[Date] Dear DTE Energy Retiree, It s our pleasure to welcome you to PayFlex! You re enrolled in a Retiree Reimbursement Account (RRA). Your RRA comes with some great tools to help you manage your account. Let s get started. Important note: If you DON T have internet access, you can call PayFlex at 1-855-652-0112 to get your account balance, claim and payment information. You can also call this number to request a paper claim form, if you need to file a claim for reimbursement of eligible expenses you paid out of pocket or to pay your provider directly from your RRA. If you DO have internet access, you can use the online tools below. 1. Online account access PayFlex s member website gives you access to account information and tools to help you manage your RRA. Through the PayFlex member website, you can: Submit claims for reimbursement or pay your provider directly from your RRA. You can pay your doctor or hospital directly from your RRA; however, at this time, payments to your insurance carrier can t be made directly from your RRA. View your account balance, claim history, payments and deposits. Sign up for a variety of account notifications. View a list of common eligible expenses, frequently asked questions, educational materials, as well as download commonly used forms, such as claim or direct deposit forms, and IRS related publications. QUICK TIP: Download a Quick Reference Guide from the Resource Center to help you use the PayFlex member website. 2. How to use your RRA Once your funds are available in your account, you can: Use the online tool Pay Them to pay your provider directly from your RRA. Provider means your doctor or hospital. You can pay your doctor or hospital Page 1 of 5
directly from your RRA; however, at this time, payments to your insurance carrier can t be made directly from your RRA. Pay for eligible expenses with cash, check or personal credit card. Then submit a claim to PayFlex for reimbursement. You can do this online, through the PayFlex Mobile TM app or complete a claim form and mail or fax it to us with your Explanation of Benefits or itemized statement. MAIL: PayFlex Systems USA, Inc. FAX: 1-888-238-3539 PO Box 4000 Richmond, KY 40476-4000 3. How to view your account balance, claims and payments To view your account activity: Log onto the Retiree Health Access (RHA) website at www.rhaexchange.com/dte and click the PayFlex icon to get to the PayFlex member website. On My Dashboard, you ll see your RRA balance. To view your claims or payments, click on the Financial Center tab. o Select your Retiree Reimbursement Account from the drop down menu next to Select Account directly under the Financial Center tab. o To view all of your claims, select Claims. o To view all of your payments, select Transactions. 4. For faster claim reimbursements enroll in direct deposit If you currently receive claim reimbursements from WageWorks by direct deposit to your personal bank account, this information will not transfer to PayFlex. You ll need to enroll in direct deposit at PayFlex in order to continue having your RRA claim reimbursements deposited directly into your bank account. To enroll in direct deposit: Log onto the RHA website at www.rhaexchange.com/dte and click the PayFlex icon to get to the PayFlex member website. On My Dashboard, click on the Financial Center tab at the top of the page. Click on Enroll in Direct Deposit on the left side of the screen. Select the bank account type. Enter your account number, routing number and bank name. Click Next. Review your account information. If the information is correct, click Confirm. If you need to make a change, click Previous. 5. How to sign up for Automatic Reimbursement for Insurance Premiums In order to be automatically reimbursed each month for your insurance premium or Medicare Part B premium, you ll need to complete the Retiree Reimbursement Arrangement (RRA) Reoccurring Premium Reimbursement Claim Form and send it back to PayFlex. We have included a copy of the form with this communication. You can also access the form online: Page 2 of 5
