for reimbursement of a paid expense (which was not paid for with your HRA Benny Card) This claim has not been previously reimbursed This is not a duplicate of a claim which has already been submitted/reimbursed This claim meets the timely filing criteria IBEW-NECA Benefits Administration Association - Proprietary

Did you pay for a prescription at the pharmacy Did you pay for a prescription at the pharmacy? Did you pay online at CVS Caremark? You are done. In most cases, documentation is NOT required What happens next? This depends on where and how you used your Benny Card. The IRS has set guidelines for Benny Card use which allows us some leeway when validating these claims. One of the IRS guidelines is regarding IIAS Merchants. These merchants use a special coding at the point-of-sale that identifies whether or not the item you are trying to purchase is HRA-eligible. When the item is HRA-eligible and coded as a prescription, our system will automatically substantiate the transaction and no paperwork is needed. Note: your card may allow you to purchase an item that is HRA-eligible but non-Rx. In this case, your transaction will not be automatically substantiated and you may be required to submit documentation. Note: every time you use your Benny Card you are re-affirming that you are following the terms and conditions. Just in Case  Save your pharmacy tag and receipt IBEW-NECA Benefits Administration Association - Proprietary

Did you pay a co-pay at the doctor’s office? You are done. In most cases, documentation is NOT required CO-PAY = $15 Another IRS regulation allows us to auto-substantiate your transaction is the one that references copays. If more than one family member goes to the doctor on the same day, can total co-pays for all up to 5 times Valid co-pays are $15 $30 $45 $60 $75 Please note some doctors are still charging the old co-pay of $10. This amount will NOT automatically substantiate. Again, you are agreeing to terms and conditions when you use your Benny Card. ALLOWED CO-PAYS: up to 5 times co-pay amount Just in Case  Save your office visit receipt and any itemized statements or EOBs related to this visit IBEW-NECA Benefits Administration Association - Proprietary

Did you pay a previously approved amount? You are done. In most cases, documentation is NOT required Another IRS regulation allows us to auto-substantiate your transaction is the one that references recurring expense. For this method to be initiated, we must have previously manually approved, by review of submitted documentation, a specific dollar amount payment to a specific provider. This is on a per-member basis. If another transaction of same $ amount to same provider occurs, the transaction will be automatically substantiated. Note: this method effective 3/9/16 and it may take a period of time before you see this happen in your account. Recurring Expense: if we have previously approved (with documentation) the exact payment amount to the same provider (per member), the transaction will be automatically substantiated Just in Case  Save your documentation related to this transaction IBEW-NECA Benefits Administration Association - Proprietary

Allowed by IRS Regulation Prescriptions, Co-Pays, and Recurring Expenses can be automatically validated by our system Per IRS Bulletin 2007-39 PLEASE NOTE We do not manually validate these Benny Card transactions. You are responsible for following the terms and conditions for use of the Benny Card. These first three methods of auto-substantiation are allowed by the IRS and do not require documentation to be sent in for these transactions. Again, remember the terms and conditions of Benny Card use. Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

NECA-IBEW Matched Claims Why do you have to send back the EOB that we sent to you? Per IRS regulations, you must supply supporting documentation for HRA claims that are not auto-substantiated or for which you are requesting reimbursement It is not efficient use of the fund’s time to search for documentation for your HRA claim Member responsibility: by providing the EOB(s), you are validating that these are the charges that apply to your Benny Card transaction/reimbursement request. Note: An itemized statement, billing statement, or receipt from the provider can be used for supporting documentation in place of EOBs. One of the most common questions that we get is: why do you we have to send the eob back to you that you sent us? Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

NECA-IBEW Matched Claims BUT….what we can do for you… After you use your Benny Card, we will try to match that transaction to a claim in our system. We will try to do that for 30 days. How will we match it? Benny Card Transaction Amount in our HRA system $129.32 Patient Liability of one of your claims in our main system $129.32 Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

NECA-IBEW Matched Claims Pay this amount to the provider. We will match it to the patient liability of a claim in our main system No Letter Sent No documentation required How can you use this new process? Amount due by participant on the EOB Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

Why Did I Get a Documentation Request Letter The Benny Card charge was not for a prescription The Benny Card charge was not for a co-pay The Benny Card charge was not for a previously-approved amount The Benny Card charge did not match the patient liability of one of your claims in our main system It’s been 30 days since your Benny Card transaction If none of the three previous methods of substantiation apply, rx, copay, match Then you will get a doc request letter 30 days after first letter  Overdue Notice 30 days after Overdue Notice  Suspension Notice, card is suspended Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

What Documentation Do I Need to Send? Paid Receipt from the Provider Billing Statement from the Provider EOB(s) Itemized Statement from the Provider If you have other insurance/Coordination of Benefits Itemized Statement from the Provider or an EOB from other insurance If we do not have your dependents in our system and the claim is for them, will need marriage certificate, birth certificate, etc. as applicable Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

How to Submit Documentation Mail to Fund Office – attn: HRA Fax to Fund Office – attn: HRA Upload on HRA Participant Portal* Upload on Mobile App* You can fax or you can mail. Email is not secure. Preferred method is HRA portal or mobile app. Mobile app is the easiest. The benefit of sending supporting documentation via the mobile app (or HRA Participant Portal) is that the documentation is immediately attached to your claim, there is no chance that the documentation might get misplaced, and all documentation requests will stop until the claim is reviewed. You will only get another notification if more documentation is required or if the claim is denied. After your account is set up, download the mobile app from the iTunes store (for iPhone users) or Google Play (for Android users). Use ‘NECA IBEW HRA Benefits’ as the search term. The mobile app icon looks like this: * Preferred Methods – having documentation attached to claim in the system will prevent suspension of card due to missing documentation IBEW-NECA Benefits Administration Association - Proprietary

