Experience Choice : OPERS HRA Edition OneExchange Newsletter for Medicare-eligible Retirees
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1 Experience Choice : OPERS HRA Edition OneExchange Newsletter for Medicare-eligible Retirees In This Issue Direct Deposit We Heard You! Step 1: Reimbursement Types & Considerations Step 2: Tips for Submitting Reimbursement Requests Successfully Examples of Approved Documentation Step 3: What to Do if Your Request for Reimbursement is Denied Top 3 Reasons Reimbursement Requests Are Denied Resources at the Ready Need Help Managing Your HRA? Examples of Reimbursement Forms Look for These in the Mail: NEW! Personalized Reimbursement Request Forms Information You Can Use You re receiving this newsletter because our records show that you ve enrolled in a Medicare plan through Towers Watson s OneExchange. The newsletter is sent out twice a year to make sure you re up to date on the latest Medicare information. Straightforward and easy to understand that s our goal. In this edition of the Experience Choice newsletter, we focus on providing detailed information about how to use your HRA. We have organized the instructions in steps starting with choosing how to be reimbursed for premiums to information on how to avoid a Reimbursement Request denial. Need help? Give OneExchange a call. We are here for you and happy to assist. Direct Deposit OPERS requires that you receive your HRA reimbursement by Direct Deposit into your bank account. This means that you must keep a bank account on file with OneExchange in order to receive your reimbursements. As a convenience to you, OPERS provides OneExchange with the bank account information in which you receive your monthly benefit deposit. If you d like to change the bank account information in which you receive your HRA, you may call OneExchange at Press 3 to speak to the Funding Department, and you will hear a new option to say Agent, which will connect you directly to a person. We Heard You! Dedicated Call Center Team Trained exclusively on OPERS-specific procedures and expectations, this team is made up of experienced call center personnel and is ready to answer your HRA questions. Do More with a Single Call We are making improvements to our automated voice system. Starting later this year, you will be able to request forms, hear information about your HRA, and track submissions and payments without waiting or being transferred. Updated HRA Denial Codes If you receive notification that your HRA claim has been denied, a clearer explanation with steps for resubmission is now provided. This enhancement will help you to better understand why your claim has been denied, and what you need to do to resubmit successfully. 1
2 Step 1: Reimbursement Types & Considerations * What is it? Auto-Reimbursement Option that allows for automatic reimbursement of premiums without manually submitting a claim form each year. Available for you to select upon enrollment if offered by your insurance company. May enroll at any time if available. Recurring Reimbursement Option that allows for monthly reimbursement for eligible premiums by completing and submitting a Recurring Reimbursement Form each calendar year. What are the considerations of each type of You don t need to use any forms just set it and forget it. If you keep the same plan next year, auto reimbursement continues. You do not need to do anything if you remain enrolled with the same carrier (even if your premium changes). Reimbursement timeframes can vary depending upon the carrier s process. Is not intended to be the quickest way to receive your reimbursement. You need to complete reimbursement forms each calendar year. It does not automatically renew. You need to complete new reimbursement forms if your premium changes during the calendar year. Which premiums can be reimbursed? Medical or prescription drug premiums, ONLY if offered by your insurance company. Medical, prescription drug, dental and vision *NOTE: Medicare Part B Premium Reimbursement is a different form. How long does it take for me to get my first and subsequent It takes 2 3 months to receive your first reimbursement. OneExchange cannot reimburse you until they receive notice from the carrier. You ll receive subsequent reimbursement(s) every 4-6 weeks. It takes about 10 business days for the Recurring Reimbursement Form to be processed. You ll receive your reimbursement the same time every month. * If you are satisfied with the way you receive reimbursements, no action is necessary. 2
3 Step 2: Tips for Submitting Reimbursement Requests Successfully The most common reason for denial of an HRA reimbursement request is because the correct documentation was not included with the claim form or the claim form was not completely filled out. The following reminders help to ensure your next reimbursement request is processed smoothly. Submitting the correct form saves time. Please make certain your form fits the requested reimbursement. This will ensure faster processing time and improved accuracy. Documentation sent with the form must include: Covered participant Type of coverage Date of service Proof of payment Provider name On every form you will find a checklist titled What I Need To Do to help ensure that your request includes the correct documents and information for a successful submission. Use copies, not originals When mailing your reimbursement requests, use a copy and keep your original receipt for your records. Medicare has neither reviewed nor endorsed this information. 3
