Health Reimbursement. Account. Guide for Employers

Transcription

1 Health Reimbursement Account Guide for Employers

2 A Health Reimbursement Account (HRA) is a benefit plan funded by the employer that reimburses the employee for qualified medical expenses. Flexible and easy to use, an HRA is an allowance (or promise to pay) provided by employers for their staff to access when they incur qualified medical expenses. BlueShield offers health plans, including high deductible health plans (HDHP), that may be combined with an HRA as a way for you to obtain more affordable health coverage for your group while encouraging your employees to become more involved in their health care. Employer Advantages No up-front funding leads to better cash flow. No trust required. HDHP premiums are lower than most plans. Tax Savings contributions made by employers are made with pre-tax dollars, which lowers FICA taxes. Flexibility in designing the plan. Can be combined with a Flexible Spending Account (FSA). Encourages your employees to take a more active role in their health care and educates them on the true cost of health care. Product Offerings An HRA can be combined with any of our group health or dental plans. We will also allow your employees who do not have BlueShield coverage to enroll in the HRA. Most of our plans offer the following benefits: Coverage from the most recognized name in health care. No referrals. Access to the BlueCard network, the largest provider network in the world. Out-of-network coverage options. No claim forms when using participating providers. Access to Online Services. Health education and wellness programs. Prescription drug coverage.

3 How It Works Only the employer may fund the HRA. When you establish an HRA and FSA together, you ll determine which account money is drawn from first. When an individual incurs an expense: The participating provider will submit a claim to BlueShield for processing. If any applicable deductible hasn t been met, an Explanation of Benefits will be sent to both the provider and member with a balance due from the member. Debit card users can pay with their debit card and the amount is automatically deducted from their HRA, up to the amount available in their HRA. If the account isn t sufficiently funded to pay the claim, the member is responsible for the balance of the bill. Additional Options to Enhance the Value of Your Plan Debit Card Fast, accurate, easy. Most consumer driven plans give members the option of using a debit card to pay bills at a physician s office, hospital, pharmacy or other providers. Funds will be automatically deducted from the HRA. Members can track their account balance by accessing their account online at Those members enrolled in both an HRA and FSA can still use one card for both accounts. eelect Making enrollment seamless for you and your employees Your group can enroll using eelect (a web and IVR tool) for automated enrollment in our health plans, any pre-tax financial account available with our health plans, and any other benefits your company offers. eelect Employer Advantages Automated process reduces time, cost, and errors associated with paper enrollment. Provides employees with benefit information 24/7. Messaging capability, calculator, and invisible paycheck features provide valuable information about companysponsored benefits and consumer driven options. eelect Employee Advantages Built-in calculator helps employees choose benefits based on options, coverage and cost. Messaging capabilities provide timely and consistent information about benefit options. With eelect, employees can easily complete even the most complex benefit selections. Innovative Process Administration, LLC, is an independent company that provides the service of eelect.

4 Funding the Account Only the employer can fund the HRA. Employers may also adjust contributions for seniority or income, limit the amount that may be rolled over, and fully fund the account in a trust or set it up as a promise to pay. There s no minimum contribution amount for an employer. Flexible Spending Account (FSA) forfeitures cannot fund the HRA. Guidelines The employer group must have at least two eligible employees to enroll in a health plan. The HRA can be combined with an FSA. The employer must define which account funds will be drawn from first. Typically, employers require that funds are drawn from the FSA first. Getting Started If you re interested in learning more about how our health plans combined with an HRA and FSA can work for your company and your employees, please call your BlueShield representative or our Marketing Services Unit at , or you can contact your health insurance broker. Find out more about these plans by visiting our web site at FREE Online Tools for Members at Our plans give our members more incentive to take control of their health. That s why we provide them with useful tools and information on our web site to help them get the most value from their BlueShield Plan. Link to Account Administrator Web Sites Employees can click on a link to the web site for their HRA administrator to view information regarding their account. eservices Health plan customer service 24/7 including PCP changes, ordering an ID card, claims status and more. Get Health Information and resources on the health topics that matter most, including wellness programs, interactive tools and health topics A to Z. Qualified Expenses Here s a partial list of benefits and services that can be paid for with funds from an HRA. Abdominal supports Acupuncture Alcoholism treatment Ambulance Anesthetist Arch supports Artificial limbs Autoette (when used for relief of sickness/disability) Blood tests Blood transfusions Braces Cardiographs Chiropractor Contact lenses Crutches Dental treatment Dental x-rays Dentures Dermatologist Diagnostic fees Drug addiction therapy Drugs (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor FICA and FUTA tax paid for medical care service Fluoridation unit Guide dog Gum treatment Gynecologist Healing services Hearing aids and batteries Hospital bills Hydrotherapy Insulin treatments Lab tests