Mobile App Before you can login to the mobile app, you must set up your account on the HRA Participant Portal at https://necaibew.lh1ondemand.com. For instructions on setting up your account, please refer to this document in the Documents and Forms Library: After your account is set up, download the mobile app from the iTunes store (for iPhone users) or Google Play (for Android users). Use ‘NECA IBEW HRA Benefits’ as the search term. The mobile app icon looks like this: Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

IBEW-NECA Benefits Administration Association - Proprietary Mobile App After you download the mobile app, you can login using the username and password created on the HRA Participant Portal. After you log in successfully, you will be prompted to create a 4-digit PIN code. This will be your login for the mobile app. You will be asked to enter it twice. You can also choose to enable Fingerprint Login by clicking on ENABLE TOUCH ID. IBEW-NECA Benefits Administration Association - Proprietary

IBEW-NECA Benefits Administration Association - Proprietary Mobile App This is the home screen. You can: View your Account Activity under My Accounts File a Claim Eligible Expense Scanner - NEW View Account Snapshot Note: If you used your Benny Card to pay a bill, you do NOT need to file a claim! There is no ‘I Want To submit a receipt for a debit card transaction’. Instead, you will see an Alert in the Messages at the bottom of your screen. This indicates that the debit card transaction claim has been created and is ready for you to upload a receipt. (this may take a few days after you use the card). Also, the terms ‘receipt’ and ‘supporting documentation’ are used interchangeably. A receipt does not necessarily mean just a payment receipt; it could refer to an EOB or an itemized statement from the provider. You can fax or you can mail. Email is not secure. Preferred method is HRA portal or mobile app. Mobile app is the easiest. The benefit of sending supporting documentation via the mobile app (or HRA Participant Portal) is that the documentation is immediately attached to your claim, there is no chance that the documentation might get misplaced, and all documentation requests will stop until the claim is reviewed. You will only get another notification if more documentation is required or if the claim is denied. After your account is set up, download the mobile app from the iTunes store (for iPhone users) or Google Play (for Android users). Use ‘NECA IBEW HRA Benefits’ as the search term. The mobile app icon looks like this: IBEW-NECA Benefits Administration Association - Proprietary

Mobile App Your claim that was created by using your Benny Card is highlighted in blue and is titled Claim Submission. Click the arrow on the Claim Submission line to access the claim information and to upload receipts. Note: on an Android device, this line item may have a different font color rather than an arrow. Just in Case  Save your documentation IBEW-NECA Benefits Administration Association - Proprietary

IBEW-NECA Benefits Administration Association - Proprietary Mobile App Your claim will be displayed. Click on New Receipt to upload a receipt (also called supporting documentation). When you click on New Receipt, the mobile app will access your device’s camera function, which will then allow you to simply take a picture of your receipts. You can also access your camera roll to select a photo. Maybe more than 4? IBEW-NECA Benefits Administration Association - Proprietary

Why Is My Benny Card Suspended? Documentation is required, but was not received Documentation was received, and after review by the HRA Department, the expense was determined to be ineligible for HRA. The ineligible amount must be repaid back to the HRA account. IBEW-NECA Benefits Administration Association - Proprietary

What do I need to do to unsuspend my card? Send in documentation Use preferred methods of Mobile App/Consumer Portal upload Submit a claim for reimbursement Instead of sending you a reimbursement check, we will apply the reimbursement to the repayment amount. Repay your HRA account Send check to NECA-IBEW Welfare Trust Fund Note ‘HRA Repayment’ on memo line Do none of the above You will receive a 1099-M IBEW-NECA Benefits Administration Association - Proprietary

Save all of your documentation! From the Provider From NECA-IBEW Pharmacy Tags Pharmacy Receipts Doctor Visit Notes Doctor Visit Bills Itemized Statements Hospital Bills Documentation Requests Emails Explanation of Benefits (EOBs) IBEW-NECA Benefits Administration Association - Proprietary

IBEW-NECA Benefits Administration Association - Proprietary What’s New? Automatic reimbursement of Retiree Premiums – offered as a service by NECA-IBEW Complete an authorization form NECA-IBEW will reimburse you from your HRA account as funds allow – you will NOT need to file a claim for reimbursement each month Three methods of auto-substantiation (reduces need for documentation) Prescriptions, Co-pays, Recurring Expenses Revised processing procedures for your HRA claims which should simplify and expedite the claim review process. Fingerprint Login on both iPhone and mobile devices. Eligible Expense Scanner: scan barcodes to see if HRA-eligible. Has terms and conditions to agree to. Limited to 100 scans per month per member. Retiree Premiums: have sign up forms if anyone interested 3 methods: recurring is new, established this week. For a member, if a payment is made to a provider with the Benny Card and that transaction amount is 100% approved, then future payments of the same amount to that provider for that member will be automatically substantiated without the need to send in documentation. Allowed by IRS. IBEW-NECA Benefits Administration Association - Proprietary

Visit www.neca-ibew.org for More Information! Click here to see HRA information IBEW-NECA Benefits Administration Association - Proprietary