commonly asked questions and answers [email protected] i toll-free fax 866-450-1480 i tasc...

[email protected] I toll-free fax 866-450-1480 I TASC I P.O. Box 7213 I Madison, WI 53707-7213 Service: [email protected] I toll-free 866-678-8322

DP-6161-100818

COMMONLY ASKED QUESTIONS AND ANSWERS ABOUT PARTICIPATION IN A RETIREE HRA

What is a Retiree Health Reimbursement Arrangement (RHRA)? An RHRA is an employer sponsored medical benefit plan through which you can get reimbursed tax-free for your retiree medical and prescription benefit insurance premiums and/or eligible out-of-pocket medical or dental expenses (e.g., expenses that are not paid for by insurance or any other benefit plan). The County contributes money to your RHRA and you don’t have to pay taxes on these contributions. Then, that non-taxable money is paid back to you as reimbursement for your retiree medical and prescription drug insurance premiums and eligible out-of-pocket healthcare expenses that you incurred by you, your spouse or dependents, if applicable eligible under the plan.

When can I start to submit insurance premiums and eligible health care expenses for reimbursement? RHRA reimbursements must be incurred on or after the date you enroll in the HRA and become Medicare-eligible. When are expenses “incurred?” IRS rules state that insurance premiums are incurred on the first day of the month of coverage and you cannot be reimbursed for expenses prior to that, regardless of the date the insurance bill was paid. A non-insured medical expense is incurred at the time that services are provided, not when an appointment is made, a bill is dated, or a bill is paid. What kinds of expenses qualify for an RHRA Account? For Wayne County, eligible expenses will depend if you are enrolled in an AmWINS Group Benefit Plan or an Individual Plan. Please see below for specifics. If you are enrolled in an AmWINS Group Benefit Plan, only health insurance premiums are eligible for reimbursement. AmWINS will bill TASC for the amount that Wayne County will be contributing towards your premiums each month on your behalf. If you are enrolled in an Individual Plan, you are eligible to be reimbursed for all medical expenses as defined by IRS Code Section 213(d) and certain insurance premiums. Examples of eligible expenses include:

Individual health insurance premiums Deductible expenses (the part of covered expenses you pay before your health or dental plan pays

any benefits) or co-insurance amounts (the percentage of covered expenses you must pay, if any, after the deductible requirement has been met.)

Prescription drugs/copayments Medically necessary equipment or supplies Dental procedures (non-cosmetic) Vision care expenses, such as eye exams, eyeglasses/contacts, lens solution, laser surgery

Expenses incurred prior to the time you become eligible to incur and receive reimbursement for such expenses under the provisions of the plan are not reimbursable.

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DP-6161-100818

Can the money be withdrawn for anything other than the above? RHRA accounts can only be used for tax-eligible medical expenses and insurance premiums as specified above. How are deposits made to my RHRA Account? Deposits to your RHRA Account are made by the County on a monthly basis.

Do I pay federal, state, or local taxes on this money? No. Contributions to your account are non-taxable and reimbursements are also non-taxable. How do I pay for eligible expenses? The TASC Card is the most convenient way to pay for your eligible expenses. Simply swipe the card at the point of purchase (doctor’s office, hospital, pharmacy) and the amount is paid from your HRA. You may also submit claims via the website. Substantiation providing date of service and description of service will be required for TASC Card purchases not automatically approved by the Inventory Information Approval System (IIAS). Expenses paid via your card may not require any additional validation if they meet certain transaction requirements; you will receive a request for substantiation when required. If requested debit card substantiation is not submitted within a reasonable time, your TASC Card will be temporarily deactivated until the matter is resolved. How do I receive reimbursements from my RHRA? For Wayne County, eligible expenses will depend if you are enrolled in an AmWINS Group Benefit Plan or an Individual Plan. Please see below for specifics. If you are enrolled in an AmWINS Group Benefits Plan, reimbursements will be automatically sent to AmWINS on a monthly basis. On or about the fifteenth day of each month AmWINS will bill TASC for the amount that Wayne County is contributing toward your monthly premiums on your behalf. TASC will remit these contributions to AmWINS around the first of each month for that month’s premium payment. Example: On December 15, AmWINS will send an invoice to TASC for your January premium payments. On or about January 1, TASC will remit payment to AmWINS to be contributed towards your January premium. If you are enrolled in an Individual Plan, you must complete an online or paper claim form and a Direct Deposit Authorization Form and submit it to TASC by email, mail or fax. For each eligible expense, the IRS requires that you indicate the person who provided the service, the nature of the service, the date the service was provided, the person who received the service, and the amount. You must also include documentation (copies of insurance Explanation of Benefits statements, itemized receipts, invoices, etc.) for each service. To receive automatic monthly recurring reimbursements for your individual premium expenses, you will need to also complete the Recurring Individual Premium Reimbursement Request Form. For your convenience, we have included the form with this letter. You will need to complete this form at the start of each January as your insurance plans renew. Please complete the form and include proof of your insurance coverage (detailed invoice) that must include the type of coverage, premium amount and contract period. Return these completed documents to TASC by email, mail, or fax. Then, every month TASC will reimburse you directly for your health insurance premiums without having to submit a reimbursement request each month. Recurring claims are batched on the first Thursday after the first day of each month and reimbursement is sent to you checking or savings account the following week on Friday.




