Getting to Know the High Deductible Medical Plan with the Health Reimbursement Arrangement (HRA) February 19, 2014

Transcription

1 Getting to Know the High Deductible Medical Plan with the Health Reimbursement Arrangement (HRA) February 19, 2014

2 Agenda High Deductible Medical Plan HRA Process and Frequently Asked Questions (FAQ) Premera s Online and Mobile Resources Appendix: Common Terms Contact List 2

3 High Deductible Medical Plan 3

4 Medical Plan Summary Medical In-Network Out-of-Network Annual Deductible $1,500 Individual $3,000 Individual $3,000 Family $6,000 Family University s HRA Contribution Up to $750 Individual Up to $1,500 Family Coinsurance 20% 40% Out-of-Pocket Maximum (Includes Deductible) Preventive Care Office Visit $3,500 Individual $7,000 Family $8,000 Individual $16,000 Family Covered in full with no cost-share required Non-Preventive Care Office Visit Deductible and Coinsurance Emergency Room (Waived if Admitted) Prescription - Retail (30-day supply) Prescription - Mail Order (90-day supply) Vision Exam $75 Copayment then Deductible and Coinsurance $10 Generic $30 Preferred Brand $60 Non-Preferred $20 Generic $60 Preferred Brand $120 Non-Preferred Cost share, then 40% of allowable plus balance bill Cost share, then 40% of allowable plus balance bill Deductible and Coinsurance 4

5 HRA Process and Frequently Asked Questions (FAQ) 5

6 How does the HRA work? University of Puget Sound deposits half the annual in-network deductible into an account (HRA) for you to use towards medical deductible expenses. University of Puget Sound contributes: Employee only on the High Deductible HRA Plan: $750 Employee plus one or more dependents on the High Deductible HRA Plan : $1,500 Unused HRA money will carry over into the next plan year, up to the annual in-network deductible. 6

7 How does the HRA work? Faculty and staff members are not eligible to contribute to an HRA; it is funded solely by the university. You may contribute to a Health Care Flexible Spending Account (FSA) to offset further health care expenses in excess of the HRA dollars. Should you have both accounts, the HRA will always pay first, unless the expense is not eligible under the HRA, or if the HRA dollars are depleted. Dependent Care FSA is not affected by your enrollment in an HRA plan. 7

8 How does the HRA work? HRA funds can be used to pay for medical deductibles for you and any dependents enrolled on the high deductible HRA plan Most medical deductible expenses will be automatically paid by the HRA Certain medical deductible expenses must be manually submitted for reimbursement by the HRA Sensitive medical claims for you and enrolled dependents age 13+ (i.e. reproductive health, mental and/or behavioral health) Claims for domestic partner or child of domestic partner Coordination of benefits 8

9 Using the Premera Member Portal Single login for your medical, pharmacy, dental, HRA and FSA plans. Register at Verify whether your HRA paid automatically or if you need to authorize or submit your claim to pay Submit HRA and FSA claims online, download claim forms and check status of the claims Payments are completed each Thursday Checks: mailed to address on file, received within 7 business days Direct deposit: available in account within 72 business hours 9

10 Member Portal HRA/FSA 10

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14 Main Page of Funding Account 14

15 Payment Process Example 1 HRA Streamline Member presents ID card at physician s office and does not pay anything Doctor submits claim to Premera Premera processes claim, and issues Explanation of Payment (EOP) to provider showing if member is responsible for any payment and Explanation of Benefit (EOB) to member (mail or electronic) For non-preventive care, your EOB will illustrate your payment responsibility; it will not show you if HRA dollars were used/available Member logs into and sees that payment was made from their HRA; no payment owed to doctor 15

16 Payment Process Example 2 HRA is Exhausted Member presents ID card at physician s office and does not pay anything Doctor submits claim to Premera Premera processes claim, and issues EOP to provider showing if member is responsible for any payment and EOB to member (mail or electronic) Member logs into and finds their HRA exhausted, so the amount becomes the member responsibility Doctor bills patient, and member pays doctor out of pocket 16

