HRA guide: Out-of-pocket expenses
The Ohio Public Employees Retirement System uses a reimbursement process administered by OneExchange to help participants in the OPERS Medicare Connector pay their expenses.
Today’s blog addresses how to pay for out-of-pocket medical expenses and how to be reimbursed for them. Refer to the eligible expense list on the OneExchange website for covered items, including co-pays, deductibles and co-insurance, as well as glasses, dental X-rays, lab tests and many other items. You can view an accompanying video series on our YouTube channel.
Paying your bill
You pay for these expenses as you incur them. That might mean paying at your doctor’s office or at a retail location, or being billed by the provider.
Getting your money
To be reimbursed for pay-as-you-go costs, you’ll complete a manual reimbursement form. It’s in your Connector welcome packet, and you can find it on the OneExchange website. Or call OneExchange at 844-287-9945.
Verifying your claim
You’ll need to document your expenses. Make sure your submitted documents include:
- The covered participant’s name
- The insurance provider name
- The date of service
- A description of coverage (for example, Medigap)
Proof of payment
Proof of purchase can include the following:
- Itemized receipts
- An explanation of payment
- Itemized invoices from your providers
It’s OK to save up several receipts and submit them together. Remember that you’ll be reimbursed only up to the amount that’s currently in your HRA account when the request is processed.
Michael Pramik
Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.
We continue to have nightmares with reimbursement thanks to One Exchange. They still 5 months in are denying payment for my husband’s monthly medical premium. One Exchange admits that I am submitting reimbursement requests correctly but can’t explain why they are routinely denied. I have asked OPERS for assistance, spent countless hours on hold on the phone with One Exchange and no luck. Am now filing a complaint with the Ohio Insurance Dept.
Mary,
We have forwarded your comment to OneExchange, and they should be contacting you.
–Ohio PERS
I guess I am just realizing that I could have gotten reimbursed for this. I don’t save my receipts because I have never had enough to claim on my taxes. I wonder how many thousand people are in the dark like I am. It has been made too difficult to follow all the new rules, and I think that is what they are counting on. I am not happy.
As of July 2016 I for the part feel oper and one-exchange are to be commended for “being available” as we all become adjusted . My major concern is being just 60 but unfortunately went from disabled to now a retiree. As I do have chronic health conditions that effect my need for monthly medications some I have been on for years. Some I had to discontinue due to allergic reactions , some quite serious. In reviewing comments/questions from others I find I am increasingly concerned with after a four hour conversation not a medical report what guarantee or even a document stating why they chose the healthcare provider for me. I had questions at the time I was given providers name. The response was ridiculous let alone Clearly meant to prevent further questions. As I read what providers tell me I pay for and what they won’t pay for I feel as though I had no choice or opinion in decision. Yes I perused the numerous Available providers unfortunately I did not have enough information of all that was pertinent to me. I had a flash back to when HMOs first came about , as a healthy twenty-something I still knew that it was all going downhill from there. I now can watch read the thousands of information available via internet so I can help make a choice I’m comfortable with with Gods help the insurance companies/pharmaceutical companies don’t lobby for more holes for us to fall in.
Currently Social Security deducts 104.50 per month for Medicare Part A.
Is this an allowable reimbursement through my HRA
If so what’s the process..
Charles,
Are you sure that’s a deduction for Medicare Part A? Not Medicare Part B? If it really is for Part B, watch our Med B video.
–Ohio PERS
Can you use the online reimbursement from PayFlex to submit this type of claim. It seemed to work at least it did. I scan my receipts and other information into a pdf document and attach it to the claim using the PayFlex prompts. The online process results in much quicker payments.
Daniel,
Yes, you can submit claims online via PayFlex.
–Ohio PERS
The reimbursement idea is great . . . if only OneExchange would cooperate. The last FOUR requests for reimbursement have been denied, and their logic is ridiculous! The first claim for a whopping $29 paid as our part of a dental visit was denied because the receipt stated that the dental office had an “expected” insurance receipt of $259, which meant that the claim was still open, so they wouldn’t pay for what we had already spent. The second and third claims were for $50 each for two medical specialist visits, and was denied because the receipt did not specifically state “co-pay,” so for all they know, it might be covered by insurance. The fourth claim was for $75.58 for vitamins to promote eye health purchased from the doctor’s office, submitted as a claim for OTC, and denied by OneExchange because we did not send them a “letter of medical necessity” from the doctor.
