Diocese of Worcester. Health Reimbursement Arrangement (HRA) Flexible Spending Accounts (FSA) 6/1/2017-5/31/2018

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Diocese of Worcester Health Reimbursement Arrangement (HRA) Flexible Spending Accounts (FSA) 6/1/2017-5/31/2018

Health Reimbursement Arrangement (HRA) 6/1/2017 5/31/2018 Evolution1 Inc. 2013 All Rights Reserved 2

Health Reimbursement Arrangement The Diocese of Worcester is providing a Health Reimbursement Arrangement to reimburse you for a portion of the $1,000/$2,000 deductible expenses you and/or your family may incur in your 2017-2018 plan year. Single Plans: Employees pay the 1 st $500 of medical deductible expenses out of pocket. The HRA will then reimburse employees for the last $500 of medical deductible expenses if incurred. 2 Person & Family Plans: Employees pay the 1st $500 of each family member s medical deductible expenses incurred, up to $1,000 total out of pocket. The HRA will then reimburse employees for the last $500 of each family member s medical deductible expenses incurred, up to $1,000 total reimbursement.

Health Reimbursement Arrangement An HRA is an IOU you have no claim to the money unless you incur eligible expenses. Any payment/reimbursement made from the HRA is considered tax-free.

Health Reimbursement Arrangement The HRA is administered by HRC Total Solutions, a HPHC partner. HPHC sends HRCTS all the information that s needed to process the eligible claim. You don t have to complete any enrollment forms. You don t have to file any claims. You don t have to provide follow-up substantiation.

Health Reimbursement Arrangement HRCTS will send a paper check directly to you after the claim is processed. (Direct Deposit reimbursement is an option) Almost always before the provider bill arrives. Always before the provider bill is due. You are responsible to pay your provider once billed.

HRA Mechanics You visit the provider Show your HPHC ID Card HPHC sends claims information to HRC HRC issues payment directly to you (Email Notification of payment is sent to the email address on file, if any.) You pay the provider once billed

Managing Your HRA Tip: Put all HPHC Summaries and bills in one folder or envelope. That way, you can have everything together when you compare HPHC Summary, bill, and reimbursement received. If there s a discrepancy between HPHC Summary and bill, call HPHC Member Services. If there s a discrepancy between the HPHC Summary and your reimbursement amount, call HRC Total Solutions Customer Service at 603-647-1147 option 1. If you receive a bill before you receive the HPHC Summary or before reimbursement is received, call HPHC (no Summary) or HRC Total Solutions (no reimbursement).

Reversed Claims If a claim that was sent to HRCTS from HPHC was reimbursed and is then Reversed by HPHC, you will be required to pay the HRA back. HRCTS will email or mail you a Request for Repayment and notify your Employer of this Repayment Request. You will be responsible to send this amount back to HRCTS so we can credit your HRA balance. You can either send a check to HRCTS directly or you can repay the account via Direct Deposit if you are signed up for Direct Deposit. If HRCTS is unable to recoup these amounts back from you during the plan year. Your Employer will contact you directly to recoup these over reimbursed amounts.

Healthcare Account FSA 6/1/2017 5/31/2018 Evolution1 Inc. 2013 All Rights Reserved 10

What is an FSA? With an FSA, you elect to have your annual contribution (contribution maximum to an FSA is $2,600; limit set by the IRS) deducted from your paycheck each pay period, in equal installments throughout the year, until you reach the yearly maximum you have specified. The amount of your pay that goes into an FSA will not count as taxable income, so you will have immediate tax savings. FSA dollars can be used during the plan year to pay for qualified expenses and services. A Healthcare FSA allows reimbursement of qualifying out of pocket medical, dental & vision expenses incurred by you, your spouse or your children up to the end of the month they turn 26.

Maximum Election $2,600 What is an FSA? $500.00 Rollover of unused fund to 2018 2019 plan year. (Amounts left in account above $500 are forfeited back to the Plan. IRS Rule.) The full Healthcare FSA election you make is available to use on your plan effective date. (Loan from your Employer you pay back via pre tax payroll deductions) 90 day run out You are allowed to submit any claims incurred within the plan year for 90 days after 5/31/2018.

Change of Election Can only change election if: Qualifying Event: Marriage, Divorce, Legal Separation, Death, Birth, Adoption During Annual Open Enrollment

What Expenses Can Be Reimbursed Through a Healthcare FSA? Deductibles Office Visit Copays Prescription Drug Copays Orthodontia Vision care, eyeglasses, and contact lenses Laser eye surgery Over the counter medications (If prescribed) FSAStore.com partnership allows participants to use their FSA VISA Card to purchase eligible items online HRCTS will periodically email coupons to use towards your purchase at FSAStore.com

Accessing Funds VISA CARD You can request debit cards for your spouse or dependents 18+ Arrive in white envelope with Manchester Mailing address 10-14 business days after HRC Total Solutions processes enrollment. The envelope will state Benefits Material Enclosed & Do Not Throw Away. MANUAL CLAIM SUBMISSION Pay out of pocket and submit for reimbursement by completing the Universal Claim Submission Form & attaching a copy of the itemized receipt. Scan and email, Fax or send U.S Mail to HRC Total Solutions ONLINE/Mobile App SUBMISSION Once account is set up you can upload itemized receipts for reimbursement Submit receipts for debit card purchases that need to be substantiated Claims are processed daily, checks issued daily and direct deposits are processed twice a week on Tuesday and Friday. 2-3 days to apply to your banking account from date processed.

FSA Receipt Submission Receipt Requests will be generated anytime you need to submit a receipt for substantiation of a Visa Card purchase: Non IIAS Merchants Medical, Vision and Dental other than a co-pay How to submit receipts to HRC? Upload through employee portal Mail, Fax or Email Download Free HRC Mobile Application and submit by taking a picture with your Smart Phone

HRCTS Mobile iphone and Android Mobile Apps Available Via: Consumer Portal Apple App Store Google Android Market Simple Login Access Available Balance and Important Dates Convenient Customer Service Contact Information

HRCTS Mobile Text Message Alerts Balance and Transaction Inquiry Configurable Alerts iphone and Android Mobile Apps Access Account Details File Claims with Camera Based Receipt Imaging

Information You Need, When You Need It Consumer Portal Robust portal empowers users - providing everything you need to know about your account, with an industry-leading design that enables quick and easy navigation of content. 19

Action Items: Sign up today and complete your enrollment form then submit to your HR Dept. Save your receipts as you incur eligible expenses in case HRCTS request the receipt. Debit Cards will arrive within 30 days after you submit your enrollment to your HR Department. 20

Contact Us! MEMBER SERVICES ARE HERE TO HELP YOU AND CAN BE REACHED AT: 1-603-647-1147 (Ext. 1) 1-877-647-1147 (Monday-Friday: 8:30am 7:30 pm EST) www.hrcts.com CustomerService@HRCTS.com Live chat available