Log in to the RHA website at www.rhaexchange.com/dte and click the PayFlex icon to get to the PayFlex member website. On My Dashboard, at the top of the screen, click on Resource Center. Under Administrative Forms, select Reimbursement Account Forms. Then click on Health Reimbursement/Retiree Reimbursement Arrangement Recurring Premium Claim Form. You ll need to include a copy of the supporting documentation along with the completed claim form. Supporting documentation needs to include the covered individual s name, insurance carrier s name, type of coverage, dates of coverage, and monthly premium amount. Mail or fax the completed form to PayFlex. MAIL: PayFlex Systems USA, Inc. FAX: 1-888-238-3539 PO Box 4000 Richmond, KY 40476-4000 6. How to file a claim using Pay Me or Pay Them Log onto the RHA website at www.rhaexchange.com/dte and click the PayFlex icon to get to the PayFlex member website. Under Quick Links, click on File a Spending Account Claim. To get reimbursed for your eligible out-of-pocket expense(s), select Pay Me. To pay your health care provider directly from your RRA, select Pay Them. Note: When you use the Pay Me or Pay Them features, you ll need to include supporting If documentation. you select Pay See Me: enclosed FAQs for acceptable documentation. If you select Pay Me: Enter your claim information. To add additional claims select Add Another Claim. Once you enter in all of your claims, click Next. Confirm all expense details, and click Next. To make changes, click Previous. Select Fax or Upload. o To Fax, click on Create Coversheet. Print and sign the form. Fax it with your documentation to the number on the coversheet. o To Upload, use the Browse button. Select your documentation from your computer. To add additional documents, click on Add Additional Document. Note: Each document must be uploaded in PDF format. Check the signature box at the bottom of the page to electronically sign your claim and confirm your submission is for eligible expenses. Click Sign up for the Explanation of Payment notification through My Settings to receive an e-mail when your claim has been processed. Page 3 of 5
If you select Pay Them*: Select your payee from the drop-down menu and click Next. To add a new payee, click on the + symbol. If you add a new payee, complete all the required fields. Click Save, then click Next. Enter your contact number, statement date and invoice number (if applicable); patient name; and any comments you may have. Click Next. Fill in your claim information and click Next. Verify that your claim information is correct. Click Next. Select Fax or Upload. o To Fax, click on Create Coversheet. Print and sign the form. Fax it with your documentation to the number on the coversheet. o To Upload, use the Browse button. Select your documentation from your computer. To add additional documents, click on Add Additional Document. Note: Each document must be uploaded in PDF format. Check the signature box at the bottom of the page to electronically sign your claim and confirm your submission is for eligible expenses. Click Sign up for the Explanation of Payment notification through My Settings to receive an e-mail when your claim has been processed. * You can only use the Pay Them feature for one-time payments to your provider. This means when you use Pay Them, PayFlex will only pay the provider for that specific month; it will not automatically pay your provider on an ongoing monthly basis. However, you won t have to re-enter the provider information; it will remain in the payee drop down menu for convenience. You can t use the Pay Them feature to pay your insurance carrier for your insurance premiums. The Pay Them feature can only be used to pay a provider such as your doctor or hospital. 7. Sign up for important account notifications Managing your RRA is even easier when you sign up for account notifications. You can receive notifications such as your RRA balance, explanation of payment and claim received. Notifications can be sent through email, text message, or web alert. To sign up: Log in to the RHA website at www.rhaexchange.com/dte and click on the PayFlex icon to get to the PayFlex member website. At the top of the page, click on My Settings and select the notifications link. Enter your e-mail address, select the notifications you wish to receive and click Page 4 of 5
Questions? If you have any questions, call us at 1-855-652-0112. We re here to help Monday - Friday, 8 a.m. - 8 p.m. ET, and Saturday, 10 a.m. - 3 p.m. ET. Enclosures 1. Frequently Asked Questions (FAQs) 2. Health Reimbursement Arrangement (HRA)/Retiree Reimbursement Arrangement (RRA) Recurring Premium Reimbursement Claim Form 3. Health Reimbursement Arrangement (HRA)/ Retiree Reimbursement Arrangement (RRA) Claim Form 4. Authorization to Release Personal Information This material is for informational and educational purposes only. It does not contain legal advice. You should contact your legal counsel if you have any questions or if you need additional information. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about PayFlex, go to www.payflex.com. Page 5 of 5