DP-6161-100818

How long will it take to get reimbursed when I submit claims? Eligible claims and substantiation received by TASC by close of business on Wednesdays are reimbursed the following week on Friday. Direct deposit reimbursements will be in your checking or savings account on Friday. How much will I receive when I submit a claim? You will receive the lesser of the amount you submitted or the balance in your account at the time of reimbursement. If your balance is less than the amount that you submitted, the unreimbursed amount will automatically be reimbursed to you if another contribution of sufficient amount is made to your RHRA. After I have incurred an eligible expense how long do I have to submit a claim for reimbursement? All eligible expenses must be incurred and reimbursed within the calendar year.

What about claims incurred late in the year? It is understood that sometimes you incur expenses late in the year and it takes some time for those expenses to be processed. That’s why you will be given a runout period after the close of each plan year in order to get all of your claims in for the preceding plan year. The length of the runout period will be specified in other materials provided to you.

Can I request reimbursement of medical expenses and also deduct the same expenses on my income tax return? No. You can use your RHRA or the itemized deduction, but not both.

How do I access my claim activity information? Access your account information by logging on to the TASC website at https://mybenefitsportal.tasconline.com. You can submit claims, view your account balance, claims, and payments, and print forms. Please Note: These questions and answers represent a brief summary of Retiree Health Reimbursement Arrangement rules. They are not intended to provide legal or tax advice. If any statement in this document conflicts with the provisions of your formal plan document, the formal plan document will be considered to be correct.

Check the status of your claim online at https://mybenefitsportal.tasconline.com.



https://mybenefitsportal.tasconline.com/

https://mybenefitsportal.tasconline.com/

Submit completed form to: Claims: [email protected] I toll-free fax 866-450-1480 I TASC I P.O. Box 7213 I Madison, WI 53707-7213

Service: [email protected] I toll-free 866-678-8322 FH-5709-012918

RECURRING INDIVIDUAL PREMIUM REIMBURSEMENT REQUEST

(Former) Employer Name: From what initial date would you like reimbursements of

Plan Year: your premium(s) to start?

Retiree/Employee Information

Retiree/Employee Name: Last 4 of Social Security #:

Home Address: Retirement Date:

Email: Phone:

Individual Policy Information – This is required information and must be filled out completely to process your request.

Name of Insured Person:

Name of Insurance Carrier:

Type of Coverage:

Plan Year/Policy Start Date: Plan Year/Policy End Date*:

Total Monthly Individual Premium Amount Requested:

Employee Acknowledgement of Recurring Premium Reimbursement Request Please initial next to each line to indicate you acknowledge the terms of this recurring premium reimbursement request. ________ I understand that insurance premium claims are considered to be incurred on the first day of the month of coverage and that I cannot be reimbursed for expenses prior to that, regardless of the date the insurance bill was paid. ________ I understand that claims are batched on the first Thursday after the 1st day of each month and reimbursement is sent the following week on Friday. ________ I have attached a proof of my insurance coverage that includes the type of coverage, premium amount and contract period. Acceptable documents include a letter from the insurance company that includes the above information, a copy of a contract renewal letter or a letter from the former employer sponsoring the plan. ________ *I understand that I will be set up for recurring reimbursement until the plan year/policy end date, when the rates will most likely change. I understand that I will need to complete a new form and send proof of insurance coverage when my insurance premiums change at the end of the plan year/contract or for any other reason. ________ I understand that I am required to have direct deposit set up with TASC to receive claim reimbursements. ________ In the event that my coverage is terminated for any reason, I am required to inform TASC within five (5) days of the termination so that future reimbursements can be stopped. ________ I certify the above information is correct and the expenses claimed will incur on a regular basis by me or my eligible dependents after my effective date of coverage in my employer’s Retiree FHRA Plan or Individual Premium Reimbursement Account. I certify these expenses are not eligible for reimbursement under any other plan, and comply with the requirements of this plan. I have not and will not claim these expenses on my personal income tax return and I certify, to the extent required by federal law, that I will file the designated form with the IRS by April 15 of the year after the expenses were incurred.

EMPLOYEE CERTIFICATION OF RECURRING EXPENSES AND CLAIMS FOR REIMBURSEMENT

Employee Signature: ________________________________________________ Date: _______________





DIRECT DEPOSIT AUTHORIZATION

I hereby authorize TASC to initiate deposit of my medical expense reimbursements to the bank account indicated below and, if necessary, debit entries and adjustments for any credit entries made in error to my account. Please attach a copy of a voided check if you are electing to have reimbursement sent to a checking account.

*If you are electing to use your savings account please contact your bank for the Transit ABA Routing Number.

If you are re-enrolling during Open Enrollment and are already signed up for direct deposit, you do not have to complete this form. We will continue to deposit reimbursements to the bank account on record.