The purpose of the reimbursement plan is to recover funds paid out for legitimate reasons, and in all of these cases, receipts from the doctor/dentist office accompanied the claims. That, in itself, should be sufficient proof that 1) the charges were legitimate and 2) the funds were paid. Why they are making these outrageous additional requests, or even expecting that we should know anything other than a legitimate receipt from a legitimate doctor or dentist should suffice as proof of payment, is ridiculous. Similar claims were sent in with similar proof of payment under the “old” OPERS Medical Savings Plan with no such pushback, and to have to fight for every claim with OneExchange is a great disservice to the clients (us). Additionally, not allowing response to denials by the internet, but rather requiring additional information to be supplied via either fax (how many people have them in their home) or regular mail appear to be simply another ploy to delay them having to pay out legitimate filings.
Larry & Margaret,
Regarding the first three reimbursements you mentioned, we would suggest your health care provider give you more-accurate receipts. A co-pay does have to be labeled as a co-pay, for instance.
As for the over-the-counter medication, that is not an expense that can be reimbursed, according to IRS rules. See pages 16-17 of this document for further explanation.
–Ohio PERS
Is there a deadline for how long a request for reimbursement can be submitted after the charges are incurred?
What about time limits to send in reimbursement requests after a person has died?
Alfred,
There is no such deadline. As long as the claim is for expenses incurred this year, it can be submitted anytime.
In the event of a death of an OPERS member who is participating in the Connector, an additional HRA may be established for the survivor benefit recipient as a mechanism to continue receiving the respective allowance through the end of 2017. The retiree’s original HRA will stay available to the survivor benefit recipient and other eligible dependents to use for a rolling 24-month period. In this situation, there would be two HRA accounts.
–Ohio PERS
If a legitimate out of pocket expense is submitted and the HRA (One Exchange) does not have enough money to cover it fully, but covers it partially, will the HRA automatically carry over the left amount to be covered to next month when the HRA will have the adequate funds to complete this coverage? Or does one have to resubmit the claim for the remaining amount to be covered?
Martha,
The request will carry over, and you will be reimbursed when funds become available. There should be no need to refile the claim.
–Ohio PERS
OPERS:
Please work with OneExchange to get all of their folks to understand that First Health Part D (Aetna) does not do auto-reimbursement.
The lady that signed me up for First health Part D was very clear that First Health Part D does not accept auto-reimbursement and that I needed to send the coupons with my check to First Health Part D every month, quarterly or yearly.
Someone else (I assume) then enrolled me for auto-reimbursement for First Health Part D.
I paid my yearly premium to First Health Part D and submitted my payment for manual/one-time reimbursement. And OneExchange paid it.
Then OneExchange started paying me the monthly First Health Part D amounts.
Then OneExchange wanted money back because “I” had filed twice for the same benefit.
I sent them the money. They sent the check back with a “never mind” note.
Between the screw-ups on Part B and Part D my account is not worth checking anymore (in addition to the web stuff and the Utah accounts don’t match the Texas folk’s numbers and Texas is the only ones that matter – a quote from Texas before I quit calling OneExchange)
My pleas in January to fix this communication problem within OneExchange fell on deaf ears.
Please try to communicate to OneExchange that First Health Part D does not do auto-reimbursement.
I know it is not your job but somebody needs to do it. I tried and failed.
Thank you,
John
John,
Thanks for your comment. We forwarded it to our Health Care team.
–Ohio PERS
First Health Part D does set up automatic reimbursements. I too was originally told they did not do this when we first signed up but about three months into it I was told they do and they set it up. It all is flowing through just fine now. You may want to try again. Good Luck!
I have not requested any reimbursement for any out of the pocket expenses. What happens when you use the amount that was allowered?
Dorothy,
You will be reimbursed for qualifying out-of-pocket expenses when you make a claim and provide documentation. Please look over the eligible expense list to see what you can be reimbursed for. Please note that over-the-counter drugs are not on this list.
