Group Name Plan Year : 1/1/11-12/31/11. Find and Replace ( to be edited) Getting Started: Enrollment presentations can be shown to your employees to help.

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Presentation transcript:

Group Name Plan Year : 1/1/11-12/31/11

Find and Replace ( to be edited) Getting Started: Enrollment presentations can be shown to your employees to help explain how to use their Choice Strategies card in conjunction with their health insurance plan. Before distributing this handout to employees, please find and edit the following: Group Name : Group Name Health Insurance Carrier : Carrier Plan Year : 1/1/11-12/31/11 Plan Start Date : 1/1/11 HRA Single Deductible : $$$ HRA Family Deductible : $$$$ Carrier Single Deductible : $$$$$ Carrier Single Deductible : $$$$$$ FSA Maximum : $2500 Footer info here 2

3 New Health Plan Health Plan Deductible: –Single : $$$$$ –Family : $$$$$$ Effective 1/1/11, Choice Strategies will be administering: –Health Reimbursement Arrangement (HRA) –Flexible Spending Account (FSA) –Dependent Care Account (DCA)

Split Co-pay Plan Group Name’s plan Plan Year: 1/1/11 – 12/31/11 The following chart indicates the only expenses for which your Choice Strategies card can be used: Footer info here 4 Member Pays Choice Strategies Pays (Split Co-pay) Total HIP Cost Primary Care$$$ Specialist$$$ Emergency Room$$$ In-Network Deductible $$$ Out-of-Network$$$ Prescription Drugs$/ $ / $

Flexible Spending Account (FSA) You can elect up to $2500 Plan Year: 1/1/11 – 12/31/11 Pre-tax money, contributed through payroll deductions “Use it or Lose it” Eligible expenses: –Medical & Rx expenses –Dental Expenses –Vision Expenses –Limited OTC Footer info here 5

Dependent Care Account (DCA) You can elect up to: –$2500 if single, or married filing separately –$5000 if married filing jointly Plan Year: 1/1/11 – 12/31/11 Pre-tax money, contributed through payroll deductions Pay as you go, can only spend what you have contributed “Use it or Lose it” Eligible Expenses : Custodial Care of dependents while employee is at work Footer info here 6

Savings Example Footer info here 7 Without FSA/DCA Gross Monthly Salary$2, Less: Federal Income Tax$ State Income Tax$ Social Security Tax$ Net Income$1, Less: Health Care Expenses$ Dependent Care$ Spendable Income$1, With FSA/DCA Gross Monthly Salary$2, Less: Health Care Expenses$ Dependent Care$ Taxable Income$1, Less: Federal Income Tax$ State Income Tax$ Social Security Tax$ Spendable Income$1, Monthly Savings$ Annual Savings$2,015.04

About Your Choice Strategies Card It is a MasterCard Restricted to eligible vendors / providers Must be swiped as a Credit Card Cards arrive in a plain white envelope Spouses automatically get a card Additional cards can be issued upon request Footer info here 8

Using Card for Medical Co-Pays Footer info here 9 Reminders : Always give your provider your Carrier ID card and ask your provider to submit to insurance

Using Card at Pharmacy Footer info here 10 Reminders : Check to make sure the pharmacy has your current insurance information Use as credit card Request that your card be run for $10 for a Generic drug and $20 for a Brand name drug with your Choice Strategies card and pay the remaining cost out-of-pocket. Keep the detailed receipt as you will be asked to validate the purchase by Choice Strategies.

Substantiation Footer info here 11 Group Name is required by Federal Law to substantiate all claims. In other words, the plan must prove that the purchases made with the Choice Strategies card were for eligible expenses. Keep all receipts when the Choice Strategies card is used Receipt Notification Process Employees are sent requests via mail or to provide the documentation for substantiation of transactions and claims Documentation *EOBs *Rx Receipts *Provider Bills IIAS (Inventory Information Approval System) Merchants such as grocery stores, and pharmacies must be able to differentiate between health eligible and ineligible items at the point of purchase No Request for documentation if IIAS Approved Pharmacy (List available on website)

Substantiation Service Voluntary Service that allows Choice Strategies to view Employees’ Explanation of Benefits from their online accounts with their Carrier. Employees set-up online account with Carrier Employee fills out HIPAA Release form with User ID and Password When Employee uses Debit Card for a transaction, Choice Strategies logs in to Carrier Website and matches charge to Explanation of Benefits

End of Plan Year Plan Year: 1/1/11-12/31/11 Run-out Period - You have 3 months after the plan year ends, to submit all outstanding claims for expenses that occurred during the plan year. Reimbursement for these expenses must submitted manually through the claim process. Example: If the plan year ends 12/31/11, you have until 3/31/12 to submit manual claims for dates of service that occurred during your 2011 plan year. Do not charge your Choice Strategies card. If you charge your card, it will pull from current plan year funding. The IRS does not allow previous plan year expenses to be paid with current year funding. Footer info here 13

Contacting Member Services Toll Free Phone : 1-(888) –Mon-Thurs 8:00 am – 7:00 pm EST –Friday8:00 am – 5:00 pm EST Live Chat : –Mon-Thurs 8:00 am – 4:45 pm EST –Friday9:00 am – 4:45 pm EST Footer info here 14

Online Account Check Account Balances Submit Claims Online Edit Direct Deposit Info View Transaction History Upload Documentation Report Card Lost/Stolen Footer info here 15

How to Submit a Claim Manually Online –Login to Online Account –Select “Request Reimbursement” –Fill out required fields –Upload Documentation –Select “Submit” , Fax, or Mail –Fill out a Claim Form (available on website or by contacting Member Services) –Attach Documentation Footer info here 16

Questions? Footer info here 17