2020-2021 employee benefits booklet€¦ · labor’s employee benefits security administration at...
TRANSCRIPT
Bell County2020-2021 Employee Benefits Booklet
Table of Contents
Health and Dental Insurance Rates and Benefits 2020-2021
Baylor Scott & White Preferred HMO Member Guide
Summary of Benefits and Coverage - BSW Preferred HMO
Baylor Scott & White Plus HMO Member Guide
Summary of Benefits and Coverage - BSW Plus HMO
MDLIVE- Virtual Care
Ameritas Dental Fusion Core Plan
Ameritas Dental Fusion Buy Up Plan
Eyewear Savings Card
COVID-19 for Dental
Flexible Spending Account Introduction
Flexible Spending Account Overview for Medical
Flexible Spending Account Overview for Dependent Care
FSA Store Flyer
Colonial Life Voluntary Insurance
Medicare D Notice
HIPAA Model Privacy Notice 2020-2021
Chipra Notice
Special Enrollment Notice
Women’s Health and Cancer Rights Act
Newborns Act Disclosure
Notes
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BELL COUNTY
INSURANCE RATES FOR CONTRACT YEAR 2020 - 2021
Costs (with Tax Credit) - Current Benefits Package (employee to pay 1.5% of the premium for Employee Only, Baylor Scott & White Preferred Network (Smaller Network))
(contribution matching rate for Employee Only, Ameritas Dental, Base Plan)
COVERAGE FOR ALL INSURANCES (Health, Dental, & Life)
will be effective the First of the Month following 30 days of employment.
Baylor Scott & White Preferred Network (Smaller Network) Cost County Employee Employee Cost
($30 Copay, $1,250/$2,500 Ded, Co-Insurance 80/20%) per Month Contribution Cost per Month per Pay Period
{RX - Unlimited Maximum}
EMPLOYEE ONLY 573.83 565.22 8.61 4.31
EMPLOYEE/SPOUSE 1,416.94 565.22 851.72 425.86
EMPLOYEE/CHILDREN 1,004.89 565.22 439.67 219.84
FAMILY 1,722.80 565.22 1,157.58 578.79
5% increase. Baylor Scott & White Preferred providers belong to the Baylor Scott & White Quality Alliance Accountable
Care Organization and are contracted with Scott & White Health Plan to provide care for you.
No change to Plan Design.
Scott & White HMO (Broader Network) Cost County Employee Employee Cost
($30 Copay, $1,250/$2,500 Ded, Co-Insurance 80/20%) per Month Contribution Cost per Month per Pay Period
{RX - Unlimited Maximum}
EMPLOYEE ONLY 658.27 565.22 93.05 46.53
EMPLOYEE/SPOUSE 1,625.48 565.22 1,060.26 530.13
EMPLOYEE/CHILDREN 1,152.79 565.22 587.57 293.79
FAMILY 1,976.35 565.22 1,411.13 705.57
10% increase. Network is a Broader Network within Scott & White - Allows members to go to Doctors and Hospitals in a
larger network within the Scott & White Network . Example to include Seton in Harker Heights.
No change to Plan Design.
Ameritas Dental Coverage - Employer Sponsored Base Cost County Employee Employee Cost
(Dental with Preventive Plus / Maximum Allowable Charges per Month Contribution Cost per Month per Pay Period
and a Vision Reimbursement Benefit)
EMPLOYEE ONLY 19.56 19.56 0.00 0.00
FAMILY 69.48 19.56 49.92 24.96
0% Increase. No change to Plan Design.
Ameritas Dental Coverage - Voluntary Buy-Up Cost County Employee Employee Cost
(Dental with Preventive Plus / 90th Percentile per Month Contribution Cost per Month per Pay Period
and a Vision Reimbursement Benefit)
EMPLOYEE ONLY 28.24 19.56 8.68 4.34
FAMILY 92.40 19.56 72.84 36.42
0% Increase. No change to Plan Design.
Visit www.https://bellcounty.swhp.org for details on the health insurance.
Visit www.https://ameritas.com for details on the dental insurance.
Dated 07/13/2020
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Annual Deductible
Applies to Out of Pocket Max
$1,250 Individual
$2,500 Family
Annual Out of Pocket Maximum$3,750 Individual
$7,500 Family
Max Lifetime Benefit per member None
Primary Care Office Visit $30 copay; deductible waived
Specialty Care Office Visit $30 copay; deductible waived
BSW Virtual Visit / MD Live No Charge
Preventive Services No Charge
Standard Lab & X-ray No Charge
Diagnostic/Radiology Procedures20% after deductible
Up to the out of pocket maximum
Eye Exam
(1 refraction annually)$30 copay; deductible waived
Outpatient Surgery20% after deductible
Up to the out of pocket maximum
Inpatient Hospital 20% after deductible
Up to the out of pocket maximum
Emergency Room Services$250 copay, plus 20% of charges
Up to the out of pocket maximum
Urgent Care Services $75 Copay
Ambulance20% after deductible
Up to the out of pocket maximum
Prescription Drug Plan
Retail Quantity
(All Network Pharmacies)
(up to a 34-day supply or 100 units,
whichever is less)
No Annual Maximum
No Deductible
Preferred Generic: $10 copay
Preferred Brand: $40 copay
Non-Preferred: Lesser of $100 or 50%
Specialty Drug 10%/20%/30%
Prescription Drug Plan
Maintenance Quantity
(SWHP Pharmacies Only)
(up to a 90-day supply or 360 units,
whichever is less)
No Annual Maximum
No Deductible
Preferred Generic: $20 copay
Preferred Brand: $80 copay
Non-Preferred: Lesser of $200 or 50%
Ameritas Dental Plan Benefits Employer Sponsored Base Plan Voluntary Buy-Up
Deductible
$10 per Visit for Preventive;
$50/Policy Year/Individual for Basic and
Major; Ortho Exempt
$10 per Visit for Preventive;
$50/Policy Year/Individual for Basic and
Major; Ortho Exempt
Reimbursement Level
(Out-of-Network)Maximum Allowable Charges 90th Percentile
Preventive Services
$10 per visit charge
Cleanings (2 per policy year), x-rays,
exams, flouride, sealants
$10 per visit charge
Cleanings (2 per policy year), x-rays,
exams, flouride, sealants
Basic Services
20% after deductible
Basic restorative, simple extractions, root
canals
20% after deductible
Basic restorative, simple extractions, root
canals
Major Services
50% after deductible
Onlays, crowns, bridges, dentures, and
implants
50% after deductible
Onlays, crowns, bridges, dentures, and
implants
Orthodontic Services
50%, No deductible
Dependent under age 19
Lifetime Max. $1,000
50%, No deductible
Dependent under age 19
Lifetime Max. $1,000
Vision Reimbursement
Reimbursement up to $150 for exams,
frames, lenses, and contact lenses. Not
limited to any provider.
Reimbursement up to $150 for exams,
frames, lenses, and contact lenses. Not
limited to any provider.
RX Savings
Members and dependents (even their pets)
can save on prescription medications
through any Walmart or Sam's Club
pharmacy nationwide.
Members and dependents (even their pets)
can save on prescription medications
through any Walmart or Sam's Club
pharmacy nationwide.
Policy Year Maximum (Nov. 1 - Oct. 31)$1,000 per Individual
excludes Preventive
$1,000 per Individual
excludes Preventive
Dated 07/13/2020
Scott & White Health Plan Benefits
Benefits are the same for the Baylor
Scott & White Preferred Network and
Scott & White HMO
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Scott & White Care Plans2021 Member Guide BSW Preferred HMO
Got a question?..........................................................................................................1
Get to know your ID card .....................................................................................2
Explore your member portal .............................................................................3
Download the MyBSWHealth App ..................................................................4
Experience Virtual Care........................................................................................4
Eligibility map..............................................................................................................5
Find a provider............................................................................................................5
Access pharmacy services.................................................................................6
Know your care options ... ....................................................................................7
Better health starts with you.............................................................................9
Naturally Slim® .........................................................................................................10
Expecting the Best®..............................................................................................10
Get details on your claims .................................................................................11
Stay better, longer .................................................................................................13
Table of Contents
SWCP_GR_BellCountyPreferred_MemberGuide_2020-21
HMO products are offered through Scott and White Health Plan and Scott & White Care Plans. Insured PPO and EPO products are offered through Insurance Company of Scott and White. All are Texas registered insurance companies. Scott & White Care Plans and Insurance Company of Scott and White are wholly owned subsidiaries of Scott and White Health Plan.
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Got a question? Our highly trained Customer Advocates can help you with things like finding a provider and answering questions about your benefits or claims. Whatever your question or concern may be, our Customer Advocates will work with you to resolve it as quickly as possible—in most cases, before you hang up the phone.
Contact us through the member portalLog in at bellcounty.swhp.org to send a secure email and receive a secure response.
Nurse Advice LineNurses are available 24/7 to talk through your symptoms and help you make decisions on next steps, whether that’s an appointment or an at-home remedy. The Nurse Advice Line phone number is on the back of your member ID card.
Welcome to Scott & White Care Plans!Welcome to Scott & White Care Plans (SWCP), a wholly owned subsidiary of Scott and White Health Plan, and part of the Baylor Scott & White family of companies. With Scott & White Care Plans, you will have access to the renowned doctors, specialists and facilities of the Baylor Scott & White Health system. Baylor Scott & White Health (BSWH) provides full-range, inpatient, outpatient, rehabilitation and emergency medical services.
Beyond the Baylor Scott & White Health system, Scott & White Care Plans offers access to thousands of providers throughout North, Central and West Texas to ensure members have plenty of in-network options for care. You’ll find useful information about what we have to offer in this booklet—and if you have questions, we’re happy to answer them.
Contact us by phone 844.633.53257 AM – 7 PM Monday – Friday
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The ID card above is a sample. The exact location of certain elements may vary on your card.
Get to know your member ID card
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45
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Group name
Group ID number
Network name
Benefit effective date
Member name
Member ID number
Copays/coinsurance
Deductible
Pharmacy/prescription drug info9
Customer service phone number
24/7 Nurse Line
Information for providers
Claims mailing address
A
B
C
D
You can request a replacement ID card through the member portal oraccess an electronic card at any time through the MyBSWHealth app.
billing, find a provider at swhp.org
Self-service portal: ers.swhp.orgSWHP24/7 Nurse Line 1-000-000-0000
(TTY: 711)
00/00/0000
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TDI
SUBSCRIBERJohn Sample
DOB: 00/00/0000
DEPENDENTSJane SampleJack SampleJill SampleJames SampleJulie SampleJoe SampleJackie Sample
MEMBER ID 00000000000
00000000000000000000000000000000000000000000000000000000000000000000000000000
IN-NETWORK PLAN BENEFITSAdult PCP/Spec: 00%Pediatric PCP/Spec: 00% Emergency Room: 00%* Coinsurance:
N/A Deductible: I/$0000 F/$0000 Rx: 00%*Deductible:
I/$500, F/$1000PHARMACISTS ONLYOptumRx® Help Desk: 855-205-9182BIN: 610011 PCN: IRX GRP:
Group: Group #: 000000Network:
*Deductible may apply.
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bellcounty.swhp.org
Bell County
SWPBSWCP
FOR PROVIDERSElectronic Claims:Availity: 94999
Paper Claims:Scott and White Health PlanPO Box 211342Eagan, MN 55121
Prior Authorization: Visit the provider portal Fax: 800-626-3042 Phone: 866-384-3488
Provider Portal:
Card Issue Date: 08/01/2020
FOR MEMBER S
not guarantee coverage or payment for the service or procedure reviewed.
Important Information:• In a medical emergency, call 9-1-1 or go to the nearest
emergency facility.
• Telehealth: Download the MyBSWHealth App• 24/7 Nurse Line: 877-505-7947• Self-Service Portal: my.bswhealth.com• To avoid out-of-network costs and provider balance
DC
AB
CUSTOMER SERVICE: 844.633.5325 bellcounty.swhp.org
billing, find a provider at bellcounty.swhp.org
Customer Service: 844-633-5325 (TTY/TDD: 7-1-1)•
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3Explore your member portalThere’s a wealth of information, resources, and functionality available 24/7 in our member portal, accessible from your computer or mobile device. You’ll find a link to the portal on our website: bellcounty.swhp.org.
Download and/or print:
ID cards
Benefit Plan Documents
Claims summaries and Explanations of Benefits
Prescription medication history
Drug formulary
Pending, approved and denied authorizations
Plus you can:
Find a provider
Make an appointment with a BSWH doctor
Complete a health assessment
Access virtual care options (eVisit and Video Visit)
Track your deductible and out-of-pocket maximum
Message your BSWH doctor
Refill a prescription at BSWH pharmacies
Verify eligibility
View/update demographic information
Learn about, and register for, theExpecting the Best® Maternity Program
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Download the MyBSWHealth appVirtually all of the information in the member portal is available on your phone through the MyBSWHealth app. For example, you can view a digital copy of your ID card, see plan details, and track your deductible and out-of-pocket maximum for yourself and your dependents. Use the same user name and password you set up for the member portal to log in to the app. To learn more, visit our website: bellcounty.swhp.org
Be sure to link your account in the app:
Experience virtual care $0 copay
1. Tap the gear icon (top right corner of app welcome screen)2. Tap “Manage Linked Accounts”3. Tap “Link Account”4. Enter member information
Conduct an eVisit for common medical conditions and get care fast
Click the eVisit icon under "URGENT CARE OPTIONS" Complete an online questionnare about your symptoms; it takes only 5-10 minutes You will get a response from a Baylor Scott & White Health provider within one hour Prescriptions (if needed) will be sent immediately to your preferred pharmacy
Schedule a same-day Video Visit with a provider, face-to-face
Click the video visit icon under “URGENT CARE OPTIONS” to schedule your appointment Talk with a Baylor Scott & White Health provider live about your symptoms Visits are quick: just 10-15 minutes Prescriptions (if needed) will be sent immediately to your preferred pharmacy
MyBSWHealth 8 AM - 8 PM CT, 7 days a week Receive care from the comfort of your home, or anywhere in Texas, at no cost to you.
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Find a Provider
Need more help? Call the Baylor Scott & White Quality Alliance Health Access Line:
844.279.7589
Our provider search tool at bellcounty.swhp.org allows you to:
• Search by name, specialty and/or ZIP code
• Add filters for gender, board certification, accepting new patients and more
• See practice locations, contact information and maps
• Get details, including network participation and hospital affiliations
• Customize your own profile
Go to bellcounty.swhp.org and click on “Find a Provider-BSW Preferred” and you will be on your way.
Service Areas BSW Preferred HMO Network
Service Areas
AustinBastrop
Bell
Blanco
Bosque
Brazos
Brown
Burleson
Burnet
Caldwell
Comanche
Cooke
Coryell
Dallas
Denton
Ellis
Falls
Fannin
Fayette
Gillespie
Grayson
Grimes
Hamilton
Hays
Henderson
Hill
Hood
Hunt
Kaufman
Lampasas
Lee
Limestone
Llano
McCulloch
McLennan
Madison
Mason Milam
Mills
Navarro
Parker
Robertson
Rockwall
San Saba
Tarrant
Travis
Waller
Williamson
Wise
Johnson
Collin
Somervell
Washington
HMO: Only certain ZIP codes in Johnson, Milam and Travis counties are included.
PPO/ EPO: Only certain ZIP codes in Johnson and Travis counties are included.
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Access pharmacy servicesSWCP members may access more than 68,000 pharmacies nationwide, including most national chains and a large selection of local pharmacies.
To find your nearest pharmacy, click here:
We also offer 90-day prescription refills for select medications at Baylor Scott & White Health pharmacies.
Get the convenience of home delivery with mail order service. Call our mail order pharmacy and we will walk you through the transfer process.
Call toll-free at 855.388.3090 Monday through Friday, from 7 AM to 7 PM CT, and on Saturday, from 9 AM to 1 PM CT.
If you need detailed pharmacy claim information, pharmacy deductible information, explanation of benefits, or drug information and pricing, visit bellcounty.swhp.org or call Customer Service at 844.633.5325.
To view a formulary (a list of covered drugs), click here:
PHARMACY SEARCH
FORMULARY
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Visit your Primary Care Physicianwhen you’re sick or have a minor injury1
Your doctor knows your health history and underlying conditions. For routine illnesses and less significant injuries, many doctors’ offices are open on weekends and some evenings. This can be a good alternative to more costly urgent care or emergency care centers. Although a Primary Care Physician is not required, we encourage you to establish a relationship with a doctor.
If your doctor’s office is closed, consider an Urgent Care center2
Urgent Care centers typically have extended and weekend hours. Although costs are higher than primary care, urgent care copays are lower than those for emergency care.
Know your care optionsHow do you decide when a health-related issue is an emergency? Understanding your healthcare options can save your life... and your money.
Or opt for Virtual Care — or our Nurse Advice LineSee page 4 for information on Virtual Care. Nurses are available to our members 24 hours a day, 365 days a year. Our nurses provide information about taking care of yourself at home or they can help you decide if an appointment, an urgent care visit, or an emergency room visit is best for your symptoms. To locate your appropriate Nurse Advice Line phone number, please look on the back of your member card or log in to the Member Portal.
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If you need to speak to us, contact us in the way that works for you. In addition to the Member Portal, customer support is available by phone at 844.633.5325.
Scott & White Care Plans pays out-of-network emergency services according to Usual and Customary rates (industry standard), and members can be balance-billed for expenses beyond what insurance will pay. Your coverage documents contain additional information about emergency treatment and definitions of the terms, including a definition of emergency care. The coverage documents also contain information related to state-mandated consumer protections for facility-based provider charges.
To save on out-of-pocket costs, visit in-network emergency care facilities when possible. You can find in-network emergency care facilities by using the provider search tool at bellcounty.swhp.org.
Remember: Out-of-network emergency care costs more
Emergency Roomsare best for treating severe and life-threatening conditions and they’re always open.3
The wider range of services offered through emergency rooms, and the hospitals they are connected to, makes emergency care a more expensive option, but sometimes the best option for you.
It’s important to understand your options, and to use your best judgment when deciding which option is right for you.
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Assessment for Members
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WELL-BEING ASSESSMENTThe Well-Being Assessment is a simple, digital health survey that helps you take steps toward a more vibrant and healthier life. The Well-Being Assessment asks questions about your life and delivers customized action steps from our Lifestyle Management Program. Modules are self-paced, available online, and convenient for promoting physical and mental health — all things to help you feel your best.
Digital Health Coaching – 6-week coaching modules with action plans, important articles, online seminars and video content on topics that include:
• Live Tobacco Free• Healthy Weight
Progress Tracker – The digital platform has a dashboard to help you keep track of important health information like A1C, weight/BMI, cholesterol, blood pressure and physical activity. These biometric measurements can be charted over time to monitor your long-term health.