5 Qualified Expenses continued Laser eye surgery Lead paint removal Metabolism tests Neurologist Nursing (including board and meals) Obstetrician Operating room costs Ophthalmologist Optician Optometrist Oral surgery Organ transplant (including donor s expenses) Orthopedic shoes Orthopedist Osteopath Disallowed Expenses Advance payment for services to be received next year Athletic club membership Automobile insurance premium allocable to medical coverage Boarding school fees Bottled water Commuting expenses of a disabled person Cosmetic surgery and procedures Cosmetics, hygiene products and similar items Diaper service Domestic help Funeral, cremation or burial expenses Health programs offered by resort hotels, health clubs, and gyms Illegal operations and treatments Illegally procured drugs Over-the-counter drugs (except for vitamins and supplements) Oxygen and oxygen equipment Pediatrician Physician Physiotherapist Podiatrist Postnatal treatments Practical nurse for medical services Prenatal care Prescription medicines Psychiatrist Psychoanalyst Psychologist Psychotherapy Radium therapy Maternity clothes Premiums for life insurance, income protection, disability, loss of limbs, sight or similar benefits Scientology counseling Social activities Special food or beverages Specially designed car for the handicapped other than an autoette or special equipment Supplements (unless used to treat a specific medical condition) Swimming pool Travel for general health improvement Tuition and travel expenses for a child with special needs at a particular school Vitamins (unless used to treat a specific medical condition) Weight loss programs Registered nurse Special school costs for the handicapped Spinal fluid test Splints Sterilization Stop-smoking aids Surgeon Telephone or TV equipment to assist the hard-of-hearing Therapy equipment Transportation expenses (relative to health care) Ultraviolet ray treatment Vaccines Wheelchair X-rays

6 Frequently Asked Questions Q: What is the minimum group size to offer a BlueShield health plan? A: Our health plans can be offered to any employer with two or more eligible employees. Q: Can I offer both an HRA and FSA to my employees? A: Yes, you may offer an FSA with your HRA as another way to help your employees meet their deductible while saving on taxes. You designate which account to draw funds from first. Typically, employers require that funds be drawn from the FSA first. If no designation is made, funds will be drawn from the HRA first. Q: As an employer, who do I call with questions about the HRA? A: For questions about your insurance product, call your BlueShield account executive at For questions about your HRA, contact your HRA administrator. Q: How do I convert my current health plan combined with an HRA? A: At the end of your plan year, you can choose to offer one of our plans combined with an HRA. A report of current employee balances in the HRA will need to be provided to the chosen administrator for the account. Q: Our group currently offers BlueShield coverage. When can we begin to offer a plan with an HRA? A: On your renewal date, you can choose to offer a plan with an HRA. Q: What are the minimum employer contributions for the HRA? A: As the employer, you determine how much you will contribute to the HRA. Q: Are HRAs subject to COBRA? A: Yes. HRAs are subject to COBRA rules. As the employer, you are responsible for sending out the COBRA notice. For more information contact your HRA administrator. Q: What is a qualified medical expense? A: Qualified medical expenses are services typically covered by a healthcare plan, such as office visits, emergency room services and hospitalization. Qualified medical expenses also include prescription drugs and many over-the-counter drugs, vision expenses including eyeglasses and contact lenses, medical plan deductibles and copays, as well as non-cosmetic dental expenses. The covered items are defined by IRS code 213(d) and are listed in IRS Publication 502. A list of examples is available in this brochure. An employer may impose limits on expenses that are considered to be eligible for reimbursement under an HRA. Q: What happens if an employee enrolled in a health plan with an HRA leaves the company? A: The employer chooses whether to allow employees to have continued access to the account. Q: Who will bill me for the HRA? A: BlueShield will bill you for your insurance premiums and any administration fees for your accounts on one consolidated bill. Your administrator will bill you for the funds for the accounts.

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8 Although BlueShield is working with an administrator to make HRAs and FSAs available, BlueShield is not responsible for and makes no representation regarding the performance of HRAs offered by the administrator. In facilitating the relationship with an administrator, BlueShield is not acting in a fiduciary capacity under ERISA or otherwise. Innovative Process Administration, LLC, does not provide BlueShield any products or services, and is solely responsible for eelect. BlueShield makes no representation regarding the availability of the eelect enrollment system or the transmission of enrollment data to third parties through eelect. A Division of HealthNow New York Inc. An Independent Licensee of the BlueCross BlueShield Association. NENY_1353_12_08 BS 461 R2