17 Payment Process Example 3 HRA is Exhausted, but member has HCFSA Member presents ID card at physician s office and does not pay anything Doctor submits claim to Premera Premera processes claim, and issues EOP to provider showing if member is responsible for any payment and EOB to member (mail or electronic) Member logs into and finds their HRA exhausted, but funds are available in their HCFSA account Member submits EOB and claim form to ConnectYourCare to issue funds out of their HCFSA ConnectYourCare issues check or direct deposit to member Member submits payment to provider 17

18 Payment Process Example 4 Member Pays at Time of Service Member presents ID card at physician s office and pays a portion of the cost upfront Doctor submits claim to Premera Premera processes claim, and issues EOP to provider showing if member is responsible for any payment and EOB to member (mail or electronic) Member logs into and finds that the HRA issued payment to the provider as well (creating a duplicate payment) Provider has received duplicate payments and should issue applicable reimbursement back to member for your costs paid at time of service (this can be a time consuming process to have payments reimbursed) Do not submit manual claim to ConnectYourCare 18

19 Do I have to pay my provider at time of service? Your medical claim will still streamline over to ConnectYourCare (CYC) for reimbursement to your provider. You should tell your physician that you have an HRA with funds and that they will be receiving payment from both Premera and CYC. Ask your provider if they will wait for your HRA to pay your deductible rather than charging you on the day of your visit. If necessary, ask your provider to call Premera to verify that you have an HRA that helps pay for medical deductible. While in-network providers can charge you up front for your deductible and coinsurance, this is not common. 19

20 How to Submit Claims? You have several options to submit claims: Fax or mail (forms available on HR website) pugetsound.edu/about/offices-services/human-resources/forms/ Online through member portal ( ConnectYourCare mobile app 20

21 To add a new claim, click Add New Claim 21

22 Add New Claim Main Page 22

23 From the main page you have the option of choosing Submit Now OR Save for Later. When you choose submit now, then your screen will provide you with Pay To options. Submit Now Option: 23

24 When you choose Save for Later, you are not provided the Pay To options. This information would be available when you go in to submit/pay your claim at a later date. Save For Later Option: 24

25 Once you choose submit now OR save for later, you will need to fill in all of the required fields. Required fields are: Service For, Claim amount, Vendor/Provider, Date of service, Service Type, and if you chose Submit now the Pay To field. The Descrption field is optional. Required/Optional Fields 25

26 Set Up Direct Deposit Log in at Click on Personal Funding Account, then on Manage Your Account. Next, select Direct Deposit under My Account. Complete the short, secure form. Be sure to have your bank account and routing numbers on hand. Choose Direct Deposit as your preferred method of Claim Reimbursement and click the Confirm button. 26

27 Important Information: The service type is what decides what account the claim payment will pull from if there are multiple funding account options (i.e. HRA&FSA; HSA& LPFSA) The date of service must be entered for service types to be viewable. The service types available will be based on what accounts were active on the date of service entered. It is very important to scroll through all options to see what options are available as there may be specific options that must be chose in order to pay out of a specific account. Service Type Options: 27

28 Once you have completed filling in all the appropriate fields, click Save/Continue 28

29 You now have the option to review your claim submission. You can edit the claim, delete, save/exit or Continue. 29

30 Once you are sure everything is right and you are ready to submit your claim Click Continue 30

31 Once you click continue you will come to the final approval steps of the claim. You have the choice to upload documents at this time or not. 31

32 Once you have made the option of uploading or not, click the I Accept option and then Continue. NOTE: you cannot continue without clicking the I accept. The system will not allow you to. 32

33 You have completed submitting your claim. 33

34 Reminder What information needs to be included on receipts for reimbursement? Receipts MUST include the following information: Name of the patient (you, your spouse or dependent) Date the service was provided Name and address of the service provider Description of the service Amount/cost of the item or service provided Credit card receipts, non-itemized cash register receipts and cancelled checks are not acceptable forms of documentation. 34