–Ohio PERS
I do not receive SS. I pay Bed-B quarterly with a credit card. I submitted copies of credit card statement hi-lighted payment made. filled out Med-b form for the year I submitted also OPERS annual statement shows Part-B reimbursement. I typed a statement showing monthly B amount less reimbursement.Put that amount in box to have reimbursed.
Thankfully I have received that monthly .
A reimbursement form premium for dental and vision payments from OPERS pension can be submitted with a copy of OPERS annual statement .
Do these funds carry over to the following year or must I use all these funds each year? Also, my spouse is under Medical Mutual, may I submit medical bills on her behalf.
Thank you
Paul,
They will carry over year to year.
–Ohio PERS
Watched the films and my only question is this….why does one have to wait so long to get
the reimbursement for premium payment in any given month.
I have mine taken out of my SS and have to wait well into the month for reimbursement.
The reimbursement for expenses is far more timely and efficient.
Patricia,
It does appear that reimbursement for premiums varies depending on the provider.
–Ohio PERS
You’re about 5 months late with these videos
do you have a internet site where my reimbursement account is located so that I might find which expenses have been reimbursed and which have not? i’ve sent in a lot of items and I want to make sure I’m not sending in duplicates. Also, items have been refused and the reason given is so general as not to helpful.
William,
You can check that out through your OneExchange online account. Go to the OneExchange/OPERS website to find out how to set up this account if you haven’t already done so.
–Ohio PERS
The list of medical expenses eligible for reimbursement is comprehensive as far as the types covered, but I haven’t seen any statement of requirements regarding the date of the medical service. Can OneExchange handle reimbursements only for expenses incurred since January 1, 2016, when they began handling this process for OPERS, or may we submit expenses incurred at any time we were covered by OPERS medical insurance plans?
The reason I ask is that the largest out-of-pocket expense I’ve incurred in recent months was paying $500.10 for new prescription eyeglasses for myself on November 9, 2015. The optician provided a nicely-itemized explanation form of the charges and the insurance coverage I received to reduce them to the out-of-pocket balance noted, and as I saw that eyeglasses are a covered reimbursement item, I submitted a copy of the optician’s form and a claim for my expense to OneExchange on February 28, 2016. I have heard nothing one way or the other from OneExchange about this claim yet, though they have begun reimbursing my recurring monthly medical insurance and Medicare B premiums in the meantime. I’d prefer not to deal with OneExchange’s phone system just to be told my eyeglasses expense is too early for their coverage period, but if you think there’s potential eligibility for it to be reimbursed, I’ll pursue calling them. Thank you for your help.
Richard,
The expenses have to be incurred as of Jan. 1, 2016, or later. You can’t be reimbursed for something you paid for in 2015.
–Ohio PERS
Thanks, Michael — Now I know the covered-period requirement.
I have submitted for reimbursement for a prescription, I included the invoice sent to me with the prescribed medication. Received answer requesting a receipt for payment. I re-submitted the invoice with a note
suggesting they look closely at invoice. Under account summary it clearly gives the price of the meds , the amount paid and total due. Is there something more they might need? I also included the Reimbursement form, completed.
PRICE
One Exchange has been a NIGHTMARE for me…I have submitted and resubmitted my claims, and have been sending them copies of my bank statements, proving that I’ve paid for Medicare B & Medigap…I submitted 2nd requests (And wrote in BOLD RED MARKER: 2nd Request & the date) So, this month, I received reimbursements for 4 months Medicare ($89.99) (Feb, Mar, Apr, Apr a 2nd time) and, I had already been reimbursed for Feb..
I was reimbursed for FEB 2016 – DEC 2016 for Silverscript (19.60/month) & then last month receive a payment of $39.20 with NO EXPLANATION!
A lady I work with used to work for an insurance company and she couldn’t figure out the EOB’s from One Exchange.
How hard is it to reimburse me for Medicare, Medigap, dental, vision, & Silverscript EACH MONTH?
I have to BEG for my money each month…
I have wasted so many stamps & envelopes to that PO BOX 981155, in El Paso TX…
sigh.
I filed two appeals in February 3 days apart. On the first one, I received an email with a week or so confirming they received the appeal, and the money was deposited in my account about one week later. Very business like.
The second appeal has never been confirmed by email as having been received. In a second follow up telephone call in May, customer service finally acknowledged that they could see the appeal in the system, but asked me to be patient. it is now May 17th, and I have still not heard anything.
