DTE Energy Retiree Medical Changes for Retirees/Dependents > age 65 As of January 1, 2013 Questions & Answers Retiree Reimbursement Account (RRA) WW- 7876- HRA- Q&A- DTE (Mar 2013)
This document provides the answers to the most common questions regarding your Retiree Reimbursement Account (RRA). It provides a brief WageWorks 1.877.924.3967 www.wageworks.com RHA Direct 1.877.591.8905 www.rhadirect.net explanation for the reimbursement process; however, remember that the WageWorks QuickStart Guide and WageWorks procedures govern the actual process. If you became eligible for your Retiree Reimbursement Account as of January 1, 2013, you should have received your WageWorks QuickStart Guide in the U.S. mail in early January; this guide is also available on the DTE RHA Direct website www.rhadirect.net/dte. If you did not receive your guide and cannot access it via the internet, you should contact WageWorks at (877) 924-3967 to have them send you one. 1. I paid my January 2013 premiums in December 2012 and the next monthly premium payment is due in January now what do I do? Using the WageWorks QuickStart Guide on or after the date you were eligible for the RRA (January 1, 2013) you will submit claims to WageWorks. A. You will submit one claim to pay you back for any premiums you prepaid in December 2012. B. You may then submit a claim to pay you back for your monthly payment made in January 2013, or C. To avoid having to submit monthly claims, you may want to submit a claim to set up the process to reimburse you via an ongoing reimbursement for the remaining calendar year premiums or, to pay your provider directly. The ongoing reimbursement option is only available for insurance premiums that are deducted from your Social Security benefits. (See WageWorks QuickStart Guide for details on this process.) 2. How and when will I hear about getting reimbursed? The WageWorks QuickStart Guide and Claim Form are posted on the DTE RHA Direct website www.rhadirect.net/dte. They were also mailed the first week of January2013, to homes for those who were eligible for RHA Direct as of January 1, 2013. PLEASE open any mail that comes to your home from WageWorks. The WageWorks QuickStart Guide includes instructions for the methods of payment, a list of allowable expenses and a paper claim form. If you did not receive your guide and Page 2 of 8
cannot access it via the internet, you should contact WageWorks at (877) 924-3967 to have them send you one. 3. What do I have to do to sign up for the Retiree Reimbursement Account? Nothing. RHA Direct enrolled you through a file feed sent to WageWorks. If you want to use the WageWorks online services, register by visiting www.wageworks.com and clicking Register with WageWorks now. A. You will need to enter your: i. First & Last Name (as listed with Medicare); ii. Birth date (mm/dd); iii. Home zip code: and iv. Last 4 digits of your social security number (SSN). B. Then you will create a username and password. Your account was populated with $3,500 as of January 1, 2013. 4. When can I submit a request for reimbursement? You can submit a claim for reimbursement beginning January 1, 2013. However, only expenses incurred after December 31, 2012, or insurance premiums paid for periods after December 31, 2012, can be reimbursed. 5. Why do I have to pay first and then get reimbursed? Your DTE RRA is a Health Reimbursement Account subject to rules established by the Internal Revenue Service. You must follow the Internal Revenue Code rules to keep reimbursements from being taxable as income to you. 6. Who do I contact if I have questions? After your Retiree Reimbursement Account has been set up with WageWorks (January 1, 2013): A. Go online at www.wageworks.com, or B. Call WageWorks directly at (877) 924-3967 or RHA DIRECT at (877) 591-8905. Page 3 of 8
After January 1, 2013 you may want to monitor your RRA electronically (if you prefer not to speak with a person), or you can contact WageWorks customer service representatives specialized in Retiree Reimbursement Accounts to assist you. 7. How do I submit claims? There are several ways to submit claims, which are described in the WageWorks QuickStart Guide: A. Enter a claim online and scan and upload the supporting documentation as a.pdf,.jpg..tiff,.gif,.png, or.zip file. B. Fax the Claim Form and supporting documentation to WageWorks at 877-353- 9236. C. Mail the paper Claim Form and supporting documentation through the US Mail to: Claims Administrator, P.O. Box 14053, Lexington, KY 40512 8. What supporting documentation do I need to include with the claim form? A. Include documentation showing the monthly premium amount from the insurance company or other out-of-pocket expenses, such as co-pays, coinsurance or deductibles (examples of different types of acceptable documentation are listed below): i. Coupon Slips from the insurance company ii. Itemized Statement from the insurance company iii. Letter from the insurance company iv. Itemized receipt for the out-of pocket expense or an Explanation of Benefits (EOB) The documentation listed above must include all of the following: a. Participant name (name(s) of covered individual) b. Insurance company or other healthcare provider name c. Date(s) of service (coverage period) d. Type of service (type of coverage) e. Amount of premium or out-of-pocket expense B. Include proof of payment (a copy of any of the examples listed below): i. Bank Statements showing check to xyz insurance company has cleared ii. Insurance Company Statement showing payment in full for the coverage period iii. Ongoing monthly insurance company statements showing previous months premium payment Page 4 of 8
iv. A copy of your Social Security Cost of Living Statement or Medicare Statement clearly indicating the amount of the monthly Part B, C, or D premium v. Cancelled check for premium payment to insurance company (copy of front & back of cancelled check) vi. Credit Card Statements showing payment to insurance company vii. Itemized receipt for the out-of-pocket expense or an Explanation of benefits (EOB) 9. What are the Reimbursement Options? See the WageWorks QuickStart Guide for details, but options include: A. Pay Me Back through a direct deposit to your bank account or a paper check mailed to you; and B. Pay My Provider where you direct the payment to go to the provider. Note: Pay My Provider sends a check directly to your insurance carrier/provider. Since some carriers only accept credit cards or withdrawals from bank accounts, please make sure your insurance carrier will accept a third-party check before selecting this option. 10. How much lead time do I need to set up Pay My Provider? You need to set up your Pay My Provider account at least 10 business days prior to the date the first payment is scheduled to be made. The same 10-day period is required to discontinue Pay My Provider payments. 11. The insurance company gave me a discount for paying the full year in advance - can I be reimbursed in a lump sum? Yes, you will submit the invoice/bill or receipt reflecting the required information described in Q8 above along with proof of payment for the full year. 12. The insurance company gave me a discount for having the monthly premiums taken electronically from my bank account how do I get reimbursed? You will submit the invoice/bill or receipt reflecting the required information described in Q8 above and your proof of payment for each month. Page 5 of 8
13. I bought a combined dental insurance policy that covers both me and my spouse. How do I get reimbursed for that? Both you and your spouse will need to submit a claim form with the proper documentation requesting a reimbursement for one-half of the premium amount. 14. I set up my Medicare D (drug plan) premium to be taken out of my Social Security check, how do I get reimbursed? You will need to make a copy of your Social Security Statement reflecting the Medicare B and Medicare D premium deductions, then send the copy to WageWorks by following the instructions in Section 1 One Time Annual Request of the Pay Me Back claim form. 15. If I have an emergency (separate from premiums, maybe significant dental expense) and I spend more than the allocation from DTE during the year, what happens to the remaining expenses? Once your expenses exceed the allocation, your remaining premiums and/or claims submitted for expenses for the year will NOT be reimbursed. NOTE: You will be responsible for monitoring your account and paying any premiums or other out-of-pocket expenses after your allocation has been exhausted. Failure to pay premiums can result in loss of coverage. Claims for reimbursement are held in a pending status until the account is funded again. WageWorks will only reimburse up to the annual allocation during the year. If your claims (for premiums or other eligible expenses) exceed that amount, the additional eligible claims will be held in a pending status until the account is funded again. If you do not want the current year s unpaid claims to be taken from the next year s allocation, you must let WageWorks know prior to the end of the current year. 16. If I choose to Pay My Provider online, how will I know the bill has been paid? Similar to online banking, you must set-up this option electronically, and once you have done this: A. You will receive an email confirmation. (You cannot choose online payment via the phone.) B. You will receive a quarterly statement of your Account, reflecting any activity. Be aware that if you use up your allocation for a large expense mid-year, there will Page 6 of 8
not be any money to pay out monthly bills under Pay My Provider or Pay Me Back until the next year. You will be responsible for monitoring your account and paying any premiums or other out-of-pocket expenses after your allocation has been exhausted. 17. My spouse and I both enrolled in supplemental plans with RHA Direct on the same day. Will we receive two WageWorks QuickStart Guides from WageWorks to ensure we re both part of the RRA account? Yes, every individual with an RRA will receive their own WageWorks QuickStart Guide from WageWorks. 18. If I don t have an email address, will I get paper statements? Yes, paper statements will be mailed to each account holder quarterly. 19. What documentation will I receive to know if my insurance company has been paid through the Pay My Provider option? A. If you enroll online via the WageWorks website, email notifications will be sent when the payments are made. B. If you send the invoice via fax or mail, an EOB will be mailed to you when the payments are made. 20. What does it mean on the WageWorks website when it shows that a claim has been processed? Processed means the Submission has been reviewed by a WageWorks claims processor. 21. What is the time period between being processed and the check actually being mailed? For approved Pay Me Back claims, it takes 24-48 hours from the time the record is marked processed until the check or direct deposit is sent. For approved Pay My Provider requests on a one time basis, the payment will be issued in 2 business days from the processed day in the WageWorks system. For Pay My Provider requests on a recurring basis the payment will be issued on the requested payment date you entered in the system. Page 7 of 8
22. My claim for the January premiums I paid in November / December was denied what do I do? Since you were pre-paying for January coverage, ensure that you put the date of service as January 2013 and not 2012. Be sure to submit the appropriate proof of payment such as copy of the front and back of a check or bank statement showing premiums you have paid, and documentation from an insurance carrier showing coverage period such as a statement or a coupon. Your eligibility for, and benefits under, any DTE Energy benefit plan (including the Retiree Reimbursement Account program) are governed exclusively by the official plan documents. The descriptions provided are for your convenience only and do not replace or supersede the official terms of the plans. Any inconsistencies between this information and the official plan documents and any ambiguities in this information are controlled by the official plan documents. Medical coverage provided through an individual insurance policy purchased with assistance from RHA Direct or through any insurance policy the premiums for which are reimbursed through your RRA is not provided under a DTE Energy benefit plan. Page 8 of 8