Fitness Tracker Integration – Synchronize your personal fitness tracker with the wellness platform to monitor your physical activity progress on the dashboard.
Digital Health Library – Access to articles, videos, recipes and other content to support a healthier life. You can search for condition-specific information or explore highlighted topics.
Challenges – Sometimes you need extra motivation to go the extra mile. You can participate in step challenges, hydration and even relaxation challenges.
Online Community – Access to online community forums where you can give and receive support for goals as well as get feedback from health coaches in the community.
• Healthier Diet• Active Living
Elevate your well-being with Scott & White Care Plans’ comprehensive suite of digital resources. Log in to your member portal to get started.
• Less Stress
Better health starts with you
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Expecting the Best® Maternity ProgramWe are pleased to offer a maternity program for pregnant Scott & White Care Plans members. This initiative is focused on helping expectant mothers enjoy a healthy pregnancy.
Once enrolled, participants can benefit from diverse program features for the duration of their pregnancy and one year postpartum.Participants receive helpful educational materials across distinct categories, including proper nutrition, early identification of pregnancy risk factors and available resources for any complications.
Sign up by calling the customer service number on the back of your ID card or send an email to: [email protected].
Ever wonder how some people can eat all their favorite foods and not gain weight? Naturally Slim is an online program that will teach you how. And here’s a hint: it doesn’t include starving, counting calories or spending hours prepping ‘approved’ foods. SWCP is giving you the chance to learn how to eat the foods you love while reducing your risk of developing serious conditions, like diabetes or heart disease.
Naturally Slim is available at NO COST to you and is accessible via computer and mobile device so you can participate whenever it’s convenient, wherever you are.
For more information about Naturally Slim, visit bellcounty.swhp.org
You don’t have to give up your favorite foods to lose weight and feel your best.
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ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (800) 321-7947 (TTY: 711).
Scott & White Care Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (800) 321-7947 (TTY: 711).
Scott & White Care Plans cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số (800) 321-7947 (TTY: 711).
Scott & White Care Plans tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính.
Allowed Amount -This is the amount considered for payment based on our provider contracts and your benefits.
Amount Billed -This is the amount your provider billed for the services you requested. Note: this amount does not reflect discounts that the plan has negotiated with the provider or facility.
Amount Paid -This is the amount we paid to you or your provider.
Copay -This represents the amount you are responsible to pay for certain services, typically paid at the time of service.
Coinsurance - The coinsurance is a percentage of the “allowed amount” you are responsible for paying for services after your deductible is met. Providers may require payment when you receive services.
Deductible - A fixed-dollar amount the member is responsible for paying each plan year before the plan begins to pay for covered services. Note: “Non-Covered” amounts don’t count toward meeting the yearly deductible. Your provider may bill you for these charges.
Discount Amount -The amount you saved by using the plan’s preferred providers.
Non-Covered Amount - An amount you are responsible for paying because it is for a service that is not covered by your benefit plan. Also, if you’ve used an out-of-network provider, “non-covered amount” includes any amount the out-of-network provider bills in excess of the plan-negotiated network rates.
Other Coverage Payment -This is the amount paid by your other insurance carrier.
Out-of-Pocket Maximum -The most you have to pay for in-network health services every year. Once you have paid this amount, the Health Plan typically pays 100% of your allowed health care charges, subject to any policy limitations.
Helpful Definitions
If you suspect fraud, contact the Scott and White Health Plan Compliance HelpLine at (888) 484-6977.
Report Fraud
Language Assistance/ Nondiscrimination Notice
Get details on your claimswith your monthly insurance statement
Subscriber: John Smith
Member ID: 12345678
Group Name: SampleCompany Inc.
Group Number: 012345
Now...the Detailed VersionHere’s a detailed breakdown or Explanation of Benefits for this service. In case there’s any doubt - this is NOT a bill!
Notes:IJ THE PROVIDER IS NOT IN NETWORK AND/OR THERE IS NO AUTH ON FILE*If you elected to use your out-of-network benefit, the provider or facility may bill you for an amount greaterthan the amount reimbursed by the Health Plan. Out-of-network providers or facilities may not bill you foran amount greater than the copay/coinsurance/deductible indicated above in the following circumstances:emergency care services, treatment from an out-of-network provider while receiving services at an in-networkfacility, or for out-of network imaging or laboratory services if related to treatment from an in-network provider.
Patient: Ann SmithClaim Number: 123x456x788Provider: Test Provider 1
Out-of-Network*
Date of Service Description Amount
BilledAllowed Amount
Non-Covered Amount
Other Coverage Payment
Plan Paid Copay Deductible Coinsurance What You May Owe Notes
2/04/20 Emergency Dept Visit $1000.00 $500.00 $0.00 $0.00 $400.00 $100.00 $0.00 $0.00 $100.00 IJ
Total $1000.00 $500.00 $0.00 $0.00 $400.00 $100.00 $0.00 $0.00 $100.00
Patient: Ann SmithClaim Number: 123x456x789Provider: Test Provider 2
In-Network
Date of Service Description Amount
BilledAllowed Amount
Non-Covered Amount
Other Coverage Payment
Plan Paid Copay Deductible Coinsurance What You May Owe Notes
2/04/20 Office Visit $250.00 $150.00 $0.00 $0.00 $100.00 $50.00 $0.00 $0.00 $50.00
Total $250.00 $150.00 $0.00 $0.00 $100.00 $50.00 $0.00 $0.00 $50.00
QUESTIONS?
Customer service: (800) 321-7947 Hours: 7 a.m. to 7 p.m. CT
Website: swhp.org
Explanation of BenefitsThis is NOT a bill
1206 West Campus DriveTemple, TX 76502
Forwarding Service Requested
Member ID: 12345678Group Number: 012345Group Name: Sample Company Inc.Print date: 02/18/2020
John Smith789 TEST STREETREDCARD, MO 63141
Hi John,This document summarizes your recent benefit activity. It confirms the amount charged by your provider(s) and the amount we paid for those charges.
Cost breakdown
Amount billed: $1250.00
Plan discount: $600.00
Plan paid: $500.00
Not covered: $0.00
What you may owe
$150.00This is the portion of the billed amount you may
owe the provider(s) if payment was not collected at thetime of service. This amount may include
your deductible, copay, coinsurance, and/or non-covered amount.
Account Summary
Place holder for misc. communications
TotalAmount
AppliedAmount
Family Deductible
Family Out-of-pocket max$1,500.00
$2,477.84
$3,000.00($1,500.00 remaining)
$4,500.00($2,022.16 remaining)
Member Deductible
Member Out-of-pocket max
$250.00
$199.71
$1,500.00($1,250.00 remaining)
$2,250.00($2,050.29 remaining)
An electronic Monthly Insurance Statement, also known as an Explanation of Benefits (EOB), is available through the Member Portal an to help you manage your claims expenses at a detailed level. The statement provides line-item detail on charges for that month, including what was billed and covered by SWCP. The amount you owe is included in this statement.
Remaining balances for deductibles and out-of-pocket expenses are also reported. Information for the current month and year-to-date is included. Statements are not provided for prescription claims or claims where the member does not owe anything.
Your EOBs will be available on the Member Portal unless you specifically request to receive paper EOBs in the mail. To request paper EOBs, log in to the Member Portal and select “Update Preferences.”
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Complex Case Management If you have chronic conditions or complex care needs, our nurse case managers will work with you, your family, and your physician to create and manage your care plan. Case managers advocate for you and can help you navigate the healthcare system and arrange the services you need. They can also answer questions and help you understand your condition and care plan. If Disease Management is right for you, they’ll incorporate the program into your care. There is no additional cost to you for this voluntary program. It’s all part of our goal to help you get the best possible results and the greatest value from your health plan.
Disease ManagementDisease Management empowers you to manage your chronic condition and help prevent complications. We work with your healthcare providers to identify chronic conditions quickly and treat them effectively. We can also identify self-care activities that help you manage your condition at home. Together, we’ll work to slow down the progression of your disease and help you stay better, longer.
Stay better, longer
Accountable Care OrganizationAs a member of a health plan working with an Accountable Care Organization, you can expect care that is:
HIGH-QUALITY. You should expect the care you receive to be safe, timely, effective, efficient, equitable and patient-centered.
COORDINATED. Your doctor guides your care team and coordinates appropriate services across all sites of care that might include a specialist’s office, the hospital, or laboratory and imaging services.
CONVENIENT. Many of our doctors and facilities offer same-day appointments, extended hours, and onsite laboratory and imaging services. Urgent care centers and retail care clinics like Walgreen’s and CVS are in the BSW Preferred network.
COMPREHENSIVE. The BSW Preferred network of primary and specialty care doctors and facilities is broad. We are confident we can meet your care needs.
COST-EFFECTIVE. Copays and out-of-pocket expenses are kept in check when your care needs are delivered inside the BSW Preferred network (doctors, hospitals, laboratory, imaging and post-acute care.) All other providers are considered out-of-network and no benefits are available for services other than emergency situations.
16
HMO products are offered through Scott and White Health Plan and Scott & White Care Plans. Insured PPO and EPO products are offered through Insurance Company of Scott and White. All are Texas registered insurance companies. Scott & White Care Plans and Insurance Company of Scott and White are wholly owned subsidiaries of Scott and White Health Plan.
Thank you for choosing Scott & White Care Plans for your healthcare coverage needs.
17
The
Sum
mar
y of
Ben
efits
and
Cov
erag
e (S
BC) d
ocum
ent w
ill he
lp y
ou c
hoos
e a
healt
h pl
an. T
he S
BC s
hows
you
how
you
and
the
plan
wou
ld
shar
e the
cost
for c
over
ed h
ealth
care
serv
ices.
NOTE
: Inf
orm
atio
n ab
out t
he co
st o
f thi
s plan
(call
ed th
e pre
miu
m) w
ill be
pro
vided
sepa
rate
ly.
This
is on
ly a
sum
mar
y. Fo
r mor
e inf
orma
tion
abou
t you
r cov
erag
e, or
to g
et a
copy
of t
he c
omple
te ter
ms o
f cov
erag
e, vis
it be
llcou
nty.sw
hp.or
g or
call
1-
844-
633-
5325
. For
gen
eral
defin
itions
of c
ommo
n ter
ms, s
uch
as a
llowe
d am
ount,
bala
nce
billin
g, co
insur
ance
, cop
ayme
nt, d
educ
tible,
pro
vider
, or
other
unde
rlined
term
s see
the G
lossa
ry. Y
ou ca
n view
the G
lossa
ry at
healt
hcar
e.gov
/sbc-g
lossa
ry or
call 1
-844
-633
-532
5 to r
eque
st a c
opy.
Impo
rtant
Que
stio
ns
Answ
ers
Why
Thi
s Mat
ters
:
Wha
t is t
he o
vera
ll de
duct
ible?
$1
,250 i
ndivi
dual
/ $2,5
00 fa
mily
Gene
rally
, you
mus
t pay
all o
f the c
osts
from
prov
iders
up to
the d
educ
tible
amou
nt be
fore
this p
lan be
gins t
o pay
. If yo
u hav
e othe
r fam
ily m
embe
rs on
the p
lan, e
ach f
amily
me
mber
mus
t mee
t their
own i
ndivi
dual
dedu
ctible
until
the to
tal am
ount
of de
ducti
ble
expe
nses
paid
by al
l fami
ly me
mber
s mee
ts the
over
all fa
mily
dedu
ctible
.
Are t
here
serv
ices
cove
red
befo
re yo
u m
eet
your
ded
uctib
le?
Yes.
Pre
venti
ve ca
re an
d prim
ary c
are
servi
ces a
re co
vere
d befo
re yo
u mee
t yo
ur de
ducti
ble.
This
plan c
over
s som
e item
s and
servi
ces e
ven i
f you
have
n’t ye
t met
the de
ducti
ble
amou
nt. B
ut a c
opay
ment
or co
insur
ance
may
apply
. For
exam
ple, th
is pla
n cov
ers c
ertai
n pr
even
tive s
ervic
es w
ithou
t cos
t-sha
ring a
nd be
fore y
ou m
eet y
our d
educ
tible.
See
a lis
t of
cove
red p
reve
ntive
servi
ces a
t hea
lthca
re.go
v/cov
erag
e/pre
venti
ve-ca
re-b
enefi
ts.
Are t
here
oth
er
dedu
ctib
les fo
r spe
cific
serv
ices?
No
Yo
u don
’t hav
e to m
eet d
educ
tibles
for s
pecif
ic se
rvice
s.
Wha
t is t
he o
ut-o
f-poc
ket
limit
for t
his p
lan?
$3,75
0 ind
ividu
al / $
7,500
fami
ly Th
e out-
of-po
cket
limit i
s the
mos
t you
could
pay i
n a ye
ar fo
r cov
ered
servi
ces.
If you
ha
ve ot
her f
amily
mem
bers
in thi
s plan
, they
have
to m
eet th
eir ow
n out-
of-po
cket
limits
un
til the
over
all fa
mily
out-o
f-poc
ket li
mit h
as be
en m
et.
Wha
t is n
ot in
clude
d in
th
e out
-of-p
ocke
t lim
it?
Copa
ymen
ts on
certa
in se
rvice
s, pr
emium
s, ba
lance
-billi
ng ch
arge
s, an
d he
alth c
are t
his pl
an do
es no
t cov
er.
Even
thou
gh yo
u pay
thes
e exp
ense
s, the
y don
’t cou
nt tow
ard t
he ou
t–of–p
ocke
t limi
t.
Will
you
pay l
ess i
f you
us
e a n
etwo
rk p
rovid
er?
Yes.
See b
ellco
unty.
swhp
.org o
r call
1-
844-
633-
5325
for a
list o
f netw
ork
prov
iders.
This
plan u
ses a
prov
ider n
etwor
k. Yo
u will
pay l
ess i
f you
use a
prov
ider in
the p
lan’s
netw
ork.
You w
ill pa
y the
mos
t if yo
u use
an ou
t-of-n
etwor
k pro
vider
, and
you m
ight
rece
ive a
bill fr
om a
prov
ider f
or th
e diffe
renc
e betw
een t
he pr
ovide
r’s ch
arge
and w
hat
your
plan
pays
(bala
nce b
illing
). Be
awar
e, yo
ur ne
twor
k pro
vider
migh
t use
an ou
t-of-
netw
ork p
rovid
er fo
r som
e ser
vices
(suc
h as l
ab w
ork).
Che
ck w
ith yo
ur pr
ovide
r befo
re
you g
et se
rvice
s. Do
you
need
a re
ferra
l to
see a
spec
ialist
? No
Yo
u can
see t
he sp
ecial
ist yo
u cho
ose w
ithou
t a re
ferra
l.
18
All c
opay
men
t and
coin
sura
nce c
osts
show
n in t
his ch
art a
re af
ter yo
ur d
educ
tible
has b
een m
et, if
a ded
uctib
le ap
plies
.
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u vis
it a h
ealth
ca
re p
rovid
er’s
offic
e or
clin
ic
Prim
ary c
are v
isit to
trea
t an
injur
y or il
lness
$3
0 cop
ayme
nt/vis
it No
t cov
ered
No
ne
Sp
ecial
ist vi
sit
$30 c
opay
ment/
visit
Not c
over
ed
Prev
entiv
e ca
re/sc
reen
ing/
immu
nizati
on
No ch
arge
No
t cov
ered
Yo
u may
have
to pa
y for
servi
ces t
hat a
ren’t
pr
even
tive.
Ask y
our p
rovid
er if
the se
rvice
s ne
eded
are p
reve
ntive
. The
n che
ck w
hat y
our
plan w
ill pa
y for
.
If yo
u ha
ve a
test
Diag
nosti
c tes
t (X-
ray,
blood
wor
k) No
char
ge
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
Imag
ing (C
T/PE
T sc
ans,
MRIs)
20
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
If yo
u ne
ed d
rugs
to
treat
your
illne
ss o
r co
nditi
on
More
infor
matio
n abo
ut pr
escr
iptio
n dr
ug
cove
rage
is av
ailab
le at
bellc
ounty
.swhp
.org/p
harm
acy-i
nform
ation
.
ACA
Prev
entiv
e Dru
gs
$0 co
paym
ent/p
resc
riptio
n De
ducti
ble do
es no
t app
ly No
t cov
ered
Copa
ymen
ts ar
e per
30-d
ay su
pply.
Ma
inten
ance
-elig
ible d
rugs
are a
llowe
d up t
o a
90-d
ay su
pply
for tw
o cop
ayme
nts if
obtai
ned
throu
gh a
Baylo
r Sco
tt & W
hite P
harm
acy o
rpa
rticipa
ting 9
0-da
y reta
il or m
ail or
der
phar
macy
prov
ider.
Mail O
rder
: Ava
ilable
for a
1- to
90-d
ay su
pply.
Non-
maint
enan
ce dr
ugs o
btaine
d thr
ough
orde
r are
limite
d to a
30-d
ay su
pply
maxim
um.
Some
Spe
cialty
drug
s may
requ
ire pr
iorau
thoriz
ation
. 30-
day s
upply
only.
Tier 1
: Pre
ferre
d Gen
eric
Drug
s $1
0 cop
ayme
nt/pr
escri
ption
De
ducti
ble do
es no
t app
ly No
t cov
ered
Tier 2
: Pre
ferre
d Bra
nd
Name
Dru
gs
$40 c
opay
ment/
pres
cripti
on
Dedu
ctible
does
not a
pply
Not c
over
ed
Tier 3
: Non
-Pre
ferre
d Ge
neric
/ Bra
nd N
ame
Drug
s
The l
esse
r of $
100
copa
ymen
t or 5
0%
copa
ymen
t De
ducti
ble do
es no
t app
ly No
t cov
ered
Spec
ialty
Drug
s T1
: 10%
of ch
arge
s T2
: 20%
of ch
arge
s T3
: 30%
of ch
arge
s De
ducti
ble do
es no
t app
ly No
t cov
ered
19
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u ha
ve o
utpa
tient
su
rger
y
Facil
ity fe
e (e.g
., am
bulat
ory s
urge
ry ce
nter)
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
Refer
to be
llcou
nty.sw
hp.or
g or
Custo
mer S
ervic
e at 1
-844
-633
-532
5.
Phys
ician
/surg
eon f
ees
20%
after
dedu
ctible
No
t cov
ered
If yo
u ne
ed im
med
iate
med
ical a
ttent
ion
Emer
genc
y roo
m ca
re
$250
copa
ymen
t/visi
t, plus
20
% of
char
ges
$250
copa
ymen
t/visi
t, the
n 20
% of
char
ges
Copa
ymen
t waiv
ed if
episo
de re
sults
in
hosp
italiz
ation
for t
he sa
me co
nditio
n with
in 24
ho
urs.