One of my biggest frustrations is that the folks in customer service seem to be able to see little more than on can through the website. Why isn’t there a standard operating procedure in place, as per my experience with the first appeal, to keep folks informed. It could be simple. We received your appeal. And then some kind of outcome – e.g., approved, more information required, or disapproved for some specific reason?
While overall I understand why OPERS has moved in this direction of providing health care, this has not been efficiently implemented.
We are nothing but what is short of a awake nightmare with Towers Watson and so broke over it we are barely making it now. They have over $1,000 dollars of my husband’s money and I have sent reimbursement forms in and nothing. We were lied to when we set up his insurance with the plan we were basically manhandled in picking and now his medications are over 500 dollars a month. After we pay the insurance out of pocket and basically his medications at cost we are broke. They are pocketing his medicare reimbursement and even after submitting proof of paying it nothing. I don’t know what to do anymore . My husband is going without medication because we can’t afford it and he has Parkinson’s disease.
Hello,
We have forwarded your comment to OneExchange, and a representative should be calling you soon to discuss your issue.
–Ohio PERS
I will be starting the process soon for my spouse and have him signed up with One Exchange. I was hoping most of the kinks would be ironed out by now. After reading all the responses from retirees on all the problems they have been having to deal with One Exchange, I have to say that I am not looking forward to it. I know OPERS wants to have someone else take care of our healthcare but they really need to look at One Exchange’s history and all the problems that need to be ironed out. A lot of these retirees should have been grandfathered and I’m talking about the ones that had to pick a lower retiree benefit with healthcare for their spouse. Even though OPERS keeps saying providing healthcare is not a law, a lot of us made that choice back then and now we can’t change it. If we had known that this would be our future, a lot of retirees probably would have picked a different retiree benefit. OPERS did not handle this properly in my opinion and I’m sure there are a lot of retirees who would agree with me. I see this come up a lot on blogs. It sounds like a lot of work for retirees and OPERS wants to pass the problems on to someone else. It’s not running smoothly and something needs to be done. I really hope that they listen to the retirees concerns. When I ran off some insurance companies with the drug costs, it came up $312,000.00 a year for prescriptions to be paid for my husband. I knew it had to be a glitch. The next time I ran it off, it said $5000.00 a year for his prescriptions. I don’t know what to believe but I will certainly be talking to the individual insurance companies. You can count on that.
That is exactly what you should do. Doing your own research is the best way to be satisfied with whatever plan you end up with. One Exchange advisors were helpful to me in answering questions, but I did my own research before I talked to them and found out which drug plans were best for me. I also take expensive medications, and that was a big concern. In terms of One Exchange, there were problems at first, but many of the glitches have been smoothed out. I am not having any trouble getting reimbursements and am happy with One Exchange.
The best drug cost estimator is on medicare.gov. The results apply to the one exchange programs. Once you buy your healthcare plan through One Exchange you are free to buy any drug program and get it reimbursed.
I am one of those practically illiterate people who knows very little about computer processes. This whole reimbursement process seems so unnecessary. This is money put into MY account. Why do I have to beg for it? There has to be a much simpler process. Like just give me what is really mine! If I am foolish and do not pay my bills I do not see how that has any consequences except for me. Am I really not ” getting it ” in more ways than one .
The allowance that OPERS gives us to help with our health care expenses is called a Health Reimbursement Arrangement (HRA). You can tell by what it is called that it is designed to be a reimbursement; it reimburses you for expenses that you have already spent on health care (insurance premiums, co-pays, prescription meds., etc.). OPERS set it up that way for tax purposes. If they just gave us the money directly, it would be considered additional income by the IRS, and we would have to pay taxes on it, both state and federal. After the taxes, we would have less money left over to use for health care expenses. However, under IRS rules, an HRA is not taxable to us, so we can use the entire allowance to pay health related expenses.
What Diane says is true, an HRA allows OPERS to give us tax free money. Another fact is that this is not your money. It is our money. None of your contributions went into creating the healthcare fund. Your contributions have all been used to fund your pension account. The healthcare fund was created to help all of us pay our healthcare costs. The retirees with the greatest healthcare costs are the retirees who are not eligible for medicare. The next group are the retirees that have to pay for Part A medicare coverage.
