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1 Web Administration For Members

2 Login To login into the NexgenRx Web site, the member will select MEMBER LOGIN as shown here.

3 Activate your Account First time users will be required to ACTIVATE ACCOUNT by using the user id and temporary password provided to you. For subsequent login, just sign in from here

4 Forgot Your Password? If the user forgets their password. A new temporary password can be e- mailed to the member s address on file. Simply click on the RETRIEVE button.

5 Security Features Members A member can only see their own information, their own claims history and their dependents information and their dependants claims history.

6 Certificate Information When the member logs in they are taken to their certificate information. Here they can view Division Class Plan code Effective date Etc...

7 Updating Certificate Information On the EMPLOYEE screen, the member can view their information such as address, phone number, address. The member can update their banking information. The member can also add or update their medical and drug allergy information. For confidentiality reasons, this information is not visible to the Plan Administrator

8 Updating Banking Information Please note that when a member submits a claim via the web, it is mandatory to receive EFT payments as the method of reimbursement. This area allows them to provide their banking information.

9 Medical Conditions Here the member can provide health condition information. This information can also be used for medical underwriting. The drug allergy information can also be listed.

10 Dependent Information Updates This screen allows the member to view dependent information associated with their policy. Any inaccuracies in the information should be confirmed with your administrator / employer.

11 Co-ordination of Benefit Information From this screen, the member can view the COB information for their spouse. He/She may have coverage elsewhere. This information is used during the adjudication process so that proper payment can be shared between spouses and their carriers

12 Claim History View By clicking on Covered Life the claims associated with the member and their dependents can be viewed by clicking on the appropriate dependent from the drop-down list of covered members. The claims summary view is a high level view which includes the benefit type, payment amount, claim status and date the claim was processed. The member can drill down into any claim for detailed information. Highlight the row and click on VIEW CLAIMS.

13 Privacy Consent For Privacy & Confidential reason, the member must indicate if they have consent to view the dependent claim information. This is simple just click on the green consent line, if consent is available.

14 EOB Member Web Claim Detail View The claim detail view provides a member with specifics associated with the claim including the type of claim, date of service and any Explanation of Benefit (EOB) information. The EOB can also be downloaded from here should the member need a printed copy for their records.

15 Plan Limits View The member can view all the benefits associated with their plan and drill down into the rules which make up that benefit. In addition they can view the remaining amounts available during the effective period.

16 Plan Limits View Continued As the member drills down into each benefit they can view the coverage under each benefit. The current screen indicates features such as Private Hospital Room is covered $75 per day Vision glasses/lenses covered $250 per 2 years with Eye exams covered at $34 per 2 years, etc.

17 Health Care Spending Account (Financial View) This section allows the member to view the status of their Health Care Spending Account (HCSA). The account spending summary section summarizes current balance and available funds. The Transaction Detail section allows the member to view all transactions under their account in terms of contributions and withdrawals based on claims currently processed.

18 HCSA Claims Detail View This area provides the member with a breakdown of claims put through their Health Care Spending Account (HCSA) and the status of those claims.

19 Forms Various forms such as member enrollment and claims forms are available for download from the public section of the NexgenRx web site These forms can be completed online and then mailed to NexgenRx.

20 Member Booklet Review The member booklet is produced in Adobe PDF format. This allows the member to search for a particular phrase such as dental. The search engine will scan the booklet for this phrase and give the member a table of contents for every reference to dental in their booklet. A very useful feature for navigating any coverage. They can also use the Table of Contents on the left side of the screen to review sections of their booklet.

21 Submit A Claim The member can submit claims online by clicking on the SUBMIT A CLAIM icon.

22 Submit A Claim The member must read and agree to the Terms & Conditions outlined by NexgenRx before proceeding.

23 Submit A Claim The member must sign up for EFT (Electronic Fund Transfer) in order to be able to submit claims online. This allows NexgenRx to make payments directly into the members bank.

24 Submit A Claim Be sure to enter the correct banking details as shown on the bottom of your cheque. The Transit # is always 5 digits where as the Bank # is 3 digits. Make sure to enter any preceding zeros.

25 Submit A Claim Select the patient that the claim is for. If your spouse has coverage elsewhere, click here. If your dependent is a student, you must enter the name of the school.

26 Submit A Claim The member can submit select types of claims on-line by selecting the appropriate benefit from the drop-down table. NOTE: If the benefit is not listed, the member must submit a claim by mail.

27 Submit A Claim This example is demonstrating a dental claim submission which was selected from the drop-down list.

28 Submit A Claim To locate the appropriate dentist in the NexgenRx database, the member will enter BOTH the dental office phone number & postal code. Then press the Search button. For future claims, the system will remember your dentist information from previous claims and you can select from here.

29 Submit A Claim The member will add the expense based on the paper receipt.

30 Submit A Claim The member will need to enter all the required fields as outlined on their receipt.

31 Submit A Claim The member will verify the data just entered. If change is required, just click on the EDIT button. Additional expenses can be added here by pressing the ADD EXPENSE button

32 Submit A Claim The member will need to read the Certification and Authorization section and then press the I AGREE AND SUBMIT CLAIM button to proceed.

33 Submit A Claim The system will then produce a Claim Confirmation notification showing the Claim # and the payment details of the claim. You may want to print off a copy of the screen and attach it to your receipts in the event of an audit. You can then SUBMIT ANOTHER CLAIM if needed.

34 Submit A Claim The system will then produce a Claim Confirmation notification showing the Claim # and the payment details of the claim. You may want to print off a copy of the screen and attach it to your receipts in the event of an audit. You can then SUBMIT ANOTHER CLAIM if needed.

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