Emer
genc
y med
ical
trans
porta
tion
20%
after
dedu
ctible
20
% af
ter de
ducti
ble
None
Ur
gent
care
$7
5 cop
ayme
nt/vis
it $7
5 cop
ayme
nt/vis
it
If yo
u ha
ve a
hosp
ital
stay
Facil
ity fe
e (e.g
., hos
pital
room
) 20
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Ph
ysici
an/su
rgeo
n fee
s 20
% af
ter de
ducti
ble
Not c
over
ed
If yo
u ne
ed m
enta
l he
alth,
beh
avio
ral
healt
h, o
r sub
stan
ce
abus
e ser
vices
Outpa
tient
servi
ces
$30 c
opay
ment/
visit
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
Inpati
ent s
ervic
es
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
If yo
u ar
e pre
gnan
t
Offic
e visi
ts $3
0 cop
ayme
nt/vis
it No
t cov
ered
Cost
shar
ing do
es no
t app
ly for
prev
entiv
e se
rvice
s. De
pend
ing on
the t
ype o
f ser
vices
, a
copa
ymen
t, coin
sura
nce,
or de
ducti
ble m
ay
apply
. Mate
rnity
care
may
inclu
de te
sts an
d se
rvice
s des
cribe
d else
wher
e in t
he S
BC (i.
e. ult
raso
und)
. Ch
ildbir
th/de
liver
y pr
ofess
ional
servi
ces
20%
after
dedu
ctible
No
t cov
ered
Th
e hea
lth pl
an m
ust b
e noti
fied o
f the
deliv
ery.
If a le
ngth
of sta
y for
an
unco
mplic
ated d
elive
ry ex
ceed
s 48 h
ours
for
vagin
al, or
96 ho
urs f
or ca
esar
ean,
prea
uthor
izatio
n is r
equir
ed. F
ailur
e to n
otify
or
prea
uthor
ize, w
hen r
equir
ed, m
ay re
sult o
f a
denia
l of th
e ser
vice.
Refer
to
bellc
ounty
.swhp
.org o
r Cus
tomer
Ser
vice a
t 1-
844-
633-
5325
.
Child
birth/
deliv
ery f
acilit
y se
rvice
s 20
% af
ter de
ducti
ble
Not c
over
ed
20
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u ne
ed h
elp
reco
verin
g or
hav
e ot
her s
pecia
l hea
lth
need
s
Home
healt
h car
e $3
0 cop
ay/vi
sit
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Reha
bilita
tion s
ervic
es
$30 c
opay
ment/
visit
Not c
over
ed
Limite
d to 2
0 com
bined
PT/
OT/S
P ou
tpatie
nt vis
its an
d an a
dditio
nal 1
0 visi
ts for
Hom
e Se
tting p
er pl
an ye
ar. L
imits
may
not a
pply
for
Ther
apies
for C
hildr
en w
ith D
evelo
pmen
tal
Delay
s and
Auti
sm S
pectr
um D
isord
er.
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Habil
itatio
n ser
vices
$3
0 cop
ayme
nt/vis
it No
t cov
ered
Limite
d to 2
0 com
bined
PT/
OT/S
P ou
tpatie
nt vis
its an
d an a
dditio
nal 1
0 visi
ts for
Hom
e Se
tting p
er pl
an ye
ar. L
imits
may
not a
pply
for
Ther
apies
for C
hildr
en w
ith D
evelo
pmen
tal
Delay
s and
Auti
sm S
pectr
um D
isord
er.
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Skille
d nur
sing c
are
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
Dura
ble m
edica
l eq
uipme
nt 50
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Hosp
ice se
rvice
s No
char
ge
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
If yo
ur ch
ild n
eeds
de
ntal
or ey
e car
e
Child
ren’s
eye e
xam
$30 c
opay
ment/
visit
Not c
over
ed
Limite
d to o
ne ey
e exa
m pe
r plan
year
.
Child
ren’s
glas
ses
Not c
over
ed
Not c
over
ed
None
Child
ren’s
denta
l che
ck-
up
Not c
over
ed
Not c
over
ed
None
21
Exclu
ded
Serv
ices &
Oth
er C
over
ed S
ervic
es:
Serv
ices Y
our P
lan G
ener
ally D
oes N
OT C
over
(Che
ck yo
ur p
olicy
or p
lan d
ocum
ent f
or m
ore i
nfor
mat
ion
and
a list
of a
ny o
ther
exclu
ded
serv
ices.)
•
Acup
unctu
re•
Baria
tric su
rger
y•
Child
ren’s
glas
ses
•Co
smeti
c sur
gery
•De
ntal c
are (
Adult
and C
hild)
•Inf
ertili
ty tre
atmen
t•
Long
-term
care
•No
n-em
erge
ncy c
are w
hen t
rave
ling o
utside
the U
.S.
•Pr
ivate-
duty
nursi
ng•
Routi
ne fo
ot ca
re•
Weig
ht los
s pro
gram
s
Othe
r Cov
ered
Ser
vices
(Lim
itatio
ns m
ay ap
ply t
o th
ese s
ervic
es. T
his i
sn’t
a com
plet
e list
. Plea
se se
e you
r plan
doc
umen
t.)
•Ch
iropr
actic
care
(limi
ted to
35 vi
sits p
er pl
an ye
ar)
•He
aring
aids
(limi
ted to
one d
evice
per e
ar ev
ery 3
year
s; lim
ited t
o cov
ered
mem
bers
throu
gh th
e age
of 18
)•
Routi
ne ey
e car
e (Ad
ult) (
limite
d to a
n ann
ual e
ye ex
am co
nduc
ted by
a lic
ense
d oph
thalm
ologis
t or o
ptome
trist)
Your
Rig
hts t
o Co
ntin
ue C
over
age:
The
re ar
e age
ncies
that
can h
elp if
you w
ant to
conti
nue y
our c
over
age a
fter it
ends
. The
conta
ct inf
orma
tion f
or th
ose
agen
cies i
s: Sc
ott &
Whit
e Car
e Plan
s, vis
it swh
p.org
, or c
all 1-
844-
633-
5325
; Dep
artm
ent o
f Lab
or’s
Emplo
yee B
enefi
ts Se
curity
Adm
inistr
ation
at 1-
866-
444-
EBSA
(3
272)
or do
l.gov
/ebsa
/healt
hrefo
rm. O
ther c
over
age o
ption
s may
be av
ailab
le to
you t
oo, in
cludin
g buy
ing in
dividu
al ins
uran
ce co
vera
ge th
roug
h the
Hea
lth
Insur
ance
Mar
ketpl
ace.
For m
ore i
nform
ation
abou
t the M
arke
tplac
e, vis
it Hea
lthCa
re.go
v or c
all 1-
800-
318-
2596
.
Your
Grie
vanc
e and
App
eals
Righ
ts: T
here
are a
genc
ies th
at ca
n help
if yo
u hav
e a co
mplai
nt ag
ainst
your
plan
for a
denia
l of a
claim
. This
comp
laint
is ca
lled a
gr
ievan
ce or
appe
al. F
or m
ore i
nform
ation
abou
t you
r righ
ts, lo
ok at
the e
xplan
ation
of be
nefits
you w
ill re
ceive
for t
hat m
edica
l clai
m. Y
our p
lan do
cume
nts al
so
prov
ide co
mplet
e info
rmati
on to
subm
it a cl
aim, a
ppea
l, or a
griev
ance
for a
ny re
ason
to yo
ur pl
an. F
or m
ore i
nform
ation
abou
t you
r righ
ts, th
is no
tice,
or as
sistan
ce,
conta
ct: S
cott &
Whit
e Car
e Plan
s, vis
it swh
p.org
, or c
all 1-
844-
633-
5325
; Tex
as D
epar
tmen
t of In
sura
nce,
visit t
di.tex
as.go
v or c
all 1-
800-
578-
4677
; Dep
artm
ent o
f La
bor’s
Emp
loyee
Ben
efits
Secu
rity A
dmini
strati
on at
1-86
6-44
4-EB
SA (3
272)
or do
l.gov
/ebsa
/healt
hrefo
rm, T
exas
Dep
artm
ent o
f Insu
ranc
e Tex
as H
ealth
Opti
ons a
t 1-
800-
252-
3439
or te
xash
ealth
optio
ns.co
m.
Does
this
plan
pro
vide M
inim
um E
ssen
tial C
over
age?
Yes
If y
ou do
n’t ha
ve M
inimu
m Es
senti
al Co
vera
ge fo
r a m
onth,
you’l
l hav
e to m
ake a
paym
ent w
hen y
ou fil
e you
r tax
retur
n unle
ss yo
u qua
lify fo
r an e
xemp
tion f
rom
the
requ
ireme
nt tha
t you
have
healt
h cov
erag
e for
that
month
.
Does
this
plan
mee
t the
Min
imum
Valu
e Sta
ndar
ds?
Yes
If y
our p
lan do
esn’t
mee
t the M
inimu
m Va
lue S
tanda
rds,
you m
ay be
eligi
ble fo
r a pr
emium
tax c
redit
to he
lp yo
u pay
for a
plan
thro
ugh t
he M
arke
tplac
e.
Lang
uage
Acc
ess S
ervic
es:
Span
ish (E
spañ
ol): P
ara o
btene
r asis
tencia
en E
spañ
ol, lla
me al
1-84
4-63
3-53
25.
––––
––––
––––
––––
––––
––To
see
exam
ples o
f how
this
plan
migh
t cov
er co
sts fo
r a sa
mple
med
ical s
ituat
ion, s
ee th
e ne
xt se
ction
.–––
––––
––––
––––
––––
–––
22
Peg
is Ha
ving
a Bab
y (9
mon
ths of
in-n
etwor
k pre
-nata
l car
e and
a ho
spita
l deli
very)
Mia’s
Sim
ple F
ract
ure
(in-n
etwor
k eme
rgen
cy ro
om vi
sit an
d foll
ow
up ca
re)
Mana
ging
Joe’s
type
2 Di
abet
es
(a ye
ar of
routi
ne in
-netw
ork c
are o
f a w
ell-
contr
olled
cond
ition)
Th
e plan
’s ov
erall
ded
uctib
le $
1,250
Spec
ialist
copa
ymen
t
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce
20%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Sp
ecial
ist of
fice v
isits
(pre
nata
l car
e)
Child
birth/
Deliv
ery P
rofes
siona
l Ser
vices
Ch
ildbir
th/De
liver
y Fac
ility S
ervic
es
Diag
nosti
c tes
ts (u
ltras
ound
s and
bloo
d wo
rk)
Spec
ialist
visit
(ane
sthes
ia)
Tota
l Exa
mpl
e Cos
t $1
2,800
In th
is ex
ampl
e, Pe
g wo
uld
pay:
Co
st Sh
aring
De
ducti
bles
$1,25
0 Co
paym
ents
$20
Coins
uran
ce
$2,48
0 W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$6
0 Th
e tot
al Pe
g wo
uld
pay i
s $3
,810
Th
e plan
’s ov
erall
ded
uctib
le $
1,250
Spec
ialist
copa
ymen
t
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce
20%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Pr
imar
y car
e phy
sician
offic
e visi
ts (in
cludin
g dis
ease
edu
catio
n)
Diag
nosti
c tes
ts (b
lood
work
) Pr
escri
ption
drug
s Du
rable
med
ical e
quipm
ent (
gluco
se m
eter
)
Tota
l Exa
mpl
e Cos
t $7
,400
In th
is ex
ampl
e, Jo
e wou
ld p
ay:
Cost
Shar
ing
Dedu
ctible
s $1
,250
Copa
ymen
ts $1
,130
Coins
uran
ce
$370
W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$6
0 Th
e tot
al Jo
e wou
ld p
ay is
$2
,810
Th
e plan
’s ov
erall
ded
uctib
le $1
,250
Sp
ecial
ist co
paym
ent
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce
20%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Em
erge
ncy r
oom
care
(inclu
ding
med
ical
supp
lies)
Diag
nosti
c tes
t (X-
ray)
Dura
ble m
edica
l equ
ipmen
t (cr
utch
es)
Reha
bilita
tion s
ervic
es (p
hysic
al th
erap
y)
Tota
l Exa
mpl
e Cos
t $1
,900
In th
is ex
ampl
e, Mi
a wou
ld p
ay:
Cost
Shar
ing
Dedu
ctible
s $1
,120
Copa
ymen
ts $4
60
Coins
uran
ce
$290
W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$0
Th
e tot
al Mi
a wou
ld p
ay is
$1
,870
Abou
t the
se C
over
age E
xam
ples
:
Th
is is
not a
cost
estim
ator
. Tre
atmen
ts sh
own a
re ju
st ex
ample
s of h
ow th
is pla
n migh
t cov
er m
edica
l car
e. Yo
ur ac
tual c
osts
will b
e dif
feren
t dep
endin
g on t
he ac
tual c
are y
ou re
ceive
, the p
rices
your
prov
iders
char
ge, a
nd m
any o
ther f
actor
s. Fo
cus o
n the
cost
shar
ing
amou
nts (d
educ
tibles
, cop
ayme
nts an
d coin
sura
nce)
and e
xclud
ed se
rvice
s und
er th
e plan
. Use
this
infor
matio
n to c
ompa
re th
e por
tion o
f co
sts yo
u migh
t pay
unde
r diffe
rent
healt
h plan
s. Pl
ease
note
these
cove
rage
exam
ples a
re ba
sed o
n self
-only
cove
rage
.
23
No
ndis
crim
inat
ion
No
tice
SW
CP_Nondiscrimination_Notice_01/2019_C
ATTE
NTI
ON
: If
you
spea
k En
glish
, lan
guag
e as
sista
nce
serv
ices
, fre
e of
char
ge, a
re av
aila
ble
to y
ou.
Cal
l 1-8
00-3
21-7
947
(TTY
: 711
).Sc
ott &
Whi
te C
are
Plan
s com
plie
s with
appl
icab
le F
eder
al ci
vil r
ight
s law
s and
doe
s not
disc
rimin
ate
on th
e ba
sis o
f rac
e, co
lor,
natio
nal o
rigin
, age
, di
sabi
lity,
or se
x. S
cott
& W
hite
Car
e Plan
s doe
s not
exclu
de p
eopl
e or t
reat
them
diff
eren
tly b
ecau
se o
f rac
e, co
lor,
natio
nal o
rigin
, age
, disa
bilit
y, or
sex.
Scot
t & W
hite
Car
e Pl
ans:
•Pro
vide
s fre
e ai
ds a
nd se
rvic
es to
peo
ple
with
disa
bilit
ies t
o co
mm
unic
ate
effec
tivel
y w
ith u
s, su
ch a
s:-W
ritte
n in
form
atio
n in
oth
er fo
rmat
s (la
rge
prin
t and
acc
essib
le el
ectr
onic
form
ats)
•Pro
vide
s fre
e la
ngua
ge se
rvic
es to
peo
ple
who
se p
rimar
y la
ngua
ge is
not
Eng
lish,
such
as:
-Qua
lified
inte
rpre
ters
-Inf
orm
atio
n w
ritte
n in
oth
er la
ngua
ges
If yo
u ne
ed th
ese
serv
ices
, con
tact
the
Scot
t & W
hite
Car
e Pl
ans C
ompl
ianc
e O
ffice
r at 1
-214
-820
-888
8 or
send
an
emai
l to
SWH
PCom
plia
nceD
epar
tmen
t@BS
WH
ealth
.org
If yo
u be
lieve
that
Sco
tt &
Whi
te C
are
Plan
s has
faile
d to
pro
vide
thes
e se
rvic
es o
r disc
rimin
ated
in a
noth
er w
ay o
n th
e ba
sis o
f rac
e, co
lor,
natio
nal
orig
in, a
ge, d
isabi
lity,
or se
x, y
ou c
an fi
le a
grie
vanc
e w
ith:
Scot
t & W
hite
Car
e Pl
ans,
Com
plia
nce
Offi
cer
1206
Wes
t Cam
pus D
rive,
Suite
151
Tem
ple,
Texa
s 765
02
Com
plia
nce
Hel
pLin
e; 1-
888-
484-
6977
or h
ttps:/
/app
.myc
ompl
ianc
erep
ort.c
om/r
epor
t.asp
x?ci
d=sw
hpYo
u ca
n fil
e a
grie
vanc
e in
per
son
or b
y m
ail,
onlin
e, or
em
ail.
If yo
u ne
ed h
elp
filin
g a
grie
vanc
e, th
e C
ompl
ianc
e O
ffice
r is a
vaila
ble
to h
elp
you.
Yo
u ca
n al
so fi
le a
civi
l rig
hts c
ompl
aint
with
the
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s, O
ffice
for C
ivil
Righ
ts, e
lect
roni
cally
thro
ugh
the
Offi
ce fo
r Civ
il Ri
ghts
Com
plai
nt P
orta
l, av
aila
ble
at h
ttps:/
/ocr
port
al.h
hs.g
ov/o
cr/p
orta
l/lob
by.js
f, or
by
mai
l or p
hone
at:
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s20
0 In
depe
nden
ce A
venu
e, SW
Room
509
F, H
HH
Bui
ldin
gW
ashi
ngto
n, D
.C. 2
0201
1-
800-
368-
1019
, 1-8
00-5
37-7
697
(TD
D)
Com
plai
nt fo
rms a
re av
aila
ble
at h
ttps:/
/ww
w.hh
s.gov
/civ
il-rig
hts/
filin
g-a-
com
plai
nt/in
dex.
htm
l.
24
Lang
uag
e A
ssis
tanc
e/ A
sist
enci
a d
e id
iom
as
SW
CP_LanguageAssistance_11/2
018
Eng
lish:
AT
TEN
TIO
N: I
f you
spea
k En
glis
h, la
ngua
ge a
ssis
tanc
e se
rvic
es, f
ree
of c
harg
e, a
re a
vaila
ble
to y
ou. C
all 1
-800
-321
-794
7 (T
TY: 7
11).
Span
ish:
AT
ENC
IÓN
: Si
hab
la e
spañ
ol, t
iene
a su
dis
posi
ción
serv
icio
s gra
tuito
s de
asis
tenc
ia li
ngüí
stic
a. L
lam
e al
1-8
00-3
21-7
947
(TTY
: 711
).
Vie
tnam
ese:
C
HÚ
Ý:
Nếu
bạn
nói
Tiế
ng V
iệt,
có c
ác d
ịch
vụ h
ỗ trợ
ngô
n ng
ữ m
iễn
phí d
ành
cho
bạn.
Gọi
số 1
-800
-321
-794
7 (T
TY: 7
11).