The previous post brings up an interesting question. If all our contributions are used to fund our pensions where does the money for the HRA come from?
DP,
We have a health care fund that is managed separately from the pension fund. That’s where the HRA money comes from. The health care fund receives a portion of the employer contribution that is made on behalf of our members. Our members’ contributions must, by law, go toward pensions.
–Ohio PERS
When I enrolled with One Exchange in October 2015, I was told I had to change insurance companies even though I did not go with the county’s plan when I retired. The plan I had was one I really liked and fit well with our budget. It was listed as one that I could choose from the list provided by One Exchange. I am now being told that I did not need to change. Which is correct? Thank you.
Carol,
The only way to receive the Medicare HRA allowance from OPERS is to sign up for a plan through OneExchange. If you initially waived OPERS coverage and secured a Medicare Advantage or Medigap plan on your own, then joined the Connector in 2016, you are not able to sign up for the same plan you had. That is a Medicare rule. It is illegal for a new broker, such as OneExchange to enroll someone in the same plan they had.
–Ohio PERS
Hi there – I want to make a comment about the “coverage gap.” I had no idea I was going to fall into a “gap” until I received a letter from AARP (they are my Rx insurer) and at that time I was in it. Apparently, when under PERS group insurance, Humana, this problem never surfaced and I was totally unaware that it even existed. I am now being hit with huge co-pays for my inhalers every month to the tune of several hundred dollars for just one inhaler. Inhalers are very expensive medicines. I signed up for an insurance plan where I would only pay $35 dollars for each one, besides my monthly premium cost. I feel this is going to take me under since I don’t have that kind of money just laying around to cover these expenses – I have actually had nightmares about this! I didn’t even have any prior knowledge to “try” to get prepared for this – all of a sudden I was in it! Why wasn’t One Exchange responsible to tell me this was coming when they “helped” me find the best insurance plans for the prescriptions I was on??? At least I would have had prior knowledge and a little time to prepare. I have been wondering how or who I could talk to about this problem and I found this, so I’m unloading here. I tried PERS but they were not helpful at all. I know about the reimbursement (HRA), but all that money is eaten up with all my premiums with very little left over for anything extra. I’ve contacted AARP and they tell me that as long as I am on Medicare, I will be subject to this “gap” no matter who my insurer is! Is there any medical insurance plan that covers this gap expense? I have “The Health Plan” and they do not – I called them. I pay them $200/month and that’s just a supplement to Medicare.
Shirley,
You can change your plan for next year. Call OneExchange during Open Enrollment for 2017. That will be from Oct. 15-Dec. 7 this year. Ask them to review plan options for your specific case — inhalers.
–Ohio PERS
I HAD that conversation with them. They led me to AARP because AARP had the lowest co-pay for inhalers. However, I was not told I would go only a few months and then fall into a “gap”. I could only choose from the companies offered through One Exchange. Furthermore, I have been told that there is NO WAY I can dodge the “gap.” I’ve been told, that because I’m in Medicare, I will go into the gap with any insurance I have. Is that true? How would I find the answer to that question? If I went outside of One Exchange and found an insurance plan on my own, would I still be able to submit the premium to my HRA for reimbursement?
Shirley,
Yes, it’s true that there is a gap in Medicare prescription drug coverage. It’s called the “donut hole.”
The donut hole is closing in 2020.
If you go outside of OneExchange and find a plan on your own, you can have it reimbursed through the HRA.
–Ohio PERS
Here’s the way I feel:
I cannot afford the hundreds for my inhalers. Either I don’t eat or I don’t breathe. Thanks PERS!
I will survive somehow – probably by putting costs onto my credit cards and paying interest on it – – forever! 2020 doesn’t really help me although I’m glad to hear there is an end to it! I am still working so I’m not eligible for help. My budget is blown to bits by this. I’m trying to get in a place where I can retire – this is definitely NOT helping – only prolonging my working and I’m 74 years old now.
I thought that we were only required to buy supplemental coverage for Medicare parts A and B from One Exchange, and once we had that coverage, we were free to get drug coverage from any one without losing our HRA. Michael, please clarify.