35 Premera s Resources 35

36 Register on the Premera Member Portal Visit to register. Order additional ID cards, print temporary verification of coverage Order and refill prescriptions View your benefits, claims, download EOBs Find a doctor View quality of hospitals/providers Treatment cost calculator Health assessments/trackers Health & Symptom checker, medical library For your convenience, you can select electronic EOBs with alerts instead of receiving them by mail. You can also check your personal funding account balances and check to see if a claim has been processed. 36

37 Claim Settings Grant Access to Dependents If you have a spouse/partner and/or dependent child age 13+ on the medical plan, you will need to be granted access to view their claim information You will not be able to submit manual claims online for your dependents unless you have been granted this access One time only: your dependents must log in to click My Plan Information Under the tab Overview click Change and claim access Under claim access setting, you can select which family members you want to be able to view your claims 37

38 Mobile Apps 38

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40 How to Submit via Mobile App 40

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44 Appendix Appendix 44

45 Common Terms Copay: Flat amount paid per visit or prescription. Deductible: Annual amount paid for services prior to receiving coinsurance benefit. Coinsurance: A method of cost-sharing that requires you to pay a % of all remaining medical expenses after the deductible has been paid. Out-of-Pocket Maximum: Once you reach this annual amount, further costs for the plan year are covered at 100% (excludes prescription copays). Preventive Care: Premera uses the U.S. Preventive Services Task Force Guide to Clinical Preventive Services (USPSTF) ( May include screenings, exams, immunizations. If a claim is submitted as preventive it will be covered 100%. Two common tests that are typically not covered as preventive care are: Vitamin D Metabolic panels 45

46 Common Terms Health Reimbursement Arrangement (HRA): a type of healthcare account, not an insurance plan, which is funded entirely by your employer; employees cannot contribute to an HRA. The University of Puget Sound HRA Plan may be used to pay for medical deductible expenses for individuals enrolled on the university s high deductible medical plan. Flexible Spending Account: a benefit that allows you to have pretax dollars withheld from your paycheck to pay for health care or dependent care expenses. Depending on your tax bracket, you may save up to 30% or more in taxes. The Health Care FSA pays secondary to the HRA. The HCFSA covers not just your own medical expenses, but also the expenses of your spouse and tax dependents, even if they aren t enrolled on a universitysponsored medical plan. 46

47 Common Terms Explanation of Benefit (EOB): A statement sent to the member following medical or dental services, illustrating the amount paid by the insurance company and how much is the member s responsibility. Please note, an EOB will not illustrate your HRA balance or if a claim was paid out of your HRA dollars. You must login to to verify. Streamlining HRA Claims (automatic): Medical claims that are submitted by your physician to Premera that automatically flow to your HRA to issue payment. ConnectYourCare (CYC): The administrator of both the HRA and FSA claims. Premera integrates with CYC to streamline claims and have a single signon for members at 47

48 Contact List Premera Blue Cross Customer service available weekdays, 8 am to 5 pm, Pacific Time Medical/dental benefit and claim questions, how to find a doctor/pharmacy Premera will transfer calls to CYC if you have questions regarding your HRA/FSA balance and reimbursement process Web support available if you have lost your username/password: ConnectYourCare HRA and FSA questions (balance inquiries/claim process or submissions) 24-Hour Nurseline Non-emergent health concerns FREE TO YOU! Human Resources hr@pugetsound.edu OR in person in Howarth Hall 016 Questions about enrollment; materials on the university s website 48

49 Resources Available on HR Website Flexible benefits plan election guide: pugetsound.edu/files/resources/2014_election_guide-2.pdf Plan highlights: pugetsound.edu/files/resources/hra_highlights_2014n.pdf Summary benefit comparison: pugetsound.edu/files/resources/sbc_2014_high_deductible.pdf List of preventive services: pugetsound.edu/files/resources/20601_preventive_services.pdf Frequently asked questions: pugetsound.edu/files/resources/medical-hra-fsa_faq_2014.pdf HRA and FSA claim form: pugetsound.edu/about/offices-services/human-resources/forms/ 49