Chi
nese
: 注
意:如
果 使
用繁
體中
文,可
以免
費獲
得語
言援
助服
務。請
致電
1-80
0-32
1-79
47(T
TY:7
11)。
Kor
ean:
주
의:
한국
어를
사용
하시
는 경
우, 언
어 지
원 서
비스
를 무
료로
이용
하실
수 있
습니
다. 1
-800
-321
-794
7 (T
TY: 7
11) 번
으로
전화
해 주
십시
오.
Ara
bic:
رقم
) 800
-321
-794
7-1
رقمل ب
ص ات
ن.جا
المك ب
ر لواف
تتویة
للغة ا
عدسا
المت
دما خ
إن، ف
غة الل
كر اذ
ثحد
تتت
كنإذا
ة: وظ
لح .م
711
كم:الب
وصم
الف
ھات
Urd
u:
ال۔ ک
ں ہی
بتیا
دسں
میت
مفت
دما خ
کیدد
ی من ک
زباو
پ کو آ
، تیں
ے ہولت
و برد
پ ار آ
اگر:
رداخب
1-8
00-3
21-7
947
(TTY
: 711
). یں
کر
Taga
log:
PAU
NAW
A:
Kun
g na
gsas
alita
ka
ng T
agal
og, m
aaar
i kan
g gu
mam
it ng
mga
serb
isyo
ng
tulo
ng sa
wik
a na
ng w
alan
g ba
yad.
Tum
awag
sa
1-80
0-32
1-79
47 (T
TY: 7
11).
Fren
ch:
ATTE
NTI
ON
: Si
vou
s par
lez
fran
çais
, des
serv
ices
d’a
ide
lingu
istiq
ue v
ous s
ont p
ropo
sés g
ratu
item
ent.
App
elez
le 1
-800
-321
-794
7 (A
TS :
711)
.
Hin
di:
धयान
द:
यदि आ
प हि
दी ब
ोलत
ह तो
आपक
लिए
मफत
म भ
ाषा स
हायत
ा सवा
ए उप
लबध
ह। 1
-800
-321
-794
7 (T
TY: 7
11) प
र कॉल
कर।
Pers
ian:
شما
ی را
ن بگا
رایت
ورص
ی ببان
زت
یالسھ
، تنید
ی کو م
تگ گف
سیار
ن فزبا
بھ ر
اگجھ:
تود.
ریگی
س بتما
1-8
00-3
21-7
947
(TTY
: 711
ا (. ب
شد با
میھم
راف
Ger
man
: A
CH
TUN
G:
Wen
n Si
e D
euts
ch sp
rech
en, s
tehe
n Ih
nen
kost
enlo
s spr
achl
iche
Hilf
sdie
nstle
istu
ngen
zur
Ver
fügu
ng.
Ruf
num
mer
: 1-8
00-3
21-7
947
(TTY
: 711
).
Guj
arat
i: સચ
ના: જ
ો તમ
ગજરાત
ી બોલ
તા હ
ો, તો
નિ:શ
લક ભ
ાષા સ
હાય
સવાઓ
તમા
રા મા
ટ ઉપ
લબધ
છ. ફ
ોન કર
ો 1-
800-
321-
7947
(TTY
: 711
).
Rus
sian
: В
НИ
МА
НИ
Е: Е
сли
вы го
вори
те н
а ру
сско
м яз
ыке
, то
вам
дост
упны
бес
плат
ные
услу
ги п
ерев
ода.
Зво
ните
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25
Scott & White Care Plans2021 Member GuideBSW Plus HMO
Got a question?..........................................................................................................1
Get to know your ID card .....................................................................................2
Explore your member portal .............................................................................3
Download the MyBSWHealth App ..................................................................4
Experience Virtual Care........................................................................................4
Eligibility map..............................................................................................................5
Find a provider............................................................................................................5
Access pharmacy services.................................................................................6
Know your care options ... ....................................................................................7
Better health starts with you.............................................................................9
Naturally Slim® ..........................................................................................................10
Expecting the Best®..............................................................................................10
Get details on your claims .................................................................................11
Stay better, longer .................................................................................................13
Table of Contents
SWCP_GR_BellCountyBSWPlusHMO_MemberGuide_PY2021
HMO products are offered through Scott and White Health Plan and Scott & White Care Plans. Insured PPO and EPO products are offered through Insurance Company of Scott and White. All are Texas registered insurance companies. Scott & White Care Plans and Insurance Company of Scott and White are wholly owned subsidiaries of Scott and White Health Plan.
26
1
Got a question? Our highly trained Customer Advocates can help you with things like finding a provider and answering questions about your benefits or claims. Whatever your question or concern may be, our Customer Advocates will work with you to resolve it as quickly as possible—in most cases, before you hang up the phone.
Contact us through the member portalLog in at bellcounty.swhp.org to send a secure email and receive a secure response.
Nurse Advice LineNurses are available 24/7 to talk through your symptoms and help you make decisions on next steps, whether that’s an appointment or an at-home remedy. The Nurse Advice Line phone number is on the back of your member ID card.
Welcome to Scott & White Care Plans!Welcome to Scott & White Care Plans (SWCP), a wholly owned subsidiary of Scott and White Health Plan, and part of the Baylor Scott & White family of companies. With Scott & White Care Plans, you will have access to the renowned doctors, specialists and facilities of the Baylor Scott & White Health system. Baylor Scott & White Health (BSWH) provides full-range, inpatient, outpatient, rehabilitation and emergency medical services.
Beyond the Baylor Scott & White Health system, Scott & White Care Plans offers access to thousands of providers throughout North, Central and West Texas to ensure members have plenty of in-network options for care. You’ll find useful information about what we have to offer in this booklet—and if you have questions, we’re happy to answer them.
Contact us by phone 844.633.5325 7 AM – 7 PM Monday – Friday
27
2
The ID card above is a sample. The exact location of certain elements may vary on your card.
Get to know your member ID card
1
2
3
45
6
7
8
Group name
Group ID number
Network name
Benefit effective date
Member name
Member ID number
Copays/coinsurance
Deductible
Pharmacy/prescription drug info9
Customer service phone number
24/7 Nurse Line
Information for providers
Claims mailing address
A
B
C
D
You can request a replacement ID card through the member portal oraccess an electronic card at any time through the MyBSWHealth app.
1 2
7
4
8 3
TDI
SUBSCRIBERJohn Sample
DOB: 00/00/0000
DEPENDENTSJane SampleJack SampleJill SampleJames SampleJulie SampleJoe SampleJackie Sample
MEMBER ID 00000000000
00000000000000000000000000000000000000000000000000000000000000000000000000000
IN-NETWORK PLAN BENEFITSAdult PCP/Spec: 00%Pediatric PCP/Spec: 00% Emergency Room: 00%* Coinsurance:
N/A Deductible: I/$0000 F/$0000 Rx: 00%*Deductible:
I/$500, F/$1000PHARMACISTS ONLYOptumRx® Help Desk: 855-205-9182BIN: 610011 PCN: IRX GRP:
Group: Group #: 000000Network:
*Deductible may apply.
3
1
4
2
5 6 7
9
8
bellcounty.swhp.org
Bell County
SWPBSWCP
billing, find a provider at swhp.org
Self-service portal: ers.swhp.orgSWHP24/7 Nurse Line 1-000-000-0000
(TTY: 711)
00/00/0000
FOR PROVIDERSElectronic Claims:Availity: 94999
Paper Claims:Scott and White Health PlanPO Box 211342Eagan, MN 55121
Prior Authorization: Visit the provider portal Fax: 800-626-3042 Phone: 866-384-3488
Provider Portal:
Card Issue Date: 08/01/2020
FOR MEMBER S
not guarantee coverage or payment for the service or procedure reviewed.
Important Information:• In a medical emergency, call 9-1-1 or go to the nearest
emergency facility.
• Telehealth: Download the MyBSWHealth App• 24/7 Nurse Line: 877-505-7947• Self-Service Portal: my.bswhealth.com• To avoid out-of-network costs and provider balance
DC
AB
CUSTOMER SERVICE: 844.633.5325 bellcounty.swhp.org
billing, find a provider at bellcounty.swhp.org
Customer Service: 844-633-5325 (TTY/TDD: 7-1-1)•
28
3Explore your member portalThere’s a wealth of information, resources, and functionality available 24/7 in our member portal, accessible from your computer or mobile device. You’ll find a link to the portal on our website: bellcounty.swhp.org.
Download and/or print:
ID cards
Benefit Plan Documents
Claims summaries and Explanations of Benefits
Prescription medication history
Drug formulary
Pending, approved and denied authorizations
Plus you can:
Find a provider
Make an appointment with a BSWH doctor
Complete a health assessment
Access virtual care options (eVisit and Video Visit)
Track your deductible and out-of-pocket maximum
Message your BSWH doctor
Refill a prescription at BSWH pharmacies
Verify eligibility
View/update demographic information
Learn about, and register for, theExpecting the Best® Maternity Program
29
Download the MyBSWHealth appVirtually all of the information in the member portal is available on your phone through the MyBSWHealth app. For example, you can view a digital copy of your ID card, see plan details, and track your deductible and out-of-pocket maximum for yourself and your dependents. Use the same user name and password you set up for the member portal to log in to the app. To learn more, visit our website: bellcounty.swhp.org
Be sure to link your account in the app:
Experience virtual care $0 copay
1. Tap the gear icon (top right corner of app welcome screen)2. Tap “Manage Linked Accounts”3. Tap “Link Account”4. Enter member information
Conduct an eVisit for common medical conditions and get care fast
Click the eVisit icon under "URGENT CARE OPTIONS" Complete an online questionnare about your symptoms; it takes only 5-10 minutes You will get a response from a Baylor Scott & White Health provider within one hour Prescriptions (if needed) will be sent immediately to your preferred pharmacy
Schedule a same-day Video Visit with a provider, face-to-face
Click the video visit icon under “URGENT CARE OPTIONS” to schedule your appointment Talk with a Baylor Scott & White Health provider live about your symptoms Visits are quick: just 10-15 minutes Prescriptions (if needed) will be sent immediately to your preferred pharmacy
MyBSWHealth 8 AM - 8 PM CT, 7 days a week Receive care from the comfort of your home, or anywhere in Texas, at no cost to you.
4
30
5
Find a ProviderOur provider search tool at bellcounty.swhp.org allows you to:
• Search by name, specialty and/or ZIP code
• Add filters for gender, board certification, accepting new patients and more
• See practice locations, contact information and maps
• Get details, including network participation and hospital affiliations
• Customize your own profile
Go to bellcounty.swhp.org and click on “Find a Provider-BSW Plus HMO” and you will be on your way.
If you live or work in one of the blue counties, you are eligible to participate in the BSW Plus HMO Plan.
2021 Service Area BSW Plus HMO
Sevice Area
31
Access pharmacy servicesSWCP members may access more than 68,000 pharmacies nationwide, including most national chains and a large selection of local pharmacies.
To find your nearest pharmacy, click here:
We also offer 90-day prescription refills for select medications at Baylor Scott & White Health pharmacies.
Get the convenience of home delivery with mail order service. Call our mail order pharmacy and we will walk you through the transfer process.
Call toll-free at 855.388.3090 Monday through Friday, from 7 AM to 7 PM CT, and on Saturday, from 9 AM to 1 PM CT.
If you need detailed pharmacy claim information, pharmacy deductible information, explanation of benefits, or drug information and pricing, visit bellcounty.swhp.org or call Customer Service at 844.633.5325.
To view a formulary (a list of covered drugs), click here:
PHARMACY SEARCH
FORMULARY
32
Visit your Primary Care Physicianwhen you’re sick or have a minor injury1
Your doctor knows your health history and underlying conditions. For routine illnesses and less significant injuries, many doctors’ offices are open on weekends and some evenings. This can be a good alternative to more costly urgent care or emergency care centers. Although a Primary Care Physician is not required, we encourage you to establish a relationship with a doctor.
If your doctor’s office is closed, consider an Urgent Care center2
Urgent Care centers typically have extended and weekend hours. Although costs are higher than primary care, urgent care copays are lower than those for emergency care.
Know your care optionsHow do you decide when a health-related issue is an emergency? Understanding your healthcare options can save your life... and your money.
Or opt for Virtual Care — or our Nurse Advice LineSee page 4 for information on Virtual Care. Nurses are available to our members 24 hours a day, 365 days a year. Our nurses provide information about taking care of yourself at home or they can help you decide if an appointment, an urgent care visit, or an emergency room visit is best for your symptoms. To locate your appropriate Nurse Advice Line phone number, please look on the back of your member card or log in to the Member Portal.
7
33
back to top
If you need to speak to us, contact us in the way that works for you. In addition to the Member Portal, customer support is available by phone at 844.633.5325.
Scott & White Care Plans pays out-of-network emergency services according to Usual and Customary rates (industry standard), and members can be balance-billed for expenses beyond what insurance will pay. Your coverage documents contain additional information about emergency treatment and definitions of the terms, including a definition of emergency care. The coverage documents also contain information related to state-mandated consumer protections for facility-based provider charges.
To save on out-of-pocket costs, visit in-network emergency care facilities when possible. You can find in-network emergency care facilities by using the provider search tool at bellcounty.swhp.org.
Remember: Out-of-network emergency care costs more
Emergency Roomsare best for treating severe and life-threatening conditions and they’re always open.3
The wider range of services offered through emergency rooms, and the hospitals they are connected to, makes emergency care a more expensive option, but sometimes the best option for you.
It’s important to understand your options, and to use your best judgment when deciding which option is right for you.
8
34
Assessment for Members
9
WELL-BEING ASSESSMENTThe Well-Being Assessment is a simple, digital health survey that helps you take steps toward a more vibrant and healthier life. The Well-Being Assessment asks questions about your life and delivers customized action steps from our Lifestyle Management Program. Modules are self-paced, available online, and convenient for promoting physical and mental health — all things to help you feel your best.
Digital Health Coaching – 6-week coaching modules with action plans, important articles, online seminars and video content on topics that include:
• Live Tobacco Free• Healthy Weight
Progress Tracker – The digital platform has a dashboard to help you keep track of important health information like A1C, weight/BMI, cholesterol, blood pressure and physical activity. These biometric measurements can be charted over time to monitor your long-term health.
Fitness Tracker Integration – Synchronize your personal fitness tracker with the wellness platform to monitor your physical activity progress on the dashboard.
Digital Health Library – Access to articles, videos, recipes and other content to support a healthier life. You can search for condition-specific information or explore highlighted topics.
Challenges – Sometimes you need extra motivation to go the extra mile. You can participate in step challenges, hydration and even relaxation challenges.
Online Community – Access to online community forums where you can give and receive support for goals as well as get feedback from health coaches in the community.
• Healthier Diet• Active Living
Elevate your well-being with Scott & White Care Plans’ comprehensive suite of digital resources. Log in to your member portal to get started.
• Less Stress
Better health starts with you
35
Expecting the Best® Maternity ProgramWe are pleased to offer a maternity program for pregnant Scott & White Care Plans members. This initiative is focused on helping expectant mothers enjoy a healthy pregnancy.
Once enrolled, participants can benefit from diverse program features for the duration of their pregnancy and one year postpartum.Participants receive helpful educational materials across distinct categories, including proper nutrition, early identification of pregnancy risk factors and available resources for any complications.
Sign up by calling the customer service number on the back of your ID card or send an email to: [email protected].
Ever wonder how some people can eat all their favorite foods and not gain weight? Naturally Slim is an online program that will teach you how. And here’s a hint: it doesn’t include starving, counting calories or spending hours prepping ‘approved’ foods. SWCP is giving you the chance to learn how to eat the foods you love while reducing your risk of developing serious conditions, like diabetes or heart disease.
Naturally Slim is available at NO COST to you and is accessible via computer and mobile device so you can participate whenever it’s convenient, wherever you are.
For more information about Naturally Slim, visit bellcounty.swhp.org
You don’t have to give up your favorite foods to lose weight and feel your best.
36
11
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (800) 321-7947 (TTY: 711).
Scott & White Care Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (800) 321-7947 (TTY: 711).
Scott & White Care Plans cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số (800) 321-7947 (TTY: 711).
Scott & White Care Plans tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính.
Allowed Amount -This is the amount considered for payment based on our provider contracts and your benefits.
Amount Billed -This is the amount your provider billed for the services you requested. Note: this amount does not reflect discounts that the plan has negotiated with the provider or facility.
Amount Paid -This is the amount we paid to you or your provider.
Copay -This represents the amount you are responsible to pay for certain services, typically paid at the time of service.
Coinsurance - The coinsurance is a percentage of the “allowed amount” you are responsible for paying for services after your deductible is met. Providers may require payment when you receive services.
Deductible - A fixed-dollar amount the member is responsible for paying each plan year before the plan begins to pay for covered services. Note: “Non-Covered” amounts don’t count toward meeting the yearly deductible. Your provider may bill you for these charges.
Discount Amount -The amount you saved by using the plan’s preferred providers.
Non-Covered Amount - An amount you are responsible for paying because it is for a service that is not covered by your benefit plan. Also, if you’ve used an out-of-network provider, “non-covered amount” includes any amount the out-of-network provider bills in excess of the plan-negotiated network rates.
Other Coverage Payment -This is the amount paid by your other insurance carrier.
Out-of-Pocket Maximum -The most you have to pay for in-network health services every year. Once you have paid this amount, the Health Plan typically pays 100% of your allowed health care charges, subject to any policy limitations.
Helpful Definitions
If you suspect fraud, contact the Scott and White Health Plan Compliance HelpLine at (888) 484-6977.
Report Fraud
Language Assistance/ Nondiscrimination Notice
Get details on your claimswith your monthly insurance statement
Subscriber: John Smith
Member ID: 12345678
Group Name: SampleCompany Inc.
Group Number: 012345
Now...the Detailed VersionHere’s a detailed breakdown or Explanation of Benefits for this service. In case there’s any doubt - this is NOT a bill!
Notes:IJ THE PROVIDER IS NOT IN NETWORK AND/OR THERE IS NO AUTH ON FILE*If you elected to use your out-of-network benefit, the provider or facility may bill you for an amount greaterthan the amount reimbursed by the Health Plan. Out-of-network providers or facilities may not bill you foran amount greater than the copay/coinsurance/deductible indicated above in the following circumstances:emergency care services, treatment from an out-of-network provider while receiving services at an in-networkfacility, or for out-of network imaging or laboratory services if related to treatment from an in-network provider.