This account is (Please check one of the following options)

New_____ Change_____ Cancel_____ Name of Bank: ______________________________ ________________________ ____________________________ ___________________________

Transit ABA Routing Number Account Number Account Type (Checking or Savings*)

Attach Voided Check OR Savings Deposit Slip HERE

Employer Name: __________________________________________ Address Change

Employee Name: __________________________________________ Last 4 of SSN: ___________________

Home Address: ____________________________________________________________________________

____________________________________________________________________________

Email Address: _________________________________________ Telephone: _______________________

Signature Date

Bobby Brady 3448 123 Main Street 7-1-945 Anywhere, USA 55439 Date __________________

Pay to the Order of ____________________________________

______________________________________________________________Dollars For _________________________ ____________________________

(Routing Number) (Account Number)





MEDICAL EXPENSE CLAIM FORM

Medical FSA Integrated FHRA Limited FHRA

You may track your payments, view plan balances and see claim history online anytime. Please comply with the following instructions to file your claim for reimbursement. Failure to follow these instructions will delay processing of your claim and may result in your claim being returned to you. Additional information regarding allowable expenses is provided on the reverse of this form.

1. Complete the entire claim form, including the itemized list of expenses. 2. Attach documentation, in the order it is listed on this form, supporting the expenses. Acceptable documentation

includes:

For medical care: an itemized bill from the provider or Explanation of Benefits from the insurance company showing the date of the service, provider name, type of service and/or procedure codes, and your out-of-pocket cost.

For over-the-counter drugs and supplies: the itemized receipt or drug receipt from the place of purchase showing the date, item purchased, and out of pocket cost AND a prescription from an authorized individual.

3. Note the claim line number in the upper right corner of each attachment. For example, note “1” in the upper right corner of your documentation for the health care expense listed first on the claim form.

4. List all claims separately, including prescriptions. If additional space is needed, attach a separate sheet using the same format as the itemization on the claim form. Continue the claim line numbers on the additional sheet.

5. SIGN and DATE the claim form after carefully reading the Employee Certification on the reverse. 6. Keep a copy of this form and all supporting documentation for your records. 7. Eligible claims and substantiation received by Wednesday will be reimbursed the following week on Friday.

Employer Name: ____________________________________________________ I Am Retired

Employee Name: __________________________________________ Last 4 of SSN: ___________________

Home Address: ____________________________________________________

____________________________________________________ Address Change

Email Address: _________________________________________ Telephone: _______________________

MEDICAL EXPENSES Line #

note on receipts

Service Date Provider Type of Service

(i.e. Medical, Dental, Vision, Orthodontia, Prescriptions)

Patient Name

Amount Requested

1

2

3

4

5

6

7

8

9

Total Medical Expense Claim $





EMPLOYEE CERTIFICATION OF EXPENSES AND CLAIM FOR REIMBURSEMENT

I certify that I have read and understand the Employee Certification on the reverse side of this form.

Employee Signature: _____________________________________________ Date: ______________________





MEDICAL

EMPLOYEE CERTIFICATION

Read this statement carefully then sign in the appropriate place on the front of this form. I certify that I am claiming reimbursement only for eligible expenses incurred during the applicable plan year for qualifying individuals. I certify that these expenses have not been reimbursed and I will not seek reimbursement for them under any other health plan. I understand that the expense for which I am reimbursed may not be claimed as an income tax deduction. I understand that if I am reimbursed for an ineligible expense and the IRS audits my personal income tax return, I may be subjected to taxation on the reimbursement amount. I have provided sufficient documentation to support all expenses for which I am requesting reimbursement.

MEDICAL ELIGIBLE EXPENSES

Expenses allowed by your employer sponsored plan may vary from those permitted by the IRS. Consult your plan document to determine what expenses are allowed by your plan.

Expenses must be incurred by you, your spouse, or eligible dependents.

Expenses must be incurred primarily for medical care as defined by the IRS, which includes “amounts paid for the diagnosis, cure, mitigation, treatment, prevention of disease, or for the purpose of affecting any structure or function of the body.”

Expenses for personal items are not reimbursable even if recommended by your physician. Generally, an expense is deemed “personal-only” if it would have been incurred in the absence of a medical condition. Examples are health club dues and dental hygiene products.

Expenses for dual-purpose items, which may be personal or medical in nature, require substantiation of medical necessity. Examples are blood pressure monitors, acne medication, weight loss drugs or programs, massage therapy and over-the-counter orthotics, such as ankle or knee braces. Medical necessity can be substantiated through a letter or other documentation of illness or disease from your practitioner.

Since January 1, 2011, over the counter medicines are no longer eligible for reimbursement from your medical FSA accounts without a doctor’s prescription. For more information, see the OTC Medicine Announcement.

Sufficient documentation to substantiate the medical necessity of the expense must be provided in order for your claim to be processed.

You may not claim expenses which have been reimbursed or are reimbursable under any other source. If you do not comply with this requirement and the IRS audits your tax return, you will be liable for any and all back taxes due on ineligible expenses.



commonly asked questions and answers [email protected] i toll-free fax 866-450-1480 i tasc...

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