Ed,
You’re correct. It’s auto-reimbursement that can’t be done if you go outside of OneExchange for your prescription plan.
–Ohio PERS
I call One Exchange at least a month ago or more. I requested a copy of the form to get reimbursed. As of today I have not heard from them. Every time I deal with One Exchange, they seem to not know what is going on. I would think that we could have a company located in the State of Ohio to take care of all the retirees and current employees.
I am not impressed with One Exchange.
Carol E Smith
My mother receives a monthly statement showing her out of pocket prescription costs and includes a year to date total amount. Rather than sending in several receipts from prescription co-pays, could this statement be used as proof of the payment for prescription out of pocket expense since it shows the total year to date amount?
Proper documentation must be provided for reimbursements to occur. Please call OneExchange at 1-844-287-9945; they will walk you through what is needed and help you fill out the form.
Thank you for the quick reply!
I paid my medical insurance premium last month for June and still have not been reimbursed by dumExcfhange. They usually pay by the l9th of the month, but didn’t this time. Now the July premium is due and I haven’t been reimbursed for June. Gee, thanks.
Linda, thank you for sharing your experience. We have shared your concern with OneExchange and they are researching your inquiry. OneExchange will contact you within 48 hours to discuss further.
Thanks again,
-Ohio PERS
Suggestion:It would be nice if the OneExchange and the PayFlex web sites would show a “Rollover Balance”, so you could see how much money you have coming — even if this month’s Available Balance is zero. This will especially important towards the end of the year
Question: Will the monthly amount put into the HRA accounts be going down for 2017 an 2018 or beyond?.
Great suggestion. We are working with PayFlex on other enhancements and will add your suggestion with our feedback.
To answer your question, Yes. 2017 is the second year of the health care allowance transition until the ending allowance takes effect in 2018. Retirees will continue to receive an allowance beyond 2018, while a spouses’ allowance will become zero as of Jan. 2018.
For specific questions about 2017 plans through OneExchange, please give them a call during the Medicare annual open enrollment period (Oct. 15 to Dec. 7) for plan options. If you are satisfied with your current medical/pharmacy plans, you will be automatically re-enrolled for 2017 and no action is necessary.
-Ohio PERS
There was a readable list of current and pending transactions on the one exchange account page under My account » Funds & Reimbursements » Allocation and transactions. The transactions part seems to have been removed. This makes the website less informative. I would like to see the transactions returned to this page.
One Exchange continues to deposit HRA monies without any explanation as to the reason for the deposit. This makes auditing our account difficult because we do no know what bills are being reimbursed. (All we get is a total in the bank statement).
There is no notification if an item is rejected. This means we have to make a best guess as to what they did pay versus what they did not pay. Then we have to call One Exchange to find out what or where there is a issue.
Calling One Exchange for HRA is difficult as the customer service reps do not have access to the breakdown of payment/rejection. (Typical phone call is 1-4 hours.) One Exchange’s stock remark is that The HRA is managed by a company out of Omaha. The Omaha group is difficult to to contact or they just ignore the customer.
William,
Thanks for pointing this out. We’ll forward your concern to OneExchange.
–Ohio PERS
The information that you are looking for is on the healthhub.com site. Login to OneExchange go to the Funds & Reimbursements tab and select the green Manage funds button.
Thanks Ed. While going directly through PayFlex is one method,the preferred avenue to access this information is going through the medicare.oneexchange.com/opers site.
Thanks for helping out.
OneExchange moved the information off their site on to the PayFlex site (where it always was). If you hold the mouse over the green Manage Funds button you can see a notice to this effect. See my response to your July 7 post lamenting this change.
Ed
Going to that site is not the only issue. 1st we received no notice that a deposit was made until a week after it happen. That letter was generic and I am sure it was a letter created through some software. That letter should have been sent the day the deposit was made.
2nd The letter does not say what was reimbursed and amount.
3rd the Letter does not state what was denied. This makes auditing our health care cost very difficult.
4th If we have to call OneExchange about any HRA issue we can expect 4 hours on the phone and a high probability that we will not get the information we need.