Patient: Ann SmithClaim Number: 123x456x788Provider: Test Provider 1
Out-of-Network*
Date of Service Description Amount
BilledAllowed Amount
Non-Covered Amount
Other Coverage Payment
Plan Paid Copay Deductible Coinsurance What You May Owe Notes
2/04/20 Emergency Dept Visit $1000.00 $500.00 $0.00 $0.00 $400.00 $100.00 $0.00 $0.00 $100.00 IJ
Total $1000.00 $500.00 $0.00 $0.00 $400.00 $100.00 $0.00 $0.00 $100.00
Patient: Ann SmithClaim Number: 123x456x789Provider: Test Provider 2
In-Network
Date of Service Description Amount
BilledAllowed Amount
Non-Covered Amount
Other Coverage Payment
Plan Paid Copay Deductible Coinsurance What You May Owe Notes
2/04/20 Office Visit $250.00 $150.00 $0.00 $0.00 $100.00 $50.00 $0.00 $0.00 $50.00
Total $250.00 $150.00 $0.00 $0.00 $100.00 $50.00 $0.00 $0.00 $50.00
QUESTIONS?
Customer service: (800) 321-7947 Hours: 7 a.m. to 7 p.m. CT
Website: swhp.org
Explanation of BenefitsThis is NOT a bill
1206 West Campus DriveTemple, TX 76502
Forwarding Service Requested
Member ID: 12345678Group Number: 012345Group Name: Sample Company Inc.Print date: 02/18/2020
John Smith789 TEST STREETREDCARD, MO 63141
Hi John,This document summarizes your recent benefit activity. It confirms the amount charged by your provider(s) and the amount we paid for those charges.
Cost breakdown
Amount billed: $1250.00
Plan discount: $600.00
Plan paid: $500.00
Not covered: $0.00
What you may owe
$150.00This is the portion of the billed amount you may
owe the provider(s) if payment was not collected at thetime of service. This amount may include
your deductible, copay, coinsurance, and/or non-covered amount.
Account Summary
Place holder for misc. communications
TotalAmount
AppliedAmount
Family Deductible
Family Out-of-pocket max$1,500.00
$2,477.84
$3,000.00($1,500.00 remaining)
$4,500.00($2,022.16 remaining)
Member Deductible
Member Out-of-pocket max
$250.00
$199.71
$1,500.00($1,250.00 remaining)
$2,250.00($2,050.29 remaining)
An electronic Monthly Insurance Statement, also known as an Explanation of Benefits (EOB), is available through the Member Portal an to help you manage your claims expenses at a detailed level. The statement provides line-item detail on charges for that month, including what was billed and covered by SWCP. The amount you owe is included in this statement.
Remaining balances for deductibles and out-of-pocket expenses are also reported. Information for the current month and year-to-date is included. Statements are not provided for prescription claims or claims where the member does not owe anything.
Your EOBs will be available on the Member Portal unless you specifically request to receive paper EOBs in the mail. To request paper EOBs, log in to the Member Portal and select “Update Preferences.”
37
Complex Case Management
If you have chronic conditions or complex care needs, our nurse case managers will work with you, your family, and your physician to create and manage your care plan. Case managers advocate for you and can help you navigate the healthcare system and arrange the services you need. They can also answer questions and help you understand your condition and care plan. If Disease Management is right for you, they’ll incorporate the program into your care. There is no additional cost to you for this voluntary program. It’s all part of our goal to help you get the best possible results and the greatest value from your health plan.
Members can access the program by calling 888.360.1555.
Disease Management
Disease Management empowers you to manage your chronic condition and help prevent complications. We work with your healthcare providers to identify chronic conditions quickly and treat them effectively. We can also identify self-care activities that help you manage your condition at home. Together, we’ll work to slow down the progression of your disease and help you stay better, longer.
For more information, please log in to the Member Portal, select Wellness Programs and request a screening to see if Complex Case Management is the right program for your needs.
Stay better, longer
38
HMO products are offered through Scott and White Health Plan and Scott & White Care Plans. Insured PPO and EPO products are offered through Insurance Company of Scott and White. All are Texas registered insurance companies. Scott & White Care Plans and Insurance Company of Scott and White are wholly owned subsidiaries of Scott and White Health Plan.
Thank you for choosing Scott & White Care Plans for your healthcare coverage needs.
39
The
Sum
mar
y of
Ben
efits
and
Cov
erag
e (S
BC) d
ocum
ent w
ill he
lp y
ou c
hoos
e a
healt
h pl
an. T
he S
BC s
hows
you
how
you
and
the
plan
wou
ld
shar
e the
cost
for c
over
ed h
ealth
care
serv
ices.
NOTE
: Inf
orm
atio
n ab
out t
he co
st o
f thi
s plan
(call
ed th
e pre
miu
m) w
ill be
pro
vided
sepa
rate
ly.
This
is on
ly a
sum
mar
y. Fo
r mor
e inf
orma
tion
abou
t you
r cov
erag
e, or
to g
et a
copy
of t
he c
omple
te ter
ms o
f cov
erag
e, vis
it be
llcou
nty.sw
hp.or
g or
call
1-
844-
633-
5325
. For
gen
eral
defin
itions
of c
ommo
n ter
ms, s
uch
as a
llowe
d am
ount,
bala
nce
billin
g, co
insur
ance
, cop
ayme
nt, d
educ
tible,
pro
vider
, or
other
unde
rlined
term
s see
the G
lossa
ry. Y
ou ca
n view
the G
lossa
ry at
healt
hcar
e.gov
/sbc-g
lossa
ry or
call 1
-844
-633
-532
5 to r
eque
st a c
opy.
Impo
rtant
Que
stio
ns
Answ
ers
Why
Thi
s Mat
ters
:
Wha
t is t
he o
vera
ll de
duct
ible?
$1
,250 i
ndivi
dual
/ $2,5
00 fa
mily
Gene
rally
, you
mus
t pay
all o
f the c
osts
from
prov
iders
up to
the d
educ
tible
amou
nt be
fore
this p
lan be
gins t
o pay
. If yo
u hav
e othe
r fam
ily m
embe
rs on
the p
lan, e
ach f
amily
me
mber
mus
t mee
t their
own i
ndivi
dual
dedu
ctible
until
the to
tal am
ount
of de
ducti
ble
expe
nses
paid
by al
l fami
ly me
mber
s mee
ts the
over
all fa
mily
dedu
ctible
.
Are t
here
serv
ices
cove
red
befo
re yo
u m
eet
your
ded
uctib
le?
Yes.
Pre
venti
ve ca
re an
d prim
ary c
are
servi
ces a
re co
vere
d befo
re yo
u mee
t yo
ur de
ducti
ble.
This
plan c
over
s som
e item
s and
servi
ces e
ven i
f you
have
n’t ye
t met
the de
ducti
ble
amou
nt. B
ut a c
opay
ment
or co
insur
ance
may
apply
. For
exam
ple, th
is pla
n cov
ers c
ertai
n pr
even
tive s
ervic
es w
ithou
t cos
t-sha
ring a
nd be
fore y
ou m
eet y
our d
educ
tible.
See
a lis
t of
cove
red p
reve
ntive
servi
ces a
t hea
lthca
re.go
v/cov
erag
e/pre
venti
ve-ca
re-b
enefi
ts.
Are t
here
oth
er
dedu
ctib
les fo
r spe
cific
serv
ices?
No
Yo
u don
’t hav
e to m
eet d
educ
tibles
for s
pecif
ic se
rvice
s.
Wha
t is t
he o
ut-o
f-poc
ket
limit
for t
his p
lan?
$3,75
0 ind
ividu
al / $
7,500
fami
ly Th
e out-
of-po
cket
limit i
s the
mos
t you
could
pay i
n a ye
ar fo
r cov
ered
servi
ces.
If you
ha
ve ot
her f
amily
mem
bers
in thi
s plan
, they
have
to m
eet th
eir ow
n out-
of-po
cket
limits
un
til the
over
all fa
mily
out-o
f-poc
ket li
mit h
as be
en m
et.
Wha
t is n
ot in
clude
d in
th
e out
-of-p
ocke
t lim
it?
Copa
ymen
ts on
certa
in se
rvice
s, pr
emium
s, ba
lance
-billi
ng ch
arge
s, an
d he
alth c
are t
his pl
an do
es no
t cov
er.
Even
thou
gh yo
u pay
thes
e exp
ense
s, the
y don
’t cou
nt tow
ard t
he ou
t–of–p
ocke
t limi
t.
Will
you
pay l
ess i
f you
us
e a n
etwo
rk p
rovid
er?
Yes.
See b
ellco
unty.
swhp
.org o
r call
1-
844-
633-
5325
for a
list o
f netw
ork
prov
iders.
This
plan u
ses a
prov
ider n
etwor
k. Yo
u will
pay l
ess i
f you
use a
prov
ider in
the p
lan’s
netw
ork.
You w
ill pa
y the
mos
t if yo
u use
an ou
t-of-n
etwor
k pro
vider
, and
you m
ight
rece
ive a
bill fr
om a
prov
ider f
or th
e diffe
renc
e betw
een t
he pr
ovide
r’s ch
arge
and w
hat
your
plan
pays
(bala
nce b
illing
). Be
awar
e, yo
ur ne
twor
k pro
vider
migh
t use
an ou
t-of-
netw
ork p
rovid
er fo
r som
e ser
vices
(suc
h as l
ab w
ork).
Che
ck w
ith yo
ur pr
ovide
r befo
re
you g
et se
rvice
s. Do
you
need
a re
ferra
l to
see a
spec
ialist
? No
Yo
u can
see t
he sp
ecial
ist yo
u cho
ose w
ithou
t a re
ferra
l.
40
All c
opay
men
t and
coin
sura
nce c
osts
show
n in t
his ch
art a
re af
ter yo
ur d
educ
tible
has b
een m
et, if
a ded
uctib
le ap
plies
.
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u vis
it a h
ealth
ca
re p
rovid
er’s
offic
e or
clin
ic
Prim
ary c
are v
isit to
trea
t an
injur
y or il
lness
$3
0 cop
ayme
nt/vis
it No
t cov
ered
No
ne
Sp
ecial
ist vi
sit
$30 c
opay
ment/
visit
Not c
over
ed
Prev
entiv
e ca
re/sc
reen
ing/
immu
nizati
on
No ch
arge
No
t cov
ered
Yo
u may
have
to pa
y for
servi
ces t
hat a
ren’t
pr
even
tive.
Ask y
our p
rovid
er if
the se
rvice
s ne
eded
are p
reve
ntive
. The
n che
ck w
hat y
our
plan w
ill pa
y for
.
If yo
u ha
ve a
test
Diag
nosti
c tes
t (X-
ray,
blood
wor
k) No
char
ge
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
Imag
ing (C
T/PE
T sc
ans,
MRIs)
20
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
If yo
u ne
ed d
rugs
to
treat
your
illne
ss o
r co
nditi
on
More
infor
matio
n abo
ut pr
escr
iptio
n dr
ug
cove
rage
is av
ailab
le at
bellc
ounty
.swhp
.org/p
harm
acy-i
nform
ation
.
ACA
Prev
entiv
e Dru
gs
$0 co
paym
ent/p
resc
riptio
n De
ducti
ble do
es no
t app
ly No
t cov
ered
Copa
ymen
ts ar
e per
30-d
ay su
pply.
Ma
inten
ance
-elig
ible d
rugs
are a
llowe
d up t
o a
90-d
ay su
pply
for tw
o cop
ayme
nts if
obtai
ned
throu
gh a
Baylo
r Sco
tt & W
hite P
harm
acy o
rpa
rticipa
ting 9
0-da
y reta
il or m
ail or
der
phar
macy
prov
ider.
Mail O
rder
: Ava
ilable
for a
1- to
90-d
ay su
pply.
Non-
maint
enan
ce dr
ugs o
btaine
d thr
ough
orde
r are
limite
d to a
30-d
ay su
pply
maxim
um.
Some
Spe
cialty
drug
s may
requ
ire pr
iorau
thoriz
ation
. 30-
day s
upply
only.
Tier 1
: Pre
ferre
d Gen
eric
Drug
s $1
0 cop
ayme
nt/pr
escri
ption
De
ducti
ble do
es no
t app
ly No
t cov
ered
Tier 2
: Pre
ferre
d Bra
nd
Name
Dru
gs
$40 c
opay
ment/
pres
cripti
on
Dedu
ctible
does
not a
pply
Not c
over
ed
Tier 3
: Non
-Pre
ferre
d Ge
neric
/ Bra
nd N
ame
Drug
s
The l
esse
r of $
100
copa
ymen
t or 5
0%
copa
ymen
t De
ducti
ble do
es no
t app
ly No
t cov
ered
Spec
ialty
Drug
s T1
: 10%
of ch
arge
s T2
: 20%
of ch
arge
s T3
: 30%
of ch
arge
s De
ducti
ble do
es no
t app
ly No
t cov
ered
41
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u ha
ve o
utpa
tient
su
rger
y
Facil
ity fe
e (e.g
., am
bulat
ory s
urge
ry ce
nter)
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
Refer
to be
llcou
nty.sw
hp.or
g or
Custo
mer S
ervic
e at 1
-844
-633
-532
5.
Phys
ician
/surg
eon f
ees
20%
after
dedu
ctible
No
t cov
ered
If yo
u ne
ed im
med
iate
med
ical a
ttent
ion
Emer
genc
y roo
m ca
re
$250
copa
ymen
t/visi
t, plus
20
% of
char
ges
$250
copa
ymen
t/visi
t, the
n 20
% of
char
ges
Copa
ymen
t waiv
ed if
episo
de re
sults
in
hosp
italiz
ation
for t
he sa
me co
nditio
n with
in 24
ho
urs.
Emer
genc
y med
ical
trans
porta
tion
20%
after
dedu
ctible
20
% af
ter de
ducti
ble
None
Ur
gent
care
$7
5 cop
ayme
nt/vis
it $7
5 cop
ayme
nt/vis
it
If yo
u ha
ve a
hosp
ital
stay
Facil
ity fe
e (e.g
., hos
pital
room
) 20
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Ph
ysici
an/su
rgeo
n fee
s 20
% af
ter de
ducti
ble
Not c
over
ed
If yo
u ne
ed m
enta
l he
alth,
beh
avio
ral
healt
h, o
r sub
stan
ce
abus
e ser
vices
Outpa
tient
servi
ces
$30 c
opay
ment/
visit
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
Inpati
ent s
ervic
es
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
If yo
u ar
e pre
gnan
t
Offic
e visi
ts $3
0 cop
ayme
nt/vis
it No
t cov
ered
Cost
shar
ing do
es no
t app
ly for
prev
entiv
e se
rvice
s. De
pend
ing on
the t
ype o
f ser
vices
, a
copa
ymen
t, coin
sura
nce,
or de
ducti
ble m
ay
apply
. Mate
rnity
care
may
inclu
de te
sts an
d se
rvice
s des
cribe
d else
wher
e in t
he S
BC (i.
e. ult
raso
und)
. Ch
ildbir
th/de
liver
y pr
ofess
ional
servi
ces
20%
after
dedu
ctible
No
t cov
ered
Th
e hea
lth pl
an m
ust b
e noti
fied o
f the
deliv
ery.
If a le
ngth
of sta
y for
an
unco
mplic
ated d
elive
ry ex
ceed
s 48 h
ours
for
vagin
al, or
96 ho
urs f
or ca
esar
ean,
prea
uthor
izatio
n is r
equir
ed. F
ailur
e to n
otify
or
prea
uthor
ize, w
hen r
equir
ed, m
ay re
sult o
f a
denia
l of th
e ser
vice.
Refer
to
bellc
ounty
.swhp
.org o
r Cus
tomer
Ser
vice a
t 1-
844-
633-
5325
.
Child
birth/
deliv
ery f
acilit
y se
rvice
s 20
% af
ter de
ducti
ble
Not c
over
ed
42
Com
mon
Me
dica
l Eve
nt
Serv
ices Y
ou M
ay N
eed
Wha
t You
Will
Pay
Lim
itatio
ns, E
xcep
tions
, & O
ther
Impo
rtant
In
form
atio
n Ne
twor
k Pro
vider
(Y
ou w
ill pa
y the
leas
t) Ou
t-of-N
etwo
rk P
rovid
er
(You
will
pay t
he m
ost)
If yo
u ne
ed h
elp
reco
verin
g or
hav
e ot
her s
pecia
l hea
lth
need
s
Home
healt
h car
e $3
0 cop
ayme
nt/vis
it No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
Reha
bilita
tion s
ervic
es
$30 c
opay
ment/
visit
Not c
over
ed
Limite
d to 2
0 com
bined
PT/
OT/S
P ou
tpatie
nt vis
its an
d an a
dditio
nal 1
0 visi
ts for
Hom
e Se
tting p
er pl
an ye
ar. L
imits
may
not a
pply
for
Ther
apies
for C
hildr
en w
ith D
evelo
pmen
tal
Delay
s and
Auti
sm S
pectr
um D
isord
er.
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Habil
itatio
n ser
vices
$3
0 cop
ayme
nt/vis
it No
t cov
ered
Limite
d to 2
0 com
bined
PT/
OT/S
P ou
tpatie
nt vis
its an
d an a
dditio
nal 1
0 visi
ts for
Hom
e Se
tting p
er pl
an ye
ar. L
imits
may
not a
pply
for
Ther
apies
for C
hildr
en w
ith D
evelo
pmen
tal
Delay
s and
Auti
sm S
pectr
um D
isord
er.
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Skille
d nur
sing c
are
20%
after
dedu
ctible
No
t cov
ered
Se
rvice
s tha
t are
not p
reau
thoriz
ed w
ill be
de
nied.
Dura
ble m
edica
l eq
uipme
nt 50
% af
ter de
ducti
ble
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d.
Hosp
ice se
rvice
s No
char
ge
Not c
over
ed
Servi
ces t
hat a
re no
t pre
autho
rized
will
be
denie
d. Re
fer to
bellc
ounty
.swhp
.org o
r Cu
stome
r Ser
vice a
t 1-8
44-6
33-5
325.
If yo
ur ch
ild n
eeds
de
ntal
or ey
e car
e
Child
ren’s
eye e
xam
$30 c
opay
ment/
visit
Not c
over
ed
Limite
d to o
ne ey
e exa
m pe
r plan
year
.
Child
ren’s
glas
ses
Not c
over
ed
Not c
over
ed
None
Child
ren’s
denta
l che
ck-
up
Not c
over
ed
Not c
over
ed
None
43
Exclu
ded
Serv
ices &
Oth
er C
over
ed S
ervic
es:
Serv
ices Y
our P
lan G
ener
ally D
oes N
OT C
over
(Che
ck yo
ur p
olicy
or p
lan d
ocum
ent f
or m
ore i
nfor
mat
ion
and
a list
of a
ny o
ther
exclu
ded
serv
ices.)
•
Acup
unctu
re•
Baria
tric su
rger
y•
Child
ren’s
glas
ses
•Co
smeti
c sur
gery
•De
ntal c
are (
Adult
and C
hild)
•Inf
ertili
ty tre
atmen
t•
Long
-term
care
•No
n-em
erge
ncy c
are w
hen t
rave
ling o
utside
the U
.S.
