City of Saco Health Reimbursement Arrangement Questions? Contact GDI’s Reimbursement Team at 800-626-3539 Monday to Friday, 8:00am – 5:00pm ET. November 18, 2016 - MMEHT Benefit Overview Your employer is providing you with tax-free reimbursement for certain qualified medical expenses through an HRA – Health Reimbursement Arrangement. Group Dynamic, Inc. reimburses you for eligible expenses upon receipt of required documentation. Effective date: January 1, 2017 Basic Facts About Your HRA Benefits: Who is eligible for reimbursement? Employees and IRS-defined dependents enrolled in the Anthem PPO 500 group health plan through the Maine Municipal Employees Health Trust. What types of expenses are reimbursed? Deductible and Coinsurance as defined by the Anthem Plan. What is the coverage period? The coverage period is a calendar year from January 1 to December 31. How do I submit a request for reimbursement? You do not need to submit requests. Anthem will electronically feed claim data to GDI. We process your reimbursements based on the data they provide according to the plan parameters set by your employer. How can I check the status of a reimbursement request? Access the Participant Portal from GDI’s website at www.gdynamic.com to view all account transactions. What happens if my coverage ends mid-year? If your coverage ends mid-year (due to termination of employment or change in eligibility status), claims incurred during your coverage period will continue to be processed for 60 days after your coverage end date. May I waive HRA coverage? Yes, any eligible employee may opt-out of HRA coverage. Please contact your employer. Who is NOT eligible for HRA Reimbursements? Domestic partners or participants with secondary medical coverage may be required by the IRS to waive HRA coverage. See your employer for more information. Here is How the Plan Shares Expenses with You: Total Deductible & Coinsurance: HRA Pays First: Your Responsibility Single: $1500 $1125 $375 Family: $3000* $2250* $750* *Health Plan Deductible, Coinsurance and HRA benefits are capped at the Single Plan level for individuals who are part of a Family Plan. 1. Receive your medical care as you normally would. Your medical care provider will file claims with Anthem. 2. Anthem will send Group Dynamic, Inc. an electronic report of eligible expenses on a regular basis. This data will go into our claims system. Claim payment is in the form of a check from Group Dynamic, Inc. to you at your home address, or a direct deposit to your bank account. The payment from GDI will be based upon the application of your company’s Health Reimbursement Arrangement design to the actual claims sent to us by Anthem. 3. We encourage you to use Anthem’s website (www.anthem.com) to see the details of each claim that may have been processed for you. This will help you to identify the amount received from Group Dynamic, Inc. 4. View account activity, account balance and access other information on the Participant Portal: • Go to GDI’s website at www.gdynamic.com and click on Participant Login; • Are you a New User? Click on the link to create your new username and password.
Transcript
City of Saco Health Reimbursement Arrangement
Questions? Contact GDI’s Reimbursement Team at 800-626-3539 Monday to Friday, 8:00am – 5:00pm ET.
November 18, 2016 - MMEHT
Benefit Overview Your employer is providing you with tax-free reimbursement for certain qualified medical expenses through an HRA – Health Reimbursement Arrangement. Group Dynamic, Inc. reimburses you for eligible expenses upon receipt of required documentation.
Effective date: January 1, 2017 Basic Facts About Your HRA Benefits:
Who is eligible for reimbursement?
Employees and IRS-defined dependents enrolled in the Anthem PPO 500 group health plan through the Maine Municipal Employees Health Trust.
What types of expenses are reimbursed? Deductible and Coinsurance as defined by the Anthem Plan.
What is the coverage period? The coverage period is a calendar year from January 1 to December 31.
How do I submit a request for reimbursement?
You do not need to submit requests. Anthem will electronically feed claim data to GDI. We process your reimbursements based on the data they provide according to the plan parameters set by your employer.
How can I check the status of a reimbursement request?
Access the Participant Portal from GDI’s website at www.gdynamic.com to view all account transactions.
What happens if my coverage ends mid-year?
If your coverage ends mid-year (due to termination of employment or change in eligibility status), claims incurred during your coverage period will continue to be processed for 60 days after your coverage end date.
May I waive HRA coverage? Yes, any eligible employee may opt-out of HRA coverage. Please contact your employer.
Who is NOT eligible for HRA Reimbursements?
Domestic partners or participants with secondary medical coverage may be required by the IRS to waive HRA coverage. See your employer for more information.
Here is How the Plan Shares Expenses with You:
Total Deductible & Coinsurance: HRA Pays First: Your Responsibility
Single: $1500 $1125 $375
Family: $3000* $2250* $750*
*Health Plan Deductible, Coinsurance and HRA benefits are capped at the Single Plan level for individuals who are part of a Family Plan. 1. Receive your medical care as you normally would. Your medical care provider will file claims with
Anthem.
2. Anthem will send Group Dynamic, Inc. an electronic report of eligible expenses on a regular basis. This data will go into our claims system. Claim payment is in the form of a check from Group Dynamic, Inc. to you at your home address, or a direct deposit to your bank account. The payment from GDI will be based upon the application of your company’s Health Reimbursement Arrangement design to the actual claims sent to us by Anthem.