Bill I am sorry that you are having so many problems with OneExchange. I haven’t had to call them for months, so I don’t. know what is going on now. The last time I called in February or March I did not have any problems getting through. I find the explanation of benefit letters overly complicated. The email doesn’t explain anything. You have to download it and then use the link to download the actual explanation of benefits (EOB). The first page of the PayFlex site (healthhub.com) has alerts. There is an alert every time a payment is scheduled to go out. I hope that this helps.
One Exchange Question 07/15/16
If funds in a One Exchange Health Reimbursement Account goes unclaimed who gets the monies? Does One Exchange keep the monies? Does OPERS received the monies?
Great question. If the retiree were to pass away, a qualified dependent has a rolling 24 month period to file a claim. Each time a claim is filed, it starts another 24 month period.
If the survivor were to pass away, there is a flat 24 month period that any qualified dependent has to submit a claim.
Thanks again,
-Ohio PERS
Are Dental and vision premiums allowed to be submitted as recurring expenditures, since they come directly from our monthly checks? I know this option does not come up online, but can you file a manual recurring reimbursements form?
Great question. You now have the option to submit dental and vision premiums through the recurring claim process (it was not an option at the beginning of the year) along with Medicare Part B premiums for example. Separately, you do have the option to file manual claims, typically used for copays, coinsurance, deductibles and out of pocket expenses. More information is also available at https://medicare.oneexchange.com/opers
Thanks,
-Ohio PERS
Either I am thicker than I thought, or the One-Exchange web site is less than intuitive, but I am not able to figure out the way to set up an automatic reimbursement for repayment for my dental deduction from my HRA. I see that it is being announced that it can be done, but even the link provided did not appear to tell me HOW to do it!
Good morning,
You may find the below link to the OPERS video explaining how to submit for reimbursement helpful. Give it a go, and please give OneExchange a call if you have any questions. There is also an option on their website to email questions. I hope you find this tutorial a little easier to understand.
Have a great day,
-Ohio PERS
I finally gave up and called OneExchange to ask for help. Took well over five minutes of arguing with the customer service rep about the availability of automatic payments for dental and vision . . . she kept insisting that it was only available if the plans were through OneExchange. She finally agreed to ask someone, and when she came back she said I was correct, but it was something new that they were not aware of. When I asked how I did it, she said that I first needed to get a letter from OPERS verifying all of the pertinent information. I asked what that information was, and she said that OPERS was aware of it and could supply the letter. A subsequent call to OPERS revealed that nobody there that I spoke with was aware of the letter requirement or what to do to get it beyond the monthly letter that I have been sending to OneExchange already for the manual reimbursement. Final results . . . No progress made at all!
Peggie,
Watch this video to see how you can receive reimbursement for OPERS dental and vision coverage. The document you need for proof of payment is the OPERS premium receipt, and the video shows you exactly how to find it.
–Ohio PERS
I know OPERS is putting an extra $300 into our Connector accounts in 2017 and 2018. However, Can you (or me) tell us how much the monthly allocation is going to decrease in 2017 and 2018, if you have 30 years of service? Are there a tables available that show this? Thanks.
Great question. If you still have it, look at the welcome letter that you received with your first Connector toolkit – it included a letter, magnet, calendar, etc. The back of the letter included a table that broke out 2016/2017/2018 with a $337 2018 monthly allowance amount. If you would like another copy, please call in to OPERS and one can be mailed to you. Also, at the beginning of October you will receive your Open Enrollment packet. The enclosed personalize statement will include a 2016 and 2017 comparison. This should give you everything you need.
Thanks,
-Ohio PERS
The $300 up front will be gone in 2019 — at least nothing is said about it. Will the 2019 monthly allocations be the same, or will we face further reductions? Or is this known yet? Thanks.
Great question. The decision is at the Boards discretion and will be discussed later next year. At this point, no details are known.
I went to have my taxes done & my tax prep person said I have to have a 1099 for funds I received from my HSA account–how/why/where do I get that form?
THANKS for your help!
Thanks for writing in. 1099’s hit the mail stream mid January with the last batch to arrive in-homes by February 15th. If you haven’t received a paper copy yet, the 1099 is available in your online account. Give OPERS a call if you have any concerns.
Thanks,
OPERS
My claim for an OTC medication is being denied, due to no Letter of Medical Necessity. The Letter of Medical Necessity hasn’t been required since January 2020. Some employees at Via Benefits seem to be able to look this up & others not