4 Examples of Approved Documentation Invoice from a Provider A health care provider is anyone who provides health care services to you. He or she can be a physician, dentist, surgeon, podiatrist, acupuncturist, optician, or many others who provide eligible health care services to you. The invoice is typically offered to you at time of service, and serves as a receipt of any payment you made during your visit. Doctor John Smith Internal Medicine Group 2 Main Street Anytown, CA Jane Doe 444 South Street City, State, Statement of Account STATEMENT DATE: JUNE 7, 2017 PAITIENT # ACCOUNT # TAX ID # PAYMENT METHOD CHECK NO. JOB VISA- XXX-XXXX-XXXX-4444 N/A PATIENT DATE # DESCRIPTION CHARGE INSURANCE BALANCE June 17, Evaluation $ $0.00 $ June 17, Procedure $75.00 $0.00 $75.00 Proof of Coverage: Carrier Proof of Coverage or OPERS Health Care Premium Receipt If you are enrolled in a Medicare plan, medical and/ or prescription drug plan, you will receive a Proof of Coverage or an Evidence of Coverage letter each year from your insurance carrier, usually in the fall. The letter provides details of your coverage and how much you pay. You need to submit a copy of the Proof of Coverage when you request reimbursement for your premiums. If you are enrolled in an OPERS vision or dental plan or have a spouse s medical premium deducted from your OPERS pension, you can obtain a Health Care Premium Receipt for those plans through your OPERS online account or by calling OPERS. This will be sufficient proof for your reimbursement from your HRA, and you will not need to get a Proof of Coverage from the carrier for those expenses. This is the only documentation accepted for premiums deducted from your OPERS pension. Open enrollment statements have been rejected, these statements are not proof of enrollment. 4
5 Explanation of Benefits (EOB) Provided by your health insurance company once they have paid their portion of the fees, an EOB will typically include all of the required information for out-of-pocket costs. These statements contain information about the cost of the expense, the amount covered by your plan and the remaining balance or your responsibility, which is your out-of-pocket cost. You can choose to receive your EOB electronically or via the mail. If you have not received your EOB within 30 days of your date of service, contact your insurance company to request one. If you submit a request without including the EOB or other itemized statement (including your name, your provider s name, date of service, description of service, and final patient portion of the payment) from your insurer, your request will be denied until this information is submitted, and you will need to submit a new Reimbursement Request. XXX/XX/20XX XXXXXXXXXXXX XXX-XXXXXXXX-XX XXXXXXXX Wanda Worker XX-XX-20XX Dependent Dr. Martha Wonder Wanda Worker 123 Main Street, Apt. 301 San Antonio, TX 782XX XXX-XXXX XXXXXXXXXXXXXX XX/XX/20XX XXX/XX/XX Follow-up Visit $150 $110 $40 $30 $80 $30 1 XXX/XX/XX Labwork $70 $50 $20 $40 $10 1 $10 $220 $160 $60 $10 $120 $40 $30 1- Billed amount is higher than the maxium payment insurnace allows. The payment is for the allowed amount. For Medicare Part B Reimbursement: Social Security Administration Benefit Award/Proof of Income Letter Every year in late fall, usually October or November, the Social Security Administration (SSA) sends a benefit award letter stating you receive Social Security benefits. This letter is sometimes called a budget letter, a benefits letter, a proof of income letter, or a proof of award letter. You also can use a monthly or quarterly statement from the Center of Medicare and Medicaid Services (CMS). The statement from CMS must clearly indicate that it is for Medicare Part B, states the recipient s name, and the amount of the Medicare Part B premium. You may use the Benefit Award or Proof of Income Letter as documentation when submitting your request for Medicare Part B reimbursement. 5
6 Prescription Drug Receipt Receipt from the pharmacy or mail-order pharmacy for your covered medications. How to Submit for Reimbursement: Online, by Fax, or by Mail You can submit your Reimbursement Request in any one of the following three ways: online, by fax, or by mail. With all three methods of submitting requests, you must make certain that you include a completed and signed form and all the supporting documentation needed to verify the request. If you use the online submission method and choose to fax supporting documents, please make sure to use the fax cover sheet provided online to send your request. If you mail your forms and documents, make a copy. Do not mail the originals. Please note: when you choose to submit your request online and then fax documents, you must use the fax number generated by the website, which contains the claim number and electronic signature. Dental or vision reimbursements with no EOB If you don t have dental and/or vision insurance but you have an out-of-pocket cost you want reimbursed, write on the body of the claim form, No dental (or vision) insurance/no EOB Make sure to include the receipt for the request. This will prevent your request from being denied. 6