•Pr
ivate-
duty
nursi
ng•
Routi
ne fo
ot ca
re•
Weig
ht los
s pro
gram
s
Othe
r Cov
ered
Ser
vices
(Lim
itatio
ns m
ay ap
ply t
o th
ese s
ervic
es. T
his i
sn’t
a com
plet
e list
. Plea
se se
e you
r plan
doc
umen
t.)
•Ch
iropr
actic
care
(limi
ted to
35 vi
sits p
er pl
an ye
ar)
•He
aring
aids
(limi
ted to
one d
evice
per e
ar ev
ery 3
year
s; lim
ited t
o cov
ered
mem
bers
throu
gh th
e age
of 18
)•
Routi
ne ey
e car
e (Ad
ult) (
limite
d to a
n ann
ual e
ye ex
am co
nduc
ted by
a lic
ense
d oph
thalm
ologis
t or o
ptome
trist)
Your
Rig
hts t
o Co
ntin
ue C
over
age:
The
re ar
e age
ncies
that
can h
elp if
you w
ant to
conti
nue y
our c
over
age a
fter it
ends
. The
conta
ct inf
orma
tion f
or th
ose
agen
cies i
s: Sc
ott &
Whit
e Car
e Plan
s, vis
it swh
p.org
, or c
all 1-
844-
633-
5325
; Dep
artm
ent o
f Lab
or’s
Emplo
yee B
enefi
ts Se
curity
Adm
inistr
ation
at 1-
866-
444-
EBSA
(3
272)
or do
l.gov
/ebsa
/healt
hrefo
rm. O
ther c
over
age o
ption
s may
be av
ailab
le to
you t
oo, in
cludin
g buy
ing in
dividu
al ins
uran
ce co
vera
ge th
roug
h the
Hea
lth
Insur
ance
Mar
ketpl
ace.
For m
ore i
nform
ation
abou
t the M
arke
tplac
e, vis
it Hea
lthCa
re.go
v or c
all 1-
800-
318-
2596
.
Your
Grie
vanc
e and
App
eals
Righ
ts: T
here
are a
genc
ies th
at ca
n help
if yo
u hav
e a co
mplai
nt ag
ainst
your
plan
for a
denia
l of a
claim
. This
comp
laint
is ca
lled a
gr
ievan
ce or
appe
al. F
or m
ore i
nform
ation
abou
t you
r righ
ts, lo
ok at
the e
xplan
ation
of be
nefits
you w
ill re
ceive
for t
hat m
edica
l clai
m. Y
our p
lan do
cume
nts al
so
prov
ide co
mplet
e info
rmati
on to
subm
it a cl
aim, a
ppea
l, or a
griev
ance
for a
ny re
ason
to yo
ur pl
an. F
or m
ore i
nform
ation
abou
t you
r righ
ts, th
is no
tice,
or as
sistan
ce,
conta
ct: S
cott &
Whit
e Car
e Plan
s, vis
it swh
p.org
, or c
all 1-
844-
633-
5325
; Tex
as D
epar
tmen
t of In
sura
nce,
visit t
di.tex
as.go
v or c
all 1-
800-
578-
4677
; Dep
artm
ent o
f La
bor’s
Emp
loyee
Ben
efits
Secu
rity A
dmini
strati
on at
1-86
6-44
4-EB
SA (3
272)
or do
l.gov
/ebsa
/healt
hrefo
rm, T
exas
Dep
artm
ent o
f Insu
ranc
e Tex
as H
ealth
Opti
ons a
t 1-
800-
252-
3439
or te
xash
ealth
optio
ns.co
m.
Does
this
plan
pro
vide M
inim
um E
ssen
tial C
over
age?
Yes
If y
ou do
n’t ha
ve M
inimu
m Es
senti
al Co
vera
ge fo
r a m
onth,
you’l
l hav
e to m
ake a
paym
ent w
hen y
ou fil
e you
r tax
retur
n unle
ss yo
u qua
lify fo
r an e
xemp
tion f
rom
the
requ
ireme
nt tha
t you
have
healt
h cov
erag
e for
that
month
.
Does
this
plan
mee
t the
Min
imum
Valu
e Sta
ndar
ds?
Yes
If y
our p
lan do
esn’t
mee
t the M
inimu
m Va
lue S
tanda
rds,
you m
ay be
eligi
ble fo
r a pr
emium
tax c
redit
to he
lp yo
u pay
for a
plan
thro
ugh t
he M
arke
tplac
e.
Lang
uage
Acc
ess S
ervic
es:
Span
ish (E
spañ
ol): P
ara o
btene
r asis
tencia
en E
spañ
ol, lla
me al
1-84
4-63
3-53
25.
––––
––––
––––
––––
––––
––To
see
exam
ples o
f how
this
plan
migh
t cov
er co
sts fo
r a sa
mple
med
ical s
ituat
ion, s
ee th
e ne
xt se
ction
.–––
––––
––––
––––
––––
–––
44
Peg
is Ha
ving
a Bab
y (9
mon
ths of
in-n
etwor
k pre
-nata
l car
e and
a ho
spita
l deli
very)
Mia’s
Sim
ple F
ract
ure
(in-n
etwor
k eme
rgen
cy ro
om vi
sit an
d foll
ow
up ca
re)
Mana
ging
Joe’s
type
2 Di
abet
es
(a ye
ar of
routi
ne in
-netw
ork c
are o
f a w
ell-
contr
olled
cond
ition)
Th
e plan
’s ov
erall
ded
uctib
le $
1,250
Spec
ialist
copa
ymen
t
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce 2
0%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Sp
ecial
ist of
fice v
isits
(pre
nata
l car
e)
Child
birth/
Deliv
ery P
rofes
siona
l Ser
vices
Ch
ildbir
th/De
liver
y Fac
ility S
ervic
es
Diag
nosti
c tes
ts (u
ltras
ound
s and
bloo
d wo
rk)
Spec
ialist
visit
(ane
sthes
ia)
Tota
l Exa
mpl
e Cos
t $1
2,800
In th
is ex
ampl
e, Pe
g wo
uld
pay:
Co
st Sh
aring
De
ducti
bles
$1,25
0 Co
paym
ents
$20
Coins
uran
ce
$2,48
0 W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$6
0 Th
e tot
al Pe
g wo
uld
pay i
s $3
,810
Th
e plan
’s ov
erall
ded
uctib
le $
1,250
Spec
ialist
copa
ymen
t
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce
20%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Pr
imar
y car
e phy
sician
offic
e visi
ts (in
cludin
g dis
ease
edu
catio
n)
Diag
nosti
c tes
ts (b
lood
work
) Pr
escri
ption
drug
s Du
rable
med
ical e
quipm
ent (
gluco
se m
eter
)
Tota
l Exa
mpl
e Cos
t $7
,400
In th
is ex
ampl
e, Jo
e wou
ld p
ay:
Cost
Shar
ing
Dedu
ctible
s $1
,250
Copa
ymen
ts $1
,130
Coins
uran
ce
$370
W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$6
0 Th
e tot
al Jo
e wou
ld p
ay is
$2
,810
Th
e plan
’s ov
erall
ded
uctib
le $1
,250
Sp
ecial
ist co
paym
ent
$30
Ho
spita
l (fa
cility
) coi
nsur
ance
20
%
Ot
her c
oins
uran
ce
20%
This
EXAM
PLE
even
t inc
lude
s ser
vices
like:
Em
erge
ncy r
oom
care
(inclu
ding
med
ical
supp
lies)
Diag
nosti
c tes
t (X-
ray)
Dura
ble m
edica
l equ
ipmen
t (cr
utch
es)
Reha
bilita
tion s
ervic
es (p
hysic
al th
erap
y)
Tota
l Exa
mpl
e Cos
t $1
,900
In th
is ex
ampl
e, Mi
a wou
ld p
ay:
Cost
Shar
ing
Dedu
ctible
s $1
,120
Copa
ymen
ts $4
60
Coins
uran
ce
$290
W
hat is
n’t co
vere
d Lim
its or
exclu
sions
$0
Th
e tot
al Mi
a wou
ld p
ay is
$1
,870
Abou
t the
se C
over
age E
xam
ples
:
Th
is is
not a
cost
estim
ator
. Tre
atmen
ts sh
own a
re ju
st ex
ample
s of h
ow th
is pla
n migh
t cov
er m
edica
l car
e. Yo
ur ac
tual c
osts
will b
e dif
feren
t dep
endin
g on t
he ac
tual c
are y
ou re
ceive
, the p
rices
your
prov
iders
char
ge, a
nd m
any o
ther f
actor
s. Fo
cus o
n the
cost
shar
ing
amou
nts (d
educ
tibles
, cop
ayme
nts an
d coin
sura
nce)
and e
xclud
ed se
rvice
s und
er th
e plan
. Use
this
infor
matio
n to c
ompa
re th
e por
tion o
f co
sts yo
u migh
t pay
unde
r diffe
rent
healt
h plan
s. Pl
ease
note
these
cove
rage
exam
ples a
re ba
sed o
n self
-only
cove
rage
.
45
No
ndis
crim
inat
ion
No
tice
SW
CP_Nondiscrimination_Notice_01/2019_C
ATTE
NTI
ON
: If
you
spea
k En
glish
, lan
guag
e as
sista
nce
serv
ices
, fre
e of
char
ge, a
re av
aila
ble
to y
ou.
Cal
l 1-8
00-3
21-7
947
(TTY
: 711
).Sc
ott &
Whi
te C
are
Plan
s com
plie
s with
appl
icab
le F
eder
al ci
vil r
ight
s law
s and
doe
s not
disc
rimin
ate
on th
e ba
sis o
f rac
e, co
lor,
natio
nal o
rigin
, age
, di
sabi
lity,
or se
x. S
cott
& W
hite
Car
e Plan
s doe
s not
exclu
de p
eopl
e or t
reat
them
diff
eren
tly b
ecau
se o
f rac
e, co
lor,
natio
nal o
rigin
, age
, disa
bilit
y, or
sex.
Scot
t & W
hite
Car
e Pl
ans:
•Pro
vide
s fre
e ai
ds a
nd se
rvic
es to
peo
ple
with
disa
bilit
ies t
o co
mm
unic
ate
effec
tivel
y w
ith u
s, su
ch a
s:-W
ritte
n in
form
atio
n in
oth
er fo
rmat
s (la
rge
prin
t and
acc
essib
le el
ectr
onic
form
ats)
•Pro
vide
s fre
e la
ngua
ge se
rvic
es to
peo
ple
who
se p
rimar
y la
ngua
ge is
not
Eng
lish,
such
as:
-Qua
lified
inte
rpre
ters
-Inf
orm
atio
n w
ritte
n in
oth
er la
ngua
ges
If yo
u ne
ed th
ese
serv
ices
, con
tact
the
Scot
t & W
hite
Car
e Pl
ans C
ompl
ianc
e O
ffice
r at 1
-214
-820
-888
8 or
send
an
emai
l to
SWH
PCom
plia
nceD
epar
tmen
t@BS
WH
ealth
.org
If yo
u be
lieve
that
Sco
tt &
Whi
te C
are
Plan
s has
faile
d to
pro
vide
thes
e se
rvic
es o
r disc
rimin
ated
in a
noth
er w
ay o
n th
e ba
sis o
f rac
e, co
lor,
natio
nal
orig
in, a
ge, d
isabi
lity,
or se
x, y
ou c
an fi
le a
grie
vanc
e w
ith:
Scot
t & W
hite
Car
e Pl
ans,
Com
plia
nce
Offi
cer
1206
Wes
t Cam
pus D
rive,
Suite
151
Tem
ple,
Texa
s 765
02
Com
plia
nce
Hel
pLin
e; 1-
888-
484-
6977
or h
ttps:/
/app
.myc
ompl
ianc
erep
ort.c
om/r
epor
t.asp
x?ci
d=sw
hpYo
u ca
n fil
e a
grie
vanc
e in
per
son
or b
y m
ail,
onlin
e, or
em
ail.
If yo
u ne
ed h
elp
filin
g a
grie
vanc
e, th
e C
ompl
ianc
e O
ffice
r is a
vaila
ble
to h
elp
you.
Yo
u ca
n al
so fi
le a
civi
l rig
hts c
ompl
aint
with
the
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s, O
ffice
for C
ivil
Righ
ts, e
lect
roni
cally
thro
ugh
the
Offi
ce fo
r Civ
il Ri
ghts
Com
plai
nt P
orta
l, av
aila
ble
at h
ttps:/
/ocr
port
al.h
hs.g
ov/o
cr/p
orta
l/lob
by.js
f, or
by
mai
l or p
hone
at:
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s20
0 In
depe
nden
ce A
venu
e, SW
Room
509
F, H
HH
Bui
ldin
gW
ashi
ngto
n, D
.C. 2
0201
1-
800-
368-
1019
, 1-8
00-5
37-7
697
(TD
D)
Com
plai
nt fo
rms a
re av
aila
ble
at h
ttps:/
/ww
w.hh
s.gov
/civ
il-rig
hts/
filin
g-a-
com
plai
nt/in
dex.
htm
l.
46
Lang
uag
e A
ssis
tanc
e/ A
sist
enci
a d
e id
iom
as
SW
CP_LanguageAssistance_11/2
018
Eng
lish:
AT
TEN
TIO
N: I
f you
spea
k En
glis
h, la
ngua
ge a
ssis
tanc
e se
rvic
es, f
ree
of c
harg
e, a
re a
vaila
ble
to y
ou. C
all 1
-800
-321
-794
7 (T
TY: 7
11).
Span
ish:
AT
ENC
IÓN
: Si
hab
la e
spañ
ol, t
iene
a su
dis
posi
ción
serv
icio
s gra
tuito
s de
asis
tenc
ia li
ngüí
stic
a. L
lam
e al
1-8
00-3
21-7
947
(TTY
: 711
).
Vie
tnam
ese:
C
HÚ
Ý:
Nếu
bạn
nói
Tiế
ng V
iệt,
có c
ác d
ịch
vụ h
ỗ trợ
ngô
n ng
ữ m
iễn
phí d
ành
cho
bạn.
Gọi
số 1
-800
-321
-794
7 (T
TY: 7
11).
Chi
nese
: 注
意:如
果 使
用繁
體中
文,可
以免
費獲
得語
言援
助服
務。請
致電
1-80
0-32
1-79
47(T
TY:7
11)。
Kor
ean:
주
의:
한국
어를
사용
하시
는 경
우, 언
어 지
원 서
비스
를 무
료로
이용
하실
수 있
습니
다. 1
-800
-321
-794
7 (T
TY: 7
11) 번
으로
전화
해 주
십시
오.
Ara
bic:
رقم
) 800
-321
-794
7-1
رقمل ب
ص ات
ن.جا
المك ب
ر لواف
تتویة
للغة ا
عدسا
المت
دما خ
إن، ف
غة الل
كر اذ
ثحد
تتت
كنإذا
ة: وظ
لح .م
711
كم:الب
وصم
الف
ھات
Urd
u:
ال۔ ک
ں ہی
بتیا
دسں
میت
مفت
دما خ
کیدد
ی من ک
زباو
پ کو آ
، تیں
ے ہولت
و برد
پ ار آ
اگر:
رداخب
1-8
00-3
21-7
947
(TTY
: 711
). یں
کر
Taga
log:
PAU
NAW
A:
Kun
g na
gsas
alita
ka
ng T
agal
og, m
aaar
i kan
g gu
mam
it ng
mga
serb
isyo
ng
tulo
ng sa
wik
a na
ng w
alan
g ba
yad.
Tum
awag
sa
1-80
0-32
1-79
47 (T
TY: 7
11).
Fren
ch:
ATTE
NTI
ON
: Si
vou
s par
lez
fran
çais
, des
serv
ices
d’a
ide
lingu
istiq
ue v
ous s
ont p
ropo
sés g
ratu
item
ent.
App
elez
le 1
-800
-321
-794
7 (A
TS :
711)
.
Hin
di:
धयान
द:
यदि आ
प हि
दी ब
ोलत
ह तो
आपक
लिए
मफत
म भ
ाषा स
हायत
ा सवा
ए उप
लबध
ह। 1
-800
-321
-794
7 (T
TY: 7
11) प
र कॉल
कर।
Pers
ian:
شما
ی را
ن بگا
رایت
ورص
ی ببان
زت
یالسھ
، تنید
ی کو م
تگ گف
سیار
ن فزبا
بھ ر
اگجھ:
تود.
ریگی
س بتما
1-8
00-3
21-7
947
(TTY
: 711
ا (. ب
شد با
میھم
راف
Ger
man
: A
CH
TUN
G:
Wen
n Si
e D
euts
ch sp
rech
en, s
tehe
n Ih
nen
kost
enlo
s spr
achl
iche
Hilf
sdie
nstle
istu
ngen
zur
Ver
fügu
ng.
Ruf
num
mer
: 1-8
00-3
21-7
947
(TTY
: 711
).
Guj
arat
i: સચ
ના: જ
ો તમ
ગજરાત
ી બોલ
તા હ
ો, તો
નિ:શ
લક ભ
ાષા સ
હાય
સવાઓ
તમા
રા મા
ટ ઉપ
લબધ
છ. ફ
ોન કર
ો 1-
800-
321-
7947
(TTY
: 711
).
Rus
sian
: В
НИ
МА
НИ
Е: Е
сли
вы го
вори
те н
а ру
сско
м яз
ыке
, то
вам
дост
упны
бес
плат
ные
услу
ги п
ерев
ода.
Зво
ните
1-8
00-3
21-7
947
(тел
етай
п: 7
11).
Japa
nese
:注
意事
項:日
本語
を話
され
る場
合、無
料の
言語
支援
をご
利用
いた
だけ
ます
。1-8
00-3
21-7
947
(TTY
:711
)まで
、お電
話に
てご
連絡
くだ
さい
。L
aotia
n:
ໂປດ
ຊາບ
: ຖ
າວ
າ ທ
ານ
ເວ
າພ
າສາ
ລາວ,
ການ
ບ
ລກ
ານຊ
ວຍເຫ
ອດ
ານພ
າສາ,
ໂດ
ຍບ
ເສຽ
ຄ
າ, ແ
ມ
ນມ
ພ
ອມ
ໃຫ
ທ
ານ. ໂ
ທຣ
1-80
0-32
1-79
47 (T
TY: 7
11).
