YOUR HEALTH PLAN AND HEALTH REIMBURSEMENT ARRANGEMENT. Employee Guide

Transcription

1 YOUR HEALTH PLAN AND HEALTH REIMBURSEMENT ARRANGEMENT Employee Guide

2 :: Overview :: HRA Basics... 2 :: Claim Payments... 3 :: Online Health Tools... 4 :: HRA Frequently Asked Questions... 5 TABLE OF CONTENTS

3 Your Health Plan and Health Reimbursement Arrangement Overview Welcome to your health plan and Health Reimbursement Arrangement (HRA) from CoreSource! As the administrator of your benefits plan, we created this guide to help you understand your health benefits. Your health plan offers an HRA, one of a number of products known as consumerdirected healthcare plans, which are designed to help reduce rising medical costs by empowering you to become a more active and informed healthcare consumer. Your health plan has four components: :: A high deductible health plan (HDHP) PPO offering financial protection from a major illness or injury :: An HRA, a tax-free funding arrangement you use to pay for eligible medical expenses :: Online healthcare resources that combine claims, benefits and HRA activity with health information and decision support tools :: Ongoing education and support The High Deductible Health Plan Your HDHP has lower monthly premiums than many other plans, while maintaining choice, flexibility and ease. Your medical benefits include access to a large PPO for discounts on medical services virtually anywhere in the United States. Once you meet your deductible, the HDHP provides coinsurance coverage like most other plans up to your out-ofpocket maximum for in-network and out-of-network services, depending on plan design. Once you reach your out-of-pocket maximum, the HDHP covers 100 percent of your eligible medical expenses. The Health Reimbursement Arrangement The HRA is funded by your employer to help you pay your medical plan s deductible or deductible and coinsurance, depending on plan design. Online Healthcare Resources This plan provides the most value when you take an active interest in the medical services you use, and when you better understand the options you have in selecting and paying for those services. CoreSource puts all that information at your fingertips. Through one convenient and secure website, CoreSource allows you to track your medical claims and expenses, get ratings on doctors and hospitals, and get healthy living tips that will ideally lead to fewer trips to your doctor. Visit the Participant section on to get started. Ongoing Education and Support At CoreSource, we re commited to helping you understand how your HRA works. If you have questions about your benefits, talk to your Human Resources department or contact CoreSource directly by calling the Eligibility/Benefits phone number on the back of your ID card. 1

4 HRA Basics You are automatically included in the HRA, which works like a savings account. It s set up and funded by your employer* to help you pay for your medical plan s deductible or deductible and coinsurance. The HRA pays those expenses as you incur them, either in total or in part, depending on the type of HRA your employer has selected. The HRA will pay claims submitted to CoreSource by a member or if they were automatically submitted by the medical plan. The HRA may also reimburse you for eligible medical expenses if you paid for them at the time of service. Once a payment has been made from the HRA on your behalf, you will receive an Explanation of Benefits (EOB) showing any payment that has been made. * Sole Proprietors and Partners of a partnership (including LLP and LLC members taxed as a Partnership ), and greater than 2 percent shareholders in the Subchapter S Corporation, their spouses and lineal ascendants and descendants, are not eligible to participate in the CoreSource HRA. Your employer will know if you meet this definition. 2

5 Claim Payments When you see your doctor, pay nothing at that time. Have your doctor send your claim to the address on the back of your health plan ID card. CoreSource will process the claim and send you an EOB showing: :: Coverage for the service you received :: How much your plan pays or how much you will owe if that service is not covered :: If your deductible has been met :: If there is a balance due Then, submit deductible or deductible and coinsurance balances to your HRA for payment. Contact your HR Department for the address for submission. Accessing Online HRA Tools Online healthcare resources provide ongoing education and support to help you get the most out of your health plan, including: Once your HRA plan becomes effective, log on to the CoreSource website at Click on the Participants link. First-time users will need to register online and get a username and password to access your claim and coverage status. :: Finding out whether a claim has been processed and when 1. Click on Participants :: Determining the amount and recipient of any claim checks that have been issued 2. Log in 3. S elect the CareGain tool in the left-hand navigation for HRA account balance information :: Reviewing your family s claim history for the current and prior benefit year 3

6 Online Health Tools Be sure to take advantage of the online personal health management system, the HealthCenter, which offers information and decision support tools to make the most of your health benefits. The HealthCenter offers: :: The medical library to research conditions and other health information. :: A Personal Symptom Evaluation tool to help you understand an injury or sickness, and determine when more medical attention is necessary. :: A hospital and provider rating tool so that you can compare hospital and doctors all over the country, HealthGrades is a leading ratings tool, allowing you to choose the care that s right for you and your family. Your medical plan will reimburse you for eligible in-network and out-of-network charges. But if you choose in-network doctors, your out-of-pocket costs will be much lower. HRA Documents Your medical plan and HRA provide unique benefits to you, your co-workers and your company. To help fully understand your health benefits, your employer will you provide you with a copy of the Medical Plan Summary Plan Description and HRA Summary Plan Description. These documents supplement your employee guide by outlining specific plan information for you and expenses that qualify for coverage. 4

7 HRA Frequently Asked Questions This information has been provided to help answer the most frequently asked questions employees have about their HRA. For more information, contact your HR department or CoreSource. How will my HRA pay claims for different family members? One fund is available for your entire family for eligible medical expenses, based on when the claim is processed. If only one person in your family has claims, it is possible that all your HRA funds would be used to help cover those expenses. If numerous family members have claims throughout the year, the HRA will be used to help pay the claims in the order that the claims are received. If I have primary coverage under my employer s HRA plan and secondary coverage under another health plan, how will my HRA work? The HRA may not reimburse any expenses until all employer-sponsored health plans and insurance have paid their share of an expense. If CoreSource is aware you have secondary coverage, you are required to submit your expense to your secondary plan before receiving payment from the HRA, and then send evidence of that payment to CoreSource. If CoreSource is not aware of your secondary coverage, you are responsible for notifying CoreSource and returning any HRA payments for which you were not eligible. Is there a time limit for HRA eligible claims? Yes. If your employer terminates the HRA, claims must be processed within 3 months. All eligible medical services must be received during the HRA plan year and paid within 12 months of the end of the HRA plan year. Will unused HRA funds roll over to the following year? Yes, if your employer has selected that option. Check your Summary Plan Description to see what your employer has elected. Or ask your HR department. 5

8 Can I have a Flexible Spending Account (FSA) with my HRA? Yes. However, an eligible medical expense can only be paid from one plan. Your employer must decide which fund pays first. Ultimately, you are responsible for ensuring that payments from multiple sources are not made to you or on your behalf. Check your Summary Plan Description to see what your employer has selected. If I switch from individual to family coverage, does the HRA amount change? If your employer provides a different HRA contribution for individual and family, the family amount will change on the same day that you switch from individual to family coverage. The change of funds will only be applied to claims with service dates after the coverage date change. Are all my HRA funds available on the first day of the HRA plan year, or do they become available throughout the year? The entire amount is available on the first day of the HRA plan year. What happens to my account if I leave my company? If you leave your company and continue coverage under COBRA, you can still participate in the HRA. Your employer may charge a premium for your continued participation in the HRA. If your medical plan allows coverage beyond COBRA levels, you may continue to participate in the HRA on the same basis. If you don t continue your health plan under COBRA, or decide not to continue to participate in the HRA under COBRA, expenses incurred after your termination date will not be eligible for reimbursement. For more information, please contact CoreSource by calling the number on the back of your ID, or contact your Human Resources department. 6

9 CoreSource is a wholly owned subsidiary of Trustmark Mutual Holding Company R