7 Step 3: What to Do If Your Request for Reimbursement is Denied The most common reasons for denial are missing information, an incorrectly completed form, or an ineligible expense. The best thing to do when your claim is denied is check the Explanation of Payment for the reason your claim was denied. Follow the directions and, if possible, include a copy of the EOB that has the requested reimbursement listed on the statement, if you are requesting reimbursement of insurance premiums. Once a request is denied, you must resubmit a new request with supporting documentation. Signature is the key! We cannot process your claim unless it is signed. Please do not forget to sign your form! We will work with you to identify the reason for the denied claim. If you need more help, please contact OneExchange at A benefits specialist will help you figure out why the claim was denied. Top 3 Reasons Reimbursement Requests are Denied The most common reason for denial of an HRA Reimbursement Request is because the correct documentation was not included with the claim form or the claim form was not completely filled out. When you fill out your Reimbursement Request Form, there is a checklist on the form to help you know if you have completed the form correctly and included the right supporting documents. The top three reasons for a Reimbursement Request to be denied include the following: 1. Missing Proof of Coverage and Proof of Payment 2. Incomplete form 3. No supporting documentation Resources at the Ready Among the ways to learn about your HRA are the following: Print publications such as the OneExchange Getting Reimbursed Guide. Online animated short videos that explain the basics. Go to Medicare.OneExchange.com/OPERS and scroll down to find the links within the Videos area. 7
8 Need Help Managing Your HRA? You can designate a trusted resource as little or much access to your account as you d like: To grant someone permission to fully manage your account, call OneExchange with this individual on the line with you. The only thing your approved representative cannot do is sign forms and enroll or change your plan. To grant someone authorization to speak on your behalf, fill out and submit the Authorization to Release Personal Information form. This form is available through your online account or by calling us. Press Option 3 to speak to a representative. To authorize activity on the account if you are no longer able to manage your account or provide consent, a Power of Attorney document must be on file with OneExchange. This document can be obtained from an attorney. OneExchange cannot assist with this document. Copies can be mailed or faxed to us. When the Participant Dies We understand that this is a difficult time and that it may be hard to know what steps to take next. To gain access and utilize the remaining HRA balance, authorized caregivers should call OneExchange. Spouses Who are Losing Funding in 2018 As part of OPERS three-year allowance transition, monthly HRA contributions will cease for spouses and surviving spouses of OPERS retirees in January The last spousal allowance will be provided in December If you are an OPERS spouse or surviving spouse who has received a HRA spousal allowance, you won t lose your medical or prescription drug coverage even when you are no longer receiving an allowance in You can still use the services of OneExchange to evaluate what type of plans may be best for you, and work through issues you may have with your insurance carriers. Spouses and surviving spouses that aren t yet enrolled in plans through OneExchange can also work with us to find plans that fit your needs and budget. 8
9 Examples of Reimbursement Forms The most common reasons for denial are missing information, an incorrectly completed form, or an ineligible expense. The best thing to do when your claim is denied is check the Explanation of Payment for the reason your claim was denied. Follow the directions and, if possible, include a copy of the EOB that has the requested reimbursement listed on the statement, if you are requesting reimbursement of insurance premiums. Once a request is denied, you must resubmit a new request with supporting documentation. Reimbursement Request Form Eligible out-of-pocket expenses: Prescription drugs Doctor or specialist visit Recurring Reimbursement Form Medical or prescription drug premium not available for auto-premium reimbursement. Vision or dental premiums Recurring Medicare Part B Reimbursement Form Medicare Part B premium 9
10 Look for These in the Mail: NEW! Personalized Reimbursement Request Forms New personalized Reimbursement Request Forms are being mailed during the month of September. The new forms are unique to you, prefilled with your name and address and a personalized barcode. The barcode eliminates the necessity of using your Social Security number to identify you. These forms increase accuracy and efficiency when processing your Reimbursement Requests. Start using the new forms as soon as you receive them. Each form is unique to an individual, we recommend making copies, and not sharing with any household members or friends. Using a form that is not personalized to you may result in delays, denials, and resubmissions. In September, you will be able to access your unique form from your online account. If you have any questions about the new forms, please contact OneExchange. EXP-Choice-Spring-OPERS-Interactive
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