47
Virtual Care—Powered by MDLIVEWe’ve teamed up with MDLIVE to provide our members with access to board-certified doctors as well as licensed therapists and more—using your phone, smartphone, tablet or computer—all for a $0 copayment.*
Some common conditions treated include:
*Members with high-deductible health plans must first meet their deductibleCopyright © 2019 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/. MCR-1316
SWHP-MDLIVE-$0_08.2019
General Health• Common cold / Flu• Cough• Fever• Insect bites• Allergies• Diarrhea• Nausea / Vomiting• Pink eye• Sore throat• Constipation• Ear problems• Headache
Behavioral Health• Addictions• Stress / Anxiety• Bipolar disorders• Depression• Eating disorders• Grief and loss• Life changes• Panic disorders• Parenting issues• Postpartum depression• Relationship and
marriage issues• Trauma and PTSD
High-quality healthcare with board-certified
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Online visits are secure and convenient
Prescriptions can be sent to your pharmacy
when necessary
MDLIVE.com/SWHP1-844-416-6254
Download the app.Join for free. Visit a doctor.
Get Started Today!
48
CORE PLAN Effective Date: 11/1/2020 FUSION: THE ULTIMATE CHOICESM combines dental and eye care benefits in one easy-to-administer plan. This plan combines the annual maximum between the dental and eye care plans. For the maximum:
⚫ The member can use up to $1,000 toward any covered dental expense.⚫ The member can use up to $150 towards any covered eye care expense.⚫ Total benefits paid between the two coverages will not exceed $1,000.
Dental Plan Summary subject to FUSION plan design listed above
Plan Benefit Type 1 100% Type 2 80% Type 3 50%
Deductible $10/visit Type 1
$50 Policy Year Type 2,3
No Family Maximum
Maximum (per person) $1,000 per policy year
Preventive PlusSM Included
Allowance Discounted Fee
Waiting Period None
Orthodontia Summary - Child Only Coverage
Allowance U&C
Plan Benefit 50%
Lifetime Maximum (per person) $1,000
Waiting Period None
Dental Procedure Summary Type 1 Type 2 Type 3
⚫ Routine Exam (2 per benefit period)
⚫ Bitewing X-rays (2 per benefit period)
⚫ Full Mouth/Panoramic X-rays
(1 in 3 years)
⚫ Periapical X-rays
⚫ Cleaning (2 per benefit period)
⚫ Fluoride for Children 18 and under
(1 per benefit period)
⚫ Sealants (age 16 and under)
⚫ Space Maintainers
⚫ Restorative Amalgams
⚫ Restorative Composites
⚫ Endodontics (nonsurgical)
⚫ Endodontics (surgical)
⚫ Periodontics (nonsurgical)
⚫ Periodontics (surgical)
⚫ Denture Repair
⚫ Simple Extractions
⚫ Complex Extractions
⚫ Anesthesia
⚫ Onlays
⚫ Crowns
(1 in 5 years per tooth)
⚫ Crown Repair
⚫ Implants
⚫ Prosthodontics (fixed bridge; removable
complete/partial dentures)
(1 in 5 years)
Current Dental Terminology © American Dental Association.
Eye Care Summary subject to FUSION plan design listed above
Allowances
Exam Subject to maximum
Lenses (per pair) Single Subject to maximum Bifocal Subject to maximum Trifocal Subject to maximum Lenticular Subject to maximum Progressive Subject to maximum
Contacts
Elective/Medically Necessary Subject to maximum
Frames Subject to maximum
Frequencies Based on date of service
Exam None
Lenses None
Frames None
Maximum $150
Deductibles (None) $0*
*Deductible applies to the first service received
49
Ameritas Information We're Here to Help This plan was designed specifically for the associates of Bell County. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: 800-487-5553. For plan information any time, access our automated voice response system or go online to ameritas.com. NOTICE OF CLAIM: Written notice of a claim must be given to Ameritas within 90
days after the incurred date of the services provided for which benefits are payable.
Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card.
Eyewear Savings Ameritas plan members may receive up to 10% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritas.com and sign-in (or create) a secure member account. Members
must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount.
Preventive PlusSM With this plan option, benefits for Type 1/Preventive procedures are not deducted from the plan member's annual maximum benefit. This saves the entire annual maximum for the Type 2/Basic and Type 3/Major procedures that are covered by your plan.
Dental Network Information To find a provider, visit ameritas.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your ID Card or contact Customer Connections at 800-487-5553.
Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed.
Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered.
Language Services We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment forms, claim forms and certificates of insurance.
This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.
50
BUY-UP PLAN Effective Date: 11/1/2020 FUSION: THE ULTIMATE CHOICESM combines dental and eye care benefits in one easy-to-administer plan. This plan combines the annual maximum between the dental and eye care plans. For the maximum:
⚫ The member can use up to $1,000 toward any covered dental expense.⚫ The member can use up to $150 towards any covered eye care expense.⚫ Total benefits paid between the two coverages will not exceed $1,000.
Dental Plan Summary subject to FUSION plan design listed above
Plan Benefit Type 1 100% Type 2 80% Type 3 50%
Deductible $10/visit Type 1
$50 Policy Year Type 2,3
No Family Maximum
Maximum (per person) $1,000 per policy year
Preventive PlusSM Included
Allowance 90th U&C
Waiting Period None
Orthodontia Summary - Child Only Coverage
Allowance U&C
Plan Benefit 50%
Lifetime Maximum (per person) $1,000
Waiting Period None
Dental Procedure Summary Type 1 Type 2 Type 3
⚫ Routine Exam (2 per benefit period)
⚫ Bitewing X-rays (2 per benefit period)
⚫ Full Mouth/Panoramic X-rays
(1 in 3 years)
⚫ Periapical X-rays
⚫ Cleaning (2 per benefit period)
⚫ Fluoride for Children 18 and under
(1 per benefit period)
⚫ Sealants (age 16 and under)
⚫ Space Maintainers
⚫ Restorative Amalgams
⚫ Restorative Composites
⚫ Endodontics (nonsurgical)
⚫ Endodontics (surgical)
⚫ Periodontics (nonsurgical)
⚫ Periodontics (surgical)
⚫ Denture Repair
⚫ Simple Extractions
⚫ Complex Extractions
⚫ Anesthesia
⚫ Onlays
⚫ Crowns
(1 in 5 years per tooth)
⚫ Crown Repair
⚫ Implants
⚫ Prosthodontics (fixed bridge; removable
complete/partial dentures)
(1 in 5 years)
Current Dental Terminology © American Dental Association.
Eye Care Summary subject to FUSION plan design listed above
Allowances
Exam Subject to maximum
Lenses (per pair) Single Subject to maximum Bifocal Subject to maximum Trifocal Subject to maximum Lenticular Subject to maximum Progressive Subject to maximum
Contacts
Elective/Medically Necessary Subject to maximum
Frames Subject to maximum
Frequencies Based on date of service
Exam None
Lenses None
Frames None
Maximum $150
Deductibles (None) $0*
*Deductible applies to the first service received
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Ameritas Information We're Here to Help This plan was designed specifically for the associates of Bell County. At Ameritas Group, we do more than provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: 800-487-5553. For plan information any time, access our automated voice response system or go online to ameritas.com. NOTICE OF CLAIM: Written notice of a claim must be given to Ameritas within 90 days after the incurred date of the services provided for which benefits are payable.
Rx Savings Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance. To receive the Walmart Rx discount, Ameritas plan members just need to visit us at ameritas.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card.
Eyewear Savings Ameritas plan members may receive up to 10% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, Ameritas plan members can visit ameritas.com and sign-in (or create) a secure member account. Members must present the Ameritas Eyewear Savings Card at time of purchase to receive the discount.
Preventive PlusSM With this plan option, benefits for Type 1/Preventive procedures are not deducted from the plan member's annual maximum benefit. This saves the entire annual maximum for the Type 2/Basic and Type 3/Major procedures that are covered by your plan.
Dental Network Information To find a provider, visit ameritas.com and select FIND A PROVIDER, then DENTAL. Enter your criteria to search by location or for a specific dentist or practice. California Residents: When prompted to select your network, choose the Ameritas Network found on your
ID Card or contact Customer Connections at 800-487-5553.
Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed.
Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered.
Language Services We recognize the importance of communicating with our growing number of multilingual customers. That is why we offer a language assistance program that gives you access to: Spanish-speaking claims contact center representatives, telephone interpretation services in a wide range of languages, online dental network provider search in Spanish and a variety of Spanish documents such as enrollment
forms, claim forms and certificates of insurance.
This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.
52
What is the eyewear frames and lenses savings?It provides our plan members with savings on the following vision care products at Walmart Vision Centers:
• Top-quality frames for the entire family including today’smost popular brands
• Wide selection of lens options; all lenses come withscratch-resistant coating at no additional charge
• Safety eyewear
Contact lenses and prescription sunglasses are not included in this savings arrangement.
The eyewear savings cannot be combined with any other coupon or promotion, or most insurance.
What ID card can I use?Carefully cut your ID card from this sheet or save a picture of it on your device to retain for future use. Members also can visit ameritas.com, Account Access and sign in (or create) a secure member account where they can access and print a savings card.
When making an appointment at a Walmart Vision Center, you must mention you have eyewear savings through your Ameritas plan and present the savings ID card.
GR 6436 4-20
Who do I call for insurance benefit questions?If you have questions regarding insurance benefits, you can call Ameritas toll free at 800-487-5553 or in New York at 800-659-5556. This savings arrangement is not insuranceand not intended as a replacement for insurance.
Is a vision exam required to receive the eyewear savings?No. You may bring in your current vision prescription from another vision care provider to purchase eyewear frames and lenses.
How do I find a Walmart Vision Center?Vision Centers are located in more than 2,500 Walmart stores nationwide. To find a Walmart location nearby, visit walmart.com and do a search for Vision Center.
GuaranteesWalmart Vision Centers stand behind their products and workmanship by offering:
• 60-day frame and lens satisfaction guarantee• 12-month replacement guarantee on broken or
damaged frames or lenses• Lifetime adjustments and cleanings
Save Money on Your Prescription Eyeglasses
This information is provided by Ameritas Life Insurance Corp. (Ameritas Life) and Ameritas Life Insurance Corp. of New York (Ameritas of New York). Ameritas, the bison design, “fulfilling life” and product names designated with SM or ® are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. All other brands are property of their respective owners. © 2020 Ameritas Mutual Holding Company
Ameritas Life Insurance Corp. Ameritas Life Insurance Corp. of New York
For all participating states, except New York. For New York.
Ameritas Eyewear Savings Card
Member Name: �������������������������������������������������Members: To locate a Walmart Vision Center near you, visit http://www.walmart.com/cservice/ca�storefinder.gsp. Call 800-487-5553 with questions.Walmart Vision Center Associates: Use plan name SAVINGS 10 in BOSS. Call 700-277-7710 with questions.
GR 6269 Eyewear 11-19
Ameritas Eyewear Savings Card
GR 6269 NY Eyewear 11-19
Member Name: �������������������������������������������������Members: To locate a Walmart Vision Center near you, visit http://www.walmart.com/cservice/ca�storefinder.gsp. Call 800-659-5556 with questions.Walmart Vision Center Associates: Use plan name SAVINGS 10 in BOSS. Call 700-277-7710 with questions.
Ameritas Life Insurance Corp. of New York
53
GR 7593 5-20
Continue to get the most from your dental benefitsThe COVID-19 pandemic has had significant financial and physical impact on millions of Americans. It’s more important than ever to seek the health care you need, but many find it difficult financially.
You purchased your Ameritas dental plan to make going to the dentist easy and affordable. And we want to make sure that continues.
Here are a couple ways Ameritas is helping you access dental care.
Elimination of dental deductible. We will waive the deductible for all dental claims incurred July 1 through December 31, 2020. Your plan benefits kick in right away. The deductible waiver does not apply to orthodontia claims.
Elimination of dental exam and cleaning frequency limitations. Ameritas dental plans typically cover the cost of one or two exams and cleanings each year. Your plan’s frequency limitation will be waived July 1 through December 31, 2020. So you can see the dentist when you need to and know you’re covered.
Your well-being is our top priority We want to make sure you have the confidence to obtain the dental care you need, without worrying about your coverage.
If you have questions about your dental coverage, or if there are changes to your treatment because of the pandemic, we can help. Please contact our claims contact center:
[email protected] or 800-487-5553Monday – Thursday, 7 a.m. – Midnight (CST)Friday, 7 a.m. – 6:30 p.m. (CST
We will work with you to meet your needs.
Get the Dental Care You Need NowAmeritas offers benefit enhancements during the pandemic
This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Group dental, vision and hearing care products (9000 Rev. 03-16, dates may vary by state) are issued by Ameritas Life. Ameritas, the bison design, “fulfilling life” and product names designated with SM or ® are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. © 2020 Ameritas Mutual Holding Company.
800-776-9446 ameritas.com
54
Hello Bell County Employees,
It’s that time of the year - your annual opportunity to review and choose the best benefit options for you and your family. As part of our company benefits package, we are excited to offer you the opportunity to enroll in a flexible spending account (FSA).
FSA Overview - Medical Think of an FSA like a spending account for healthcare. The account is tax-advantaged, meaning you can save up to 40% on thousands of everyday expenses. You decide how much money to set aside each year to pay for eligible expenses, such as:
• Deductibles• Copays• Prescriptions• Teeth Cleaning• LASIK• Glasses and contact lenses• Band-aids• Sunscreen• View all eligible expenses
FSA Overview – Dependent Care The Dependent Care is a spending account that can be used to pay for services like daycare, nursery school, and elder care.
Why you’ll love it • An FSA can be used to pay for thousands of eligible medical expenses• Savings on daycare and other dependent care services you are already paying for• You can use your entire yearly contribution starting day one of the plan year• The account is funded through payroll deductions, before taxes, which in turn reduces your
taxable income
Employees don't need to enroll in one FSA to get the other. They can enroll in the medical FSA without enrolling in the dependent care FSA and vice versa.
To learn more about the benefits of an FSA, visit myameriflex/participants.
Be on the lookout for more information and enrollment instructions during our annual open enrollment meeting.
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Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
Flexible Spending Account
56
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
1
2
myameriflex.com/participants
Copays, deductibles, and other payments you are responsible for under your health plan.
Routine exams, dental care, prescription drugs, eye care, and hearing aids.
Prescription glasses and sunglasses.
Certain over-the-counter (OTC) healthcare expenses such as Band-aids, medicine, First Aid supplies, etc. Note: OTC medicines require a doctor’s prescription to be eligible.
Diabetic equipment and supplies, durable medical equipment, and qualified medical products or services provided by a doctor.
57
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
myameriflex.com/participants
1
2
3
4
5
6
7
58
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
1
2
myameriflex.com/participants59
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
myameriflex.com/participants60
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
myameriflex.com/participants61
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a flexible spending account (FSA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR FSA WORKS
Your FSA is a spending account that can be used to pay for a variety of healthcare expenses.
TWO GREAT PERKS COME WITH YOUR FSA:
You will have access to your entire election on the first day of the plan year.
The funds are taken out of your paycheck “pre-tax” (meaning they are subtracted from your gross earnings before taxes) throughout the course of the year. That means you are increasing your take-home pay simply by participating!
WHAT CAN I SPEND MY FSA FUNDS ON?
The IRS determines what expenses are eligible under an FSA. Below are some examples of common eligible expenses.
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your FSA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Enroll in MyPlanConnectThere are instances when you may be asked to submit documentation to Ameriflex to verify the eligibility of an expense. MyPlanConnect does the heavy lifting for you by automatically detecting when you swipe your MyAmeriflex Debit Mastercard and matching the purchase with your insurance plan. After enrolling, all of your expenses moving forward will be processed through MyPlanConnect. To enroll, log into your MyAmeriflex account and select “MyPlanConnect.” If you aren't sure if your employer offers MyPlanConnect, please check with your HR department or call our Participant Services department at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases! Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket.
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
STEP 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
STEP 2: Click the Submit Claim button
STEP 3: Fill out all of the required fields and attach documentation
STEP 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future
reimbursements.
STEP 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
REQUEST FOR ADDITIONAL DOCUMENTATION
Due to the tax-advantaged nature of your account, the IRS has guidelines in place to ensure that purchases made with the account are for eligible medical, dental, or vision expenses. There are instances when additional documentation—like itemized receipts–are needed to verify the eligibility of your expenses.
HERE’S HOW IT WORKS:
STEP 1: You make a payment with your MyAmeriflex Debit Mastercard. This could be a copay for a doctor’s visit, prescription, etc. It’s important to note that when you
swipe your card, the provider is paid.
STEP 2: We will attempt to auto-verify the transaction instantly using stored copays, stored recurring expense values, electronic data feeds, or Inventory Information Approval Systems (IIAS).
STEP 3: If the transaction can’t be auto-verified at the point of purchase, this is normally because the merchant’s (e.g. hospital) payment terminal can’t distinguish if the transaction was for surgery (eligible) or flowers from the hospital gift store (not eligible). You’ll receive a notification if we need more information about the expense, such as an itemized receipt or insurance explanation of benefits (EOB). In some cases, a letter of medical necessity may be required for certain eligible expenses (e.g. therapy).
STEP 4: You can login to MyAmeriflex or use the MyAmeriflex App to upload the itemized receipt or EOB. You can also mail, fax, or email a manual claim form, documentation, and the request for documentation letter to:
Email: [email protected] Fax: 888.631.1038 (Attention: Claims Department) Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026
Please do not send original documents. If damaged or lost during processing.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your MyAmeriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. For more information about your account and expenses eligibility, visit myameriflex.com/participants. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my FSA account balance by the end the year?Employers may offer a $500 roll over or 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a roll over, up to $500 of unused money will carry over to the next plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associated with your company's plan.
Can I have an FSA and an HSA?You can’t contribute to an FSA and HSA within the same plan year. However, you can contribute to an HSA and a limited purpose FSA, which only covers dental and vision expenses.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, health FSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an FSA, HSA, HRA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?FSA elections are irrevocable and cannot be changed during the period of coverage unless there is a permitted change in election event, such as a change in marital status, birth or adoption of a child, change in an employment status, etc. The event and contribution change must coincide.
How can I get more information about my account?There are several options to get more information about your account. For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the MyAmeriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information. We also offer a paper direct deposit form that can be mailed, faxed, or emailed to Ameriflex.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
myameriflex.com/participants62
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
Dependent Care Account
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
63
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
myameriflex.com/participants
1
2
3
Pre-schoolNanny serviceCustodial care fordependent adults
Nursery school
Daycare Summer day camp Before and afterschool programs
Private sitter
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
64
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
1
2
3
4
5
6
myameriflex.com/participants
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
65
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
myameriflex.com/participants
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
1
2
66
Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
myameriflex.com/participants
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
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Getting real about your healthcare savings starts hereYou made a great decision by enrolling in a dependent care account (DCA)! Now that you’ve gotten the difficult decisions out of the way, use this packet to learn how to best take advantage of your account. Let’s get started!
HOW YOUR DCA WORKS
Your DCA is a spending account that can be used to pay for services like daycare, nurs-ery school, and elder care. By simply participating in a DCA, you get to experience benefits like:
A higher take-home pay thanks to your pre-tax payroll deductions
Savings on daycare and other dependent care services you’re already paying for
Easy-to-use MyAmeriflex Debit Mastercard to make purchases
WHAT CAN I SPEND MY DCA FUNDS ON?IThe IRS determines what expenses are eligible under a DCA. Here are some examples of common eligible expenses
GETTING STARTED CHECKLIST
Use this checklist to take full advantage of all the great resources made available to you through your DCA.
Set up your MyAmeriflex account MyAmeriflex is where you’ll have real-time access to all of your account information, including your current balance, transaction history, payment status, and more. To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Debit Mastercard number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
Download mobile app The MyAmeriflex App lets you access and manage your account anywhere you go, 24/7. It puts all of the great features of the MyAmeriflex Portal right at your fingertips. You can download the app on the Apple App Store and Google Play.
Register for complimentary ID theft protection Ameriflex is pleased to offer our cardholders complimentary access to Mastercard’s comprehensive Identity Theft Protection program*, powered by CSID®. You can rest assured knowing that if your MyAmeriflex Debit Mastercard (or any other debit/credit cards you choose to register!) gets misplaced or stolen, you can utilize Mastercard’s industry-leading ID theft protection and restoration services for everything you may need. To register, visit myameriflex.com/IDtheftprotection.
Use your cardYou will receive a MyAmeriflex Debit Mastercard that can be used to make eligible purchases. Your card will be mailed within 7-10 business days after your enrollment is processed by Ameriflex.
Enroll for direct depositBy enrolling for direct deposit, getting reimbursed is easier and faster anytime you need to pay for an eligible expenses out of pocket. Login to MyAmeriflex to set up direct deposit.
Start spendingYou’re ready to make purchases as funds become available! Your account will be funded each pay period. Be sure to hang on to your receipts anytime you make a purchase. Login to MyAmeriflex for a full list of eligible expenses.
HOW TO GET REIMBURSED FOR OUT-OF-POCKET EXPENSES
As you begin to use your account, it’s important to understand how to submit a request for reimbursement or payment to a provider.
Two most common reasons for requesting a reimbursement or payment:
You paid an eligible expense out of pocket
To request a payment be made directly to a provider
Your MyAmeriflex Debit Mastercard is the quickest and easiest way to access your account funds. But if you can’t use your card, getting reimbursed is quick and painless.
Step 1: Login in to your MyAmeriflex account online or through the MyAmeriflex App
Step 2: Click the Submit Claim button
Step 3: Fill out all of the required fields and attach documentation
Step 4: If requesting to pay a provider, enter the provider’s information, including address, and select “Pay Provider.” Once processed, the reimbursement will be sent directly to the provider. You can also save the provider for any future reimbursements.
Step 5: Click submit
You can view the status of a pending reimbursement anytime through MyAmeriflex or the MyAmeriflex App. If any further action is needed before the reimbursement is processed, you will receive a message through your account.
ONE-TIME CLAIM FOR DEPENDENT CARE SERVICES
Ameriflex makes it easy to get reimbursed automatically from your account as your funds build up during the year. If you’re paying for childcare or elderly care each month, you can avoid submitting a manual claim every month to get reimbursed for expenses you paid out of pocket. All you have to do is submit one Claim Form for the entire year that shows the date range for which childcare/eldercare services will be provided, along with a signature from the service provider on the designated line of the form. As long as the form is signed by the provider, no receipt is needed. Once the recurring claim has been processed, Ameriflex will automatically reimburse you every month with a check or direct deposit as funds in your Dependent Care Account become available.
FREQUENTLY ASKED QUESTIONS
How do I check my account balance?You can check your real-time balance online by logging into MyAmeriflex or through the MyAmeriflex Mobile App. Ameriflex also provides 24/7 access to automated account information via telephone. Call 888.868.FLEX (3539) and follow the prompts to listen to balance and transaction information for your account.
How do I access my account?If you’re a new user, setting up your account is easy! To register your account, visit myameriflex.com, select “Login to your account,” and click “Participants.” Then click the “New User” link to get started. You will be asked to enter an Employee ID, which will be your Social Security number with no dashes or spaces, as well as a Registration ID, which will either be your Ameriflex Mastercard debit card number or Employer ID. If you don’t know your Employer ID, please reach out to your HR representative or contact the Ameriflex Participants Services team at 888.868.FLEX (3539).
What expenses are eligible? The IRS, and sometimes your employer, determine what goods and services are eligible. This will vary based on what type of account you have. Login to MyAmeriflex for a full list of eligible expenses.
How do I order a new card?You can request a free replacement card online through your Ameriflex account or through the MyAmeriflex Mobile App.
What happens if I don’t use my DCA account balance by the end the year?Employers may offer a 2.5-month grace period to help employees use their unused money at the end of the plan year. If your employer offers a 2.5-month grace period, you can continue using your unused money 2.5 months into the new plan year. Please refer to your plan documents or contact Ameriflex to verify the specific rules and features associat-ed with your company's plan.
How do these programs save me money on taxes?Since the accounts are tax-advantaged, you get to leverage pre-tax payroll deductions -- increasing your take-home pay and saving you money on everyday expenses. In many cases, you can experience savings of up to 40% on expenses eligible under your employer-sponsored plan.
myameriflex.com/participants
If I leave my employer, can I still use my funds?No, your funds are forfeited if you leave your employer.
What does pre-tax dollars mean and why is this important?Essentially, “pre-taxing,” which can be used for life insurance, disability insurance, HSA contributions, dependent care contributions, health savings account contributions and commuter account contributions, means taking income that would otherwise be taxable and diverting it to something else before (so: “pre”) is becomes taxable.
By making pre-tax contributions to an HSA, you are lowering the amount your income is taxed, which results in taking home a bigger paycheck.
Can I change my annual election amount?DCA elections can be changed if the cost of the services received changes (i.e. daycare increases fees), or if the dependent no longer goes to daycare.
How can I get more information about my account?For an overview of account features, visit myameriflex.com/participants.
You can manage your account, check your balance, file and claim anytime online through MyAmeriflex or through the Ameriflex App.
How can I change my reimbursement setting to add direct deposit?To set up direct deposit, simply login to MyAmeriflex, select reimbursement settings under the my account tab, then enter your banking information.
If you have any questions you can contact the Ameriflex Participant Services team Monday - Friday, 8:30 a.m. - 8:00 p.m. (ET).
Phone: 888.868.FLEX (3539)Email: [email protected]: myameriflex.com
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Learning CenterGet daily money-saving info
Did you know you could use your FSA to save money on everyday health essentials like baby health items, health trackers, pain relief products and more?Use your FSA funds or risk forfeiting your money.
Visit FSAstore.com/FlyerAMERI for the largest selection ofguaranteed FSA-eligible products with zero guesswork.
Get $5 off with code, FCAMERI5. One use per customer.
Don’t knowwhat to use yourFSA money on?
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Accident Insurance Accidents can happen anytime, anywhere.Accidents are usually followed by a series of bills. Even if you have good insurance, you may still have to cover out-of-pocket costs, such as:
� Doctor bills � Ambulance fees � Hospital expenses
Accident insurance from Colonial Life & Accident Insurance Company can help protect you, your spouse and your dependent children from the unexpected expenses of an accident.
Features of Colonial Life’s Accident Insurance: � You are paid benefits to help you with the care and treatment of a covered accidental injury. � Your benefits are paid directly to you (unless you specify otherwise). � You are paid benefits regardless of any other insurance you may have with other insurance companies. � You can take your coverage with you if you change jobs or retire.
Disability InsuranceIf you got sick or hurt and couldn’t work, how long could you go without a paycheck? In today’s economy, it’d be difficult losing just one paycheck. But a disability could have you out of work for days, weeks, months or even a year:
Disability insurance from Colonial Life & Accident Insurance Company can help protect your income, so you can maintain your way of life.
Features of Colonial Life’s Accident Insurance: � You’re paid regardless of any other insurance you may have with other insurance companies. � Benefits are paid directly to you, unless you specify otherwise. � You may choose the amount of your disability benefits to meet your needs, subject to income. � You can take your coverage with you if you change jobs or leave your employer.
Colonial LifeVoluntary Insurance
Coverage is subject to policy exclusions and limitations that may affect benefits payable. Products may vary by state and may not be available in all states. For cost and complete details, see a Colonial Life benefits counselor.
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Hospital Confinement Indemnity Insurance You may have health insurance, but are you really covered? Health insurance may cover:
� Hospital fees � Outpatient surgery � Doctor/ER visits � Prescriptions
It may not cover: � Deductibles � Co-payments � Coinsurance
Hospital confinement indemnity insurance from Colonial Life & Accident Insurance Company can help you with unexpected health care expenses that your medical insurance may not cover. It pays an indemnity benefit for each covered hospital confinement. Plans also include a wellness testing benefit, which helps reimburse you for a portion of the tests you would normally have each year.
Features of Colonial Life’s Hospital Confinement Indemnity Insurance: � Benefits are paid directly to you, unless you specify otherwise. � Benefits are paid regardless of any other insurance you may have with other insurance companies. � You can take your coverage with you if you change jobs or leave your employer. � Coverage is guaranteed renewable as long as premiums are paid when they are due. � Coverage is available for you, your spouse and your dependent children.
Term Life InsuranceLife insurance protection when you need it most? Life insurance needs change as life circumstances change. You may need different coverage if you’re:
� Getting married � Buying a home � Having a child � Taking on additional debt
Term life insurance from Colonial Life & Accident Insurance Company provides protection for a specified period of time, typically offering the greatest amount of coverage for the lowest initial premium. This fact makes term life insurance a good choice for supplementing cash value coverage during life stages where obligations are higher, such as while children are young. It’s also a good option for families on a tight budget – especially since you can convert it to a permanent cash value plan later.
Benefits of Colonial Life’s Term Life Insurance: � Provides a benefit for the beneficiary that is typically free from income tax. � The policy’s Accelerated Death Benefit can pay a percentage of the death benefit if the insured is diagnosed with
a terminal illness. � You can take it with you if you change jobs or retire. � Convert to a Colonial Life cash value life insurance plan, with no proof of good health, to age 75. � Spouse and dependent children coverage is available.
Coverage is subject to policy exclusions and limitations that may affect benefits payable. Products may vary by state and may not be available in all states. For cost and complete details, see a Colonial Life benefits counselor.
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Whole Life InsuranceLife insurance that comes with guarantees … because life doesn’tWhole life insurance from Colonial Life & Accident Insurance Company provides guaranteed features – cash value accumulation, premium rates and death benefit (minus any loans and loan interest) – that help ensure those benefits will be there to help protect your family’s way of life.
Guaranteed protection: Offers lifetime protection with a guaranteed death benefit that will not change as long as premiums are paid when due.
Guaranteed premiums: Promises a level premium that stays the same from the day you purchase the policy.
Guaranteed cash value: Guarantees the cash value amount – which accumulates on a tax-deferred basis.
Features of Colonial Life’s Whole Life Insurance: � Provides a benefit for the beneficiary that is typically free from income tax. � Three option dates to purchase additional coverage with no proof of good health required if you are age 55 or younger
at the time of purchase. � The policy’s Accelerated Death Benefit can provide a percentage of the death benefit if the insured is diagnosed with
a terminal illness. � $3,000 immediate claim payment as an advance of the death benefit, paid to the designated beneficiary.
Coverage is subject to policy exclusions and limitations that may affect benefits payable. Products may vary by state and may not be available in all states. For cost and complete details, see a Colonial Life benefits counselor.
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Getting startedThe easiest way to manage your business with us is through ColonialLife.com. To sign up for the website, click Register at the top right of the home page and follow the instructions.
Consider your optionsAt Colonial Life, our goal is to give you an excellent customer experience that is simple, modern and personal. For your convenience, you can choose how you interact with us. For the quickest service, we recommend using our website, which lets you do the following:
� Review, print or download a copy of your policy/certificate by clicking on the My Correspondence tab.
� Update contact information or add family member profile information for use when filing online claims.
� Access service forms to make changes to your policy, such as a beneficiary change.
� Submit your claim using our eClaims system.
� Check the status of your claim and view claims correspondence.
� Access claim forms.
Customer Service Guide
eClaims are quick and easyWith the eClaims feature on ColonialLife.com, you can file most claims online by simply answering a few questions and uploading your supporting documentation. You’re able to spend less time on paperwork, and we’re able to process your claim faster.
� From ColonialLife.com, file claims from any device. It’s fast, easyand available 24/7.
� Select direct deposit to receive your benefit payment faster.
� Easily submit additional documents.
Paper claims � If you don’t want to file online, download the form you need byvisiting the File a Claim page on ColonialLife.com and clicking onclaim and service forms.
� You may fax your claim to 1-800-880-9325.
� Follow the instructions, tips and videos to complete and submityour claim.
ColonialLife.com
Contact us Online ColonialLife.com Log in and click on Contact Us
Telephone 1-800-325-4368
Hearing-impaired customers Please contact the National Relay service at 711 for assistance.
7-19 | 43233-40
Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2019 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.
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3
Medicare D Notice
Important Notice from Bell County About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Bell County and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can getthis coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like anHMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least astandard level of coverage set by Medicare. Some plans may also offer more coverage for a highermonthly premium.
2. Bell County has determined that the prescription drug coverage offered by the Bell County MedicalPlan is, on average for all plan participants, expected to pay out as much as standard Medicareprescription drug coverage pays and is therefore considered Creditable Coverage. Because yourexisting coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (apenalty) if you later decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Bell County coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drug. Please see the Medical Benefit Plan in this book for specific details about the prescription drug coverage.
If you enroll in a Medicare prescription drug plan, you and your eligible dependents will be eligible to receive all of your current health and prescription drug benefits and your coverage will coordinate with Medicare.
If you do decide to join a Medicare drug plan and drop your current Bell County coverage, be aware that you and your dependents may not be able to get this coverage back.
CMS Form 10182-CC Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this infor-mation collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data re-sources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
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4
Medicare D Notice
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Bell County and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. NOTE: You will get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Bell County changes. You also may request a copy of this notice at any time. More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Date: November 2020 Name of Entity/Sender: Bell County Contact Office: Human Resources Address: 101 E. Central Avenue, 3rd Floor Belton, TX 76513 Phone Number: 254-933-5111
CMS Form 10182-CC Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this infor-mation collection is estimated to average 8 hours per response initially, including the time to review instructions, search existing data re-sources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
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We may use and share your information as we:
• Help manage the health care treatment you receive• Run our organization• Pay for your health services• Administer your health plan• Help with public health and safety issues• Do research• Comply with the law• Respond to organ and tissue donation requests and
work with a medical examiner or funeral director• Address workers’ compensation, law enforcement,
and other government requests• Respond to lawsuits and legal actions
➤ See pages 3 and 4 for more information on these uses and disclosures
You have the right to: • Get a copy of your health and claims records• Correct your health and claims records• Request confidential communication• Ask us to limit the information we share• Get a list of those with whom we’ve shared
your information• Get a copy of this privacy notice• Choose someone to act for you• File a complaint if you believe your privacy
rights have been violated
➤ See page 2 for more information on these rights and how to exercise them
Our Uses and
Disclosures
Your Rights
➤ See page 3 for more information on these choices and how to exercise them
You have some choices in the way that we use and share information as we:
• Answer coverage questions from your family and friends• Provide disaster relief• Market our services and sell your information
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your Information. Your Rights.Our Responsibilities.
Your Choices
Notice of Privacy Practices • Page 1
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Notice of Privacy Practices • Page 2
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Your Rights
Get a copy of your health and claims records
• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
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Notice of Privacy Practices • Page 3
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
Your Choices
Help manage the health care treatment you receive
• We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Run our organization
• We can use and disclose your information to run our organization and contact you when necessary.
• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.
Example: We use health information about you to develop better services for you.
Pay for your health services
• We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work.
Administer your plan
• We may disclose your health information to your health plan sponsor for plan administration.
Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.
How do we typically use or share your health information? We typically use or share your health information in the following ways.
Our Uses and
Disclosures
continued on next page
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Notice of Privacy Practices • Page 4
Help with public health and safety issues
• We can share health information about you for certain situations such as: • Preventing disease• Helping with product recalls• Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence• Preventing or reducing a serious threat to anyone’s health or safety
Do research • We can use or share your information for health research.
Comply with the law • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• We can share health information about you with organ procurement organizations.
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
• We can use or share health information about you:• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official• With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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Notice of Privacy Practices • Page 5
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this NoticeWe can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.
This Notice of Privacy Practices applies to the following organizations.
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CHIPRA Notice
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Important Information
The Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 requires group health plans that provide coverage for a mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for this year. These services include:
Reconstruction of the breast upon which the
mastectomy has been performed;
Surgery / reconstruction of the other breast to
produce a symmetrical appearance;
Prostheses; and
Treatment for physical complications during all stages
of mastectomy, including lymphedemas.
In addition, the plan may not:
Interfere with a participant’s rights under the plan to
avoid these requirements; or
Offer inducements to the healthcare provider, or
assess penalties against the provider, in an attempt to interfere with the requirements of the law.
However, the plan may apply deductibles, coinsurance, and co-payments consistent with other coverage provided by the plan.
Newborns Act Disclosure Group health plans and health insurance issuers generally may not, under Federal Law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal Law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours or 96 hours as applicable. In any case, plans and issuers may not, under Federal Law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours or 96 hours.
Summary of Material Modification This Summary of Material Modification (SMM) describes changes to the Bell County Plan and supplements the Summary Plan Description (SPD) for the plan. The effective date of each of these changes is November 1st, 2020. You should read this SMM very carefully and retain this document with your copy of the SPD for future reference.
This book highlights some of the main features of your benefit programs, but does not include all plan rules, features, limitations or exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be any inconsistencies between this book and the legal plan documents, the plan documents are the final authority. Bell County reserves the right to change or discontinue its benefit plans at any time.
Special Enrollment Notice If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or you dependents in this plan if your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request and complete enrollment within 31 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request and complete enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. Special enrollment rights also may exist in the following circumstances:
If you or your dependents experience a loss of
eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP) coverage and you request enrollment within 60 days after that coverage ends; or
If you or your dependents become eligible for a state
premium assistance subsidy through Medicaid or a state CHIP with respect to coverage under this plan and you request enrollment within 60 days after the determination of eligibility for such assistance.
Note: The 60 day period for requesting enrollment applies only in these last two listed circumstances relating to Medicaid and state CHIP. As described above, a 31 days period applies to most special enrollments. To request special enrollment or obtain more information, contact Human Resources at Bell County.
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