3. We encourage you to use Anthem’s website (www.anthem.com) to see the details of each claim that may
have been processed for you. This will help you to identify the amount received from Group Dynamic, Inc.
4. View account activity, account balance and access other information on the Participant Portal:
• Go to GDI’s website at www.gdynamic.com and click on Participant Login; • Are you a New User? Click on the link to create your new username and password.
3/11/15 Medical Nathan James Dr. Frank Burns $474.45
HIPAA Authorization Form HIPAA Authorization Form
Get Started at the GDI Home Page
Go to www.gdynamic.com
Click on Participant Login at the top left side of the screen
Enter your Username and Password
If you are a New User, create your Username and Password
Once you have logged in to your Participant Portal homepage, select the Dashboard tool:
The Dashboard allows you to view all HRA claims that GDI received and processed, along with details about each claim. Click on the Status icon to expand the view to include Expense Details and Payment Details. Use the EOB Number to track and compare your HRA reimbursements with your health insurance carrier’s explanation of benefits:
Use Your Dashboard on the Participant Portal to View HRA Claim History Data Feed HRA Plans
***x***x*x*x*xxxx*AUT0xx3-DI6IT 0q0lqBeb l, AT 0.3aq
crEcD009 slNG t-:lF.+ z013o7j 1Bo0 Jsoof,'.E.lf
2013A522013392 tiild& Env [14,026] 5 cf5
EXPLANATION OF BENEFITS
PAGE:DATE:
THIS IS NOT A BILL
W€ NOW HAVE A DEDICATED CUSTOMER SERVICEUNI' ESPECIALLY FOR YOU. {SEE SACK OF PAGE 1)A PAYMENT SUMMARY AND AN EXPTANATION OFCOOES ARE AT THE ENO OF THIS STATEMENT
Si necesita ayuda en espanol para entendereste documento, puede soltcttarla sin costoadicional, llamando al nimero de servicio alcliente que aparece al dorso de su tarjetade identifrcacion o en el folleto de inscripci6n.
10F l06/2L1r3
CLAIMS PAYABLE TO YOUR PROVIDERS. HMO MAINE & HMO CHOICECLAIM: P300702900 PLAH CODE: HMOSLPATIENT:
PROVIDER/SERVICE
t{ORTIIINGLAB ANALYSIS
IIORTHII{GLAB AIIALYSIS
TIORTHINGLAB ANALYSIS
STATUS TREAT- AIIOUTIT AITOUHTCODE DATE(S) }.IEI{TS C}IARCED COVERED
A O6/I4/L3 I 15.00 2.9E
A 06/L4/I3 I
A O5/L4/L3 I
22.AO 14, 91
33.00 18.89
cLAIil ToTALS 70.00
DEDUCTIBLE IIET- Iil TIETHONKIIIDIVIDUAI- O. OOFIHILY- 200.00
DEDUCTIBI-E }IET - OUT OF HETI{ORXrilDrvlouAt- 0.00FAI{IIY- 0.00
36.78
AI.IOU}IT PATIENTPAID BALAHCE
2.39 .gg
I'ESSACE REDUCTIOIICODE A}IOUNT
A641 .59APSlA14IA932A84L 2.98
APSTA141A932A841 3.77
APSIA14IA932
2.94
3.77
7.34
11.. 93
15. 12
29.44
CO$ISURANCE IIET-INDIVIDUAL-FAIIILY-
COIIISURAHCE I{ET-IHDIVIDUAL.FA}IILY.
rt{ t{ETfloR(7.34
353.94
ouT 0F ilETHOn(0. 00
30.58
7.=4
YOU I'IAY BE BILLED FOR AI.IOU}ITS DISPTAYED III TIIE PATIENT BALAHCE CO[UI{H. PLEASEREFER TO IIESSAGE CODES BELOI{ FOR APPROPRIATE DEFII{ITIOIIS.
STATUS CODES:A - APPROVED AJ - ADJUSTIIEIIT IP - ITI PROCESS R - REJECTED V - VOID
MESSAGE CODES:APS1 THIS CLAII{ HAS BEEN PAID AT THE PREFENRED NEFERRED LEVEL OF BEHEFITSA14I PAYI{E}IT HAS BEEN I{ADE DIRECTTY TO THE PROVIDER OF SERVICE ON YOUR BETIALFAE4I AI{OUNT PAID HAS BEETI REDUCED BECAUSE OF COII{SURANCE. COITISURANCE IS THE
PERCENTAGE OF EXPENSES THAT ARE THE RESPONSTBILITY OF THE PATIEIIT.A932 A}IOUNT COVERED LIilITED TO iIHAT YOUR HEALTH PLAII'S ALLOTAHCE IS FOR THISPROCEDURE.
COMMENTS:ATITHEIT BLUE CROSS AND BLUE SHIEI.D PROVIDESAD'TINISTRATIVE CLAII,IS PAYI'E}IT SERVICES ONIY A}ID DOES }IOTASSUI{E AIIY FI}IANCIAL NISK OR OBLICATIOII I{ITH RESPECT TOCLAITIS (EXCEPT STOP LOSS OR RISK SHARINC OBLIGATIONS, IFANY).
