How Does Your Consumer-Driven Health Plan Work?

Transcription

1

2 Veritas HRA News How Does Your Consumer-Driven Health Plan Work? 1. Health Reimbursement Arrangement (HRA) Your employer is funding an annual dollar amount into your Health Reimbursement Arrangement (HRA) to help pay for eligible expenses not covered by insurance: Single Coverage - $2,000 and Family Coverage - $4, Member Responsibility If you use all the dollars in your HRA, you are responsible for paying your additional healthcare costs up to your annual out-of-pocket maximum. 3. High-Deductible Health Plan (HDHP) After you meet your annual deductible, and any applicable co-insurance out-of-pocket maximum, the Health Plan pays all eligible expenses when using In- Network Providers. Customer Service High-Deductible Health Plan (HDHP) Member Responsibility Health Reimbursement Arrangement (HRA) Veritas Health Systems Web Tools 4. Veritas Health Systems Customer Service: Providing a bridge between your group health plan and your Health Reimbursement Arrangement. Web Tools: Providing a secure and personalized web portal to handle your HRA reimbursements and account balances. Also, you will have access to a number of Consumer-Driven Health Tools to help you be a better consumer of your healthcare needs Victor Ave. Redding, CA Telephone Toll Free:

3 Veritas HRA News How To Get HRA Reimbursements Veritas plan member visits provider and presents ID card to provider and pays co-pay, if applicable (Doctor, Lab, Hospital, etc.). Provider sends claim to the insurance carrier. The insurance carrier adjusts claim and sends explanation of benefits (EOB) to member and provider. Member makes a copy of EOB, completes the Request for Reimbursement form and submits to Veritas for reimbursement (via fax or mail). For reimbursement of prescription drug expenses, member submits a copy of the documented receipt from the pharmacy with the Request for Reimbursement form. Veritas confirms eligibility, verifies qualified medical expense, adjusts claim and mails reimbursement check to the member. Plan member has access to Veritas Health Systems Web Portal at - there they will find online health tools and HRA balance/reimbursement details. Phone: Toll Free:

4 Veritas HRA News Instruction to Your New Health Plan Web Portal The purpose of this informational newsletter is to inform you of one of the key features of your new health plan. As part of your consumer-driven health plan, Veritas Health Systems has designed an employee web portal featuring valuable tools and information to help you become an effective health care consumer. You can view your personalized web portal by going to then register by clicking on 'Ready to register?' Once registered, you will have access to your personal Health Reimbursement Arrangement information and access to view account balance information. In addition, the My Benefits and My Tools area offers valuable health tools such as a Health Plan Summary, downloadable forms and documents, preferred provider directories, important contact information, and more. This is a snapshot of the Home Page of the new Employee Web Portal. If you have questions, feel free to call the Veritas Health Systems Member Care Center toll-free at Phone: Toll Free:

5 Veritas HRA News How To Get HRA Reimbursements You have $1,000 available per year Veritas plan member visits provider and pays expense (Dental and Vision expenses only). At that point you can either pay the requested amount or ask to be billed. Provider will supply you with a receipt of payment. You will submit a Request for Reimbursement Form to Veritas for reimbursement via fax, or mail. You must attach your receipt. Veritas confirms eligibility, verifies qualified dental expense, adjusts claim and mails reimbursement check to the member. You are responsible to pay the provider after you receive your check. You may also elect an Electronic Funds Transfer (EFT). Plan member has access to Veritas Health Systems Web Portal at - there they will find online health tools and HRA balance/reimbursement details Victor Ave. Redding, CA Telephone Toll Free:

6 Employee HRA Application INSTRUCTIONS 1. You, the employee, must complete this application. You are solely responsible for its accuracy and completeness. 2. All questions must be answered in full or the application may be returned to you resulting in a delay in processing. 3. Type or print clearly using blue or black ink. 1 PLEASE CHECK THE APPROPRIATE BOX Initial Enrollment Add Employee / Dependents Drop Coverage Information Change COBRA 2 EMPLOYEE INFORMATION Company Name Plan Effective Date HRA Effective Date First Name Last Name M.I. Marital Status Social Security Number Single Married - - Mailing Address Apt. # of Dependents Home Phone No. incl. Spouse City Address State Zip Code Date of Birth (MM/DD/YY) Hire Date (MM/DD/YY) 3 DEPENDENT(S) INFORMATION - List only eligible dependents who are enrolling or declining Add Drop Last Name First Name M.I. Sex Birth date (MM/DD/YY) Spouse Child 4 AUTHORIZATION - The following is to be signed by ALL EMPLOYEES applying for an HRA. I AGREE: To the best of my knowledge and belief, all information on this form is correct and true. I understand that this application and any information Veritas Health Systems obtains prior to the effective date of coverage is the basis on which my HRA (Health Reimbursement Arrangement) account will be established. I certify that I am working at the employer's place of business in permanent employment. I understand that the HRA may be used only for qualified medical expenses as defined in the health plan document. I also understand that in order to receive reimbursement for my qualified medical expenses, I must submit (1) A Request for Reimbursement form, AND (2) Either an EOB (Explanation of Benefits) OR a copy of my provider's bill. I attest by signing below that I have reviewed the information provided on this application and to the best of my knowledge and belief, it is true and accurate with no omissions or misstatements. Signature of Employee Date (MM/DD/YY)

7 EMPLOYEE DIRECT DEPOSIT AUTHORIZATION FORM You now have the option to have your HRA reimbursements directly deposited into your bank account. This will eliminate the hassle of having to deposit your reimbursement check when you receive it in the mail. Simply fill out and sign this Authorization form and return it to us to participate in this option. 1. Fill in all boxes below. 2. Attach voided check (not deposit slip). Company Name STEPS FOR COMPLETING THIS FORM 3. Sign and date form. 4. Mail to the address on bottom of page. Last Name MI First Name Social Security Number Home Phone Work Phone Check Action Effective Date Acct. Type Ownership of Account New / Change / Cancel Month/Day/Year Checking / Savings Self/Joint/Other ATTACH A VOIDED CHECK HERE DO NOT attach a Deposit Slip because deposit slips do not show the necessary information. Joan Doe Anywhere, USA Date PAY TO THE ORDER OF $ DOLLARS YOUR TOWN BANK YOUR TOWN, AR FOR VOID By signing this agreement, I authorize Veritas Health Systems to initiate credit entries to the Account(s) indicated above for the purpose of reimbursements from my Account(s) and to initiate, if necessary, debit entries and adjustments for any credit entries made in error. Signature: Date: If the account is a joint account or in someone elses name, that individual must also sign to indicate agreement with the statement above. Signature: Date: Return Form To: PO Box , Redding, CA Toll Free (877) Office (530) Fax (530)

8 Request for HRA/HCSO Reimbursement Office: (530) FAX: (530) PO Box Redding, CA INSTRUCTIONS 1. You, the employee, must complete this form. You are solely responsible for its accuracy and completeness. 2. All information must be completed in full or the request may be returned to you resulting in a delay in processing. 3. Type or print clearly using blue or black ink. 4. FAX this form along with a copy of your Explanation of Benefits (EOB) & Provider Bill to Note: A Provider's bill MUST show Patient's Name, Provider's name, Type of Service, Date of Service and Amount 1 EMPLOYEE INFORMATION - Must be completed by employee. Company Name Home Phone No. SSN Last Name First Name M.I. Work Phone No. Current Mailing Address Unit/Apt City State Zip 2 PATIENT AND PROVIDER INFORMATION - List you or enrolled dependent only Patient Last Name Patient First Name M.I. Sex Relationship to employee Self Spouse Child Provider Name Description of Service Date of Service Amount 3 AUTHORIZATION I HEREBY AUTHORIZE Veritas Health Systems and its agents or employees to make reimbursement to me from my Health Reimbursement Arrangement (HRA) account for the above listed services and related amounts. I am claiming reimbursement only for eligible expenses for eligible plan participants, as defined in the health plan document, that were incurred during the application plan year. I certify that these expenses have not been previously reimbursed under this or other benefit plans and will not be claimed as an income tax deduction. By signing this form, I acknowledge that my statements in this request for reimbursement form are complete and true. Signature of Employee Date (MM/DD/YY)

9 1415 Victor Avenue, Redding, CA PO Box , Redding, CA Toll Free: (877) Fax: (530) Web: