Your Getting Reimbursed Guide
Table of Contents Introduction to Getting Reimbursed........... 4 Managing your HRA online................ 5 The Reimbursement Process............... 8 Getting Started with Reimbursements........ 8 How to get reimbursed for your monthly premiums. 8 Setting up Automatic Premium Reimbursement (AR). 9 Manual Premium Payment Submission....... 10 Submit Reimbursement Requests for Eligible Expenses.. 12 File a reimbursement request online........ 12 Submit your receipts online............. 13 Submit your receipts by fax............. 13 Submit a reimbursement request through the mail. 14 International Reimbursement Request.......... 15 Understanding Your Explanation of Payment (EOP) Statements....................... 18 Frequently Asked Questions............... 22 2 Contact us via phone: 1-844-287-9945
Notes Use the space below to write any questions you may have after you have reviewed the information provided in this mailing. If you need to call OneExchange, be sure to write the name of the representative you spoke with and the time and date of your call. Go online Medicare.OneExchange.com/OPERS 3
Introduction to Getting Reimbursed Learn how to access and manage your reimbursement funds OPERS created your health reimbursement arrangement or HRA to help you pay for eligible health care expenses. You can use this allowance to help pay your monthly premium and to cover specific health care costs. This guide, and the documents in this mailing, consist of the materials you ll need to access your HRA allowance. We recommend keeping these materials in a secure, easy to access place so you can refer to and use them as needed. This guide contains instructions on how to access and manage reimbursements from your HRA allowance. You are able to submit reimbursement requests online or by mail or fax. We recommend managing your HRA allowance from your OneExchange online account. Instructions for creating and accessing your online account are on page five. You can find information on how to read your Explanation of Payment statements or EOP in this guide. The EOP will help you keep track of your reimbursement status and HRA allowance. OneExchange is always available to assist with questions about your reimbursements or EOP. You can go online to find the answers, or you can call. The phone number and web address are on the bottom of every page in this document. We look forward to helping you understand, access, and manage your reimbursement allowance. 4 Contact us via phone: 1-844-287-9945
Managing your HRA online Set up your online account Start by creating an online account, if you haven t already, at Medicare.OneExchange.com/OPERS. You may have set up an account when choosing your Medicare supplemental plans, but if you haven t yet we recommend doing it now. Your online account is a fast and convenient way to access your allowance information. While you don t have to go online if you don t wish to, creating an online account is easy, reducing the amount of time spent on the phone, and helping you manage your allowance. If you need assistance setting up your online account, simply call OneExchange, select option two, and a representative will walk you through the process. Create or access your account To create or access your account, enter the website address Medicare.OneExchange.com/OPERS into the address bar of your web browser. Next, select the My Account link on the website. You will need to enter some information and create a user name and password. If you re a returning visitor, enter your username and password. Once you have logged in or created your account, click on the Funds & Reimbursements tab. Please note that any information that appears in your account about you or the plans you have selected was collected during your enrollment. Go online Medicare.OneExchange.com/OPERS 5
Funds & Reimbursements The Funds & Reimbursements section provides access to your allowance information including: Current funding allowance Program contribution frequency Available balance Reimbursement and allocation history You also will find phone numbers, answers to frequently asked questions, and links that allow you to file reimbursement requests. Your eligible expenses For your convenience, a sample list of eligible expenses is included with this mailing. If you can t tell from the list whether an expense is eligible, contact OneExchange customer service. If you misplace this printed list, you can find it online or request to have another list mailed to you. To print a sample list of eligible expenses from your online account, go to the Funds & Reimbursements section and select the File Reimbursements Requests link. Next, select the Resource Center tab. Under Educational Materials, select Eligible Expense Listing. Direct Deposit Your retirement system requires that you set up direct deposit to receive reimbursements from your HRA allowance. Direct deposit speeds up the reimbursement process and removes the risk of having a paper check lost or stolen. You can set up and manage direct deposit through your online account. If you do not have access to a computer, call OneExchange and select option three. Please note that you must keep banking account information on file with OneExchange in order to keep receiving your HRA reimbursements. 6 Contact us via phone: 1-844-287-9945
Set up direct deposit online 1. Log into your OneExchange online account 2. Go to the Funds & Reimbursements section 3. Select File Reimbursements Requests 4. Select the Financial Center tab 5. Choose Enroll in Direct Deposit 6. Fill out the online form and click submit If you prefer to fill out the direct deposit form manually, you can mail or fax it to OneExchange. The address and fax number are printed at the top of the direct deposit form. If you have any questions, please call OneExchange and select option three. Go online Medicare.OneExchange.com/OPERS 7
The Reimbursement Process You can be reimbursed for your monthly premiums and for eligible health care expenses. Make certain you save all receipts and documentation from your health care provider or insurance company. You may need to submit these documents when you request reimbursement. You can choose to receive automatic reimbursement for your monthly premium expenses. For eligible expenses you will submit reimbursement requests as you incur expenses. You can submit reimbursement requests online, by fax, or through the mail. Getting Started with Reimbursements 1. Make sure that you are enrolled in direct deposit and OneExchange has accurate bank information. Remember that you must be signed up for direct deposit in order to receive your reimbursements. 2. Decide how you prefer to submit reimbursement requests: Online, by fax, or through the mail. 3. Follow directions for your preferred reimbursement process using the instructions in the following pages. How to get reimbursed for your monthly premiums There are two ways to submit your premium reimbursement request: Automatic premium reimbursement set up through your OneExchange online account Manually by fax or through mail Either way, you will be reimbursed through direct deposit. 8 Contact us via phone: 1-844-287-9945
Setting up Automatic Premium Reimbursement (AR) online Automatic Premium Reimbursement allows you to be reimbursed for insurance plan premiums without submitting a monthly reimbursement request form. AR is available for most insurance plans offered through OneExchange. You may already have set up automatic premium reimbursement during your enrollment, but if not you can choose to start using it at any time by changing the setting in your online account or by calling OneExchange. Set up your automatic premium reimbursement 1. Log on to your account at Medicare.OneExchange.com/OPERS 2. Go to the Funds & Reimbursement section 3. Select Review and Update Automatic Reimbursement Settings 4. Choose the member: You, your spouse, or dependent 5. Make the necessary updates 6. Be sure to click Save Changes Note that OneExchange will need to know how you pay your monthly health insurance premium. You may pay by check through the mail or you may pay the insurance carrier automatically through your bank or credit card account. You will need to share that information with OneExchange to set up your automatic premium reimbursement. Go online Medicare.OneExchange.com/OPERS 9
Manual Premium Payment Submission submit your premium request monthly The first step toward manual reimbursement is for you to pay your health insurance premium. 1. Retain your receipts and supporting documentation. To receive your reimbursements, it is important to submit all supporting documentation with your reimbursement request. Supporting documentation may include premium statements, receipts, and other documents such as an Explanation of Benefits statement. For more information on which documents you should watch for and save, see page 15. 2. Submit reimbursement requests for eligible expenses, along with your supporting documentation, directly to OneExchange. Information on how to submit a reimbursement request is provided on page 12. To find out which expenses may be eligible for reimbursement, refer to the Eligible Expenses Insert. 3. Receive reimbursement for your approved requests. OneExchange will process your approved request form and reimburse you from your available funds. You will receive your reimbursement by direct deposit. 10 Contact us via phone: 1-844-287-9945
Go online Medicare.OneExchange.com/OPERS 11
Submit Reimbursement Requests for Eligible Expenses You may submit the reimbursement request for eligible expenses form online, by fax, or through the mail. Whichever option you choose, you will need to provide documentation supporting your eligible expenses. A sample list of eligible expenses is included in this mailing. For more detailed information on eligible expenses contact us at the phone number printed on the bottom of every other page in this document and select option three. File a reimbursement request online To file a reimbursement request using your online account: 1. Go to the Funds & Reimbursements section 2. Select the Submit a request for reimbursement link. 3. Select the Financial Center tab 4. Click on File a Spending Account Request under the section My Account Actions. 5. Enter your reimbursement request, select the expense type, enter the date you incurred the expense, and the amount. 6. If you have more than one reimbursement request, click on Add Another Expense and enter the information. Once you have finished entering all of your reimbursement requests, click Next. 7. Confirm the details of your reimbursement(s), and click Next. To edit your reimbursement requests, click Previous. Please select a method to submit your receipts for this reimbursement: Online, by fax or through the mail. We recommend uploading your receipts and other documentation, as this will expedite the processing of your reimbursements. 12 Contact us via phone: 1-844-287-9945
Submit your receipts online To submit your receipts online, 1. Complete the File a Spending Account Request and confirm the details are correct 2. Check the Signature box 3. Click the Upload button 4. Follow the directions provided Note that receipts submitted online must be in PDF format and smaller than 5 megabytes. You can create a PDF by using a smartphone, scanner or printer that has a scanning feature. Most desktop scanners and smartphones can email the scanned or photographed document as a PDF file to your email address which you can attach to your reimbursement request. To submit your receipts by fax To submit your receipts by fax you will need to use a cover sheet, which you can print from your online account. 1. Log on to your online account 2. Go to the Funds & Reimbursements section and select the Submit a request for reimbursement link. 3. Click the Fax button 4. Follow the directions provided to create your cover sheet Please note you will need to have your internet browser pop-up blocker disabled. Print and sign your cover sheet, and then fax it and your documentation to the number provided on the cover sheet. Be sure to include all of your receipts and supporting documentation. A reimbursement request is not considered complete and cannot be approved until all of its supporting documentation is received. Go online Medicare.OneExchange.com/OPERS 13
To submit a reimbursement request through the mail To submit a reimbursement request through the mail, use the paper reimbursement request form included with this mailing. You can use the included form to make copies for future use, but you can print additional forms from your online account, or request more forms by calling OneExchange. Please follow the instructions carefully and use the address listed on the top of the form. Remember to include all receipts or other documents needed to support your reimbursement request. Recommendations when requesting reimbursement Do not mail originals; only submit copies of receipts and other documents. Instructions for submitting your reimbursement requests are printed on the back of the form. When reviewing a reimbursement request, OneExchange does not look for a specific document but rather looks for the specific information required to verify the expense in the request. This may require more than one document. We must verify: Who received the service Who provided the service What service was provided When the service was provided Proof you have paid or must pay the expense It may take more than one document to show all five pieces of information. The instructions on the reimbursement request form can help you determine if you have all of the information needed for your reimbursements. If you are still not sure, OneExchange customer service can help you. If you call a customer service representative, ask about ways to automate your reimbursement requests. 14 Contact us via phone: 1-844-287-9945
International Reimbursement Request Contact OneExchange customer service to request instructions to reimburse eligible expenses incurred outside of the United States. Documents to Save With all of the documents you receive, it can be difficult to know which ones you should be saving for future reference. Below is a list of important documents that you should watch for in the mail and should save when they arrive. Documents may be emailed if you have chosen paperless delivery. Keep these documents in a secure and accessible place. Documents from your insurer Premium Statements: Your insurance carrier will prepare a policy statement or a monthly premium statement containing your monthly premium amount and your payment schedule. This statement may be mailed or may be provided as a paperless, electronic document. Save all policy statements, premium statements, invoices, premium coupons, and receipts from your insurance company for use as supporting documentation when requesting reimbursement. If you have not received or are unable to locate an invoice or statement, you can ask for a copy by calling your insurance company at the phone number listed on the back of your insurance card. Explanation of Benefits (EOB) Statements: Your insurance company or health care provider will provide an EOB showing the amount of the expense covered by the plan, the remaining balance, and the amount you are responsible to pay. Keep these EOB statements as documentation of your out-of-pocket medical expenses. Go online Medicare.OneExchange.com/OPERS 15
If you have not received or are unable to locate an EOB, you can request a copy by calling your health care provider, or by calling your insurance company using the phone number listed on the back of your insurance card. Monthly Prescription Plan Summaries: If you are enrolled in a prescription drug plan, you will receive a monthly Medicare Prescription Drug Plan explanation of benefits document from your insurance company. Each statement summarizes important information related to your coverage that may be needed to support your documentation. Note that not everyone chooses to enroll in a prescription drug plan, so you may not receive these documents. Documents from the Social Security Administration (SSA) for eligible recipients Benefit Award/Proof of Income Letter: The Social Security Administration (SSA) will send a Social Security Benefit Award Letter or Proof of Income Letter each year, usually during October or November. The letter specifies the amount of your Social Security benefit for the coming year and any deductible amounts. This letter should be kept and used when required as supporting documentation. If you have not received or are unable to locate your Benefit Award Letter, you may call the SSA at 1-800-772-1213 and follow the prompts to request a new Proof of Income Letter. (You also may get a new letter online at www.ssa.gov; you ll find the request form under the Benefits tab on the website. You ll need to set up an online account in order to complete your request.) Documents from OneExchange Explanation of Payment (EOP) Statements: Each time OneExchange processes a request for reimbursement, you will be sent an Explanation of Payment. This statement includes a summary of your paid reimbursements, available balance, and the amounts 16 Contact us via phone: 1-844-287-9945
you have been reimbursed. The EOP will list the reason for denial when a reimbursement request is denied. More information on how to understand the EOP is available on page 18. If you have not received or are unable to locate an EOP, contact OneExchange. Use the phone number listed at the bottom of every other page in this guide. Authorizing assistance with your funding account An Authorization to Release Protected Information (ARPI) form allows you to designate someone to see your allocation and allowance balance, submit reimbursement requests and check on their status. This release permits the designated person to speak on your behalf without your presence on the telephone. To print a copy of the ARPI from your online account, go to the Funds & Reimbursements section and select the File Reimbursement Requests link. Next select the Resource Center tab where you will find the list of available forms to download and print. You can call OneExchange, and request that a copy be mailed to you. Send the completed form to OneExchange using the information on the form. You may revoke this permission at any time by calling OneExchange. Go online Medicare.OneExchange.com/OPERS 17
Understanding Your Explanation of Payment (EOP) Statements Each time OneExchange processes a request for reimbursement that you or your insurance company or health care provider has submitted, you will receive an EOP statement. Each EOP statement will include a summary of your paid reimbursements, your available allowance balance, and the amounts you have been reimbursed. If your request is denied: The EOP will list the reason for denial when a reimbursement request is denied. If a reimbursement request is denied, you may need to take action in order to receive reimbursement. Action might include resubmitting paperwork or providing additional documentation. Delivery of EOP statements: If you have provided your email address to OneExchange, expect to receive your EOP by email. If you have not provided an email address, your EOP will arrive in the mail. To change your statement delivery method, call OneExchange at the phone number printed at the bottom of every other page. If you have Automatic Premium Reimbursement: Your insurance company will submit reimbursement requests on your behalf. Each time your insurance company submits a request, you will automatically receive an EOP. If your HRA account funds are insufficient: You may receive an EOP for a request not previously paid in full. If you submit a request and do not have sufficient funds in your account, OneExchange will reimburse as much as possible, and the remainder of your requested reimbursement will be released when funds become available. 18 Contact us via phone: 1-844-287-9945
How to read an EOP statement Your EOP is divided into two sections: Your Account Balance after This Payment and This Payment Includes. Your Account Balance after This Payment This section includes: 1. Account Name: The plan year for your program in parenthesis is followed by the specific program name for your HRA. 2. Contribution: The amount contributed to your funding program as of the date of the statement. 3. Total Paid: The total amount you have been paid for approved reimbursements during the current plan year. The total paid amount includes the amount reimbursed as of this Explanation of Payment (EOP), shown under Amt This Payment (#5). 4. Available Balance: The amount available for future reimbursement requests. 5. Amt This Payment: The amount reimbursed on this statement by direct deposit 6. Total Amount: The amount approved to be paid with this reimbursement. Check #: 000122209 Check Date: 07/06/2015 Total Amount ***$150.00 Your Account Balance After This Payment 1 2 3 4 5 6 Account Name Contribution Total Paid Available Balance Amt This Payment (2015) Health Reimbursement $1,400.00 $1,050.00 $350.00 $150.00 Go online Medicare.OneExchange.com/OPERS 19
This Payment Includes The second section of your EOP titled This Payment Includes provides the following information: 7. Account Name: The plan year for your program in parenthesis is followed by the specific program name for your funding. 8. Expense Type: Expenses are listed by category. 9. Service Dates (Beginning and Ending): These dates represent the date the service was received, not the date the expense was paid. Reimbursement for premiums generally list the first day of the month as both the start and end date. 10. Amount Requested: The amount requested for reimbursement. 11. Amount Paid: The amount of the request that is eligible for reimbursement. If there are insufficient funds available the reimbursement request will be pended and the Amount This Payment Includes: 7 8 9 Account Name (2014) Health Reimbursement (2014) Health Reimbursement (2015) Health Reimbursement (2015) Health Reimbursement Expense Type Service Dates Begin End Premium 12/01/2014 12/01/1014 Premium 01/01/2015 01/01/2015 Medical 02/12/2015 02/13/2015 Medical 02/12/2015 02/13/2015 Denied Reason: Possible duplicate claim 15 20 Contact us via phone: 1-844-287-9945
Paid will be zero dollars. The request will be completed if more funds become available. 12. Amount Denied: The amount of the request that is not eligible for reimbursement. You will see a reason for the denial, if applicable; see number 15 below. 13. Request #: A system-generated identification number for your reimbursement request. 14. Amount This Payment: The amount paid to you by direct deposit. 15. If your reimbursement is denied, this section will show the denial reason. 16. The EOP includes contact information for OneExchange, reimbursement requests information, and a section where a message may be posted from your retirement system. 10 11 12 13 14 Amount Requested Amount Paid Amount Denied Request # Amount This Payment $240.00 $240.00 $0.00 921196745 $240.00 $250.00 $250.00 $0.00 921196745 $250.00 $20.00 $20.00 $0.00 921196835 $20.00 $20.00 $0.00 $20.00 921197125 $0.00 Go online Medicare.OneExchange.com/OPERS 21
Frequently Asked Questions OneExchange has helped over one million individuals access and manage their reimbursement allowance. After helping so many, we understand that many people have similar concerns. Below are answers to some of our most frequently asked questions. Which health care expenses are eligible for reimbursement? A sample list of eligible expenses is included with this mailing. To view a printable sample list of eligible health care expenses visit your OneExchange online account. Instructions for creating or accessing your account, and for locating examples of eligible expenses, are provided starting on page five. Why was my reimbursement request denied? A reimbursement request can be denied for a number of reasons, including incorrect or incomplete documentation or ineligible expenses. If a reimbursement request is denied, you can learn why in your Explanation of Payment (EOP), your online account, or by calling OneExchange to speak to a representative. What are qualification requirements? Your retirement system has qualification requirements to access reimbursement allowances. Your benefit advisor discussed your specific qualification rules during your enrollment call. Should you want to make changes to your current coverage, we encourage you to contact OneExchange for assistance to make sure that you understand all the implications of making the change. How long does it take to get reimbursed after I submit a request? Once your requests have been approved, you will receive your direct deposit payment within three days. 22 Contact us via phone: 1-844-287-9945
What is Automatic Premium Reimbursement (AR)? Automatic Premium Reimbursement allows you to obtain reimbursement for your insurance premiums without submitting a monthly reimbursement request form. You may activate this feature, if it is available for the plans that you selected, in your online account or through OneExchange customer service. Once you have elected to receive AR, you do not have to submit requests for these expenses in order to be reimbursed. To verify whether or not you chose AR, please refer to the Selection Confirmation letter you received from OneExchange shortly after your enrollment call. You can check by using your online account or by calling OneExchange to speak to a representative. How long does Automatic Premium Reimbursement take? Automatic Premium Reimbursement is not intended to be the fastest way to be reimbursed. It is intended to remove the burden of submitting monthly premium reimbursement requests. The majority of automatic reimbursements will arrive in about two to three months following the start of your plan. The first payment will usually include a reimbursement for the first two months. Timing depends on your specific insurance carrier or health care provider and when your policy was issued. Once AR begins, it will usually arrive about the same time each month. This may vary depending on when your premium payments to your company are made and the timing of the files being sent to OneExchange from your insurance provider. Who do I contact if I have questions? If you have questions that are not answered in this guide or online, or if you simply prefer to speak to someone, call a OneExchange customer service representative. Our customer service representatives are available Monday through Friday, from 8 a.m. until 9 p.m. Eastern Time. Call us Go online Medicare.OneExchange.com/OPERS 23
using the toll-free phone number printed at the bottom of every other page of this document. To direct your call accurately, the OneExchange telephone system may ask you to select from a menu of options. If you are calling about the status of an AR payment, select option two. If you are calling with questions about your allowance account or requests, select option three. To verify your identity, you may be asked a few questions before you are connected to a representative. Please be prepared to provide your zip code and the last four digits of your Social Security number. 24 Contact us via phone: 1-844-287-9945
Notes Go online Medicare.OneExchange.com/OPERS 25
Notes 26 Contact us via phone: 1-844-287-9945
Find Us On: twitter.com/oneexchange Contents 2004-2016 Towers Watson. All Rights Reserved. The information offered on our website and provided in this mailing is believed to be true and correct. Extend Insurance Services, LLC is Towers Watson s licensed insurance agency. Extend Insurance Services, LLC is a Utah resident insurance agency (Utah License No. 104741) and licensed as a non-resident insurance agency or otherwise authorized to transact business as an insurance agency in all states and the District of Columbia. Extend Insurance Services, LLC represents, and receives payment of commissions from, the insurance companies for which Extend Insurance Services, LLC is an agent and sells insurance products and services and may receive other performance-based compensation for its sale of the insurance products and services provided to you. Insurance rates for the insurance products and services offered by Extend Insurance Services, LLC are subject to change. All insurance products and services offered by Extend Insurance Services, LLC may not be available in all states. It is your responsibility to enroll for coverage during the annual Medicare Open Enrollment period. Go online Medicare.OneExchange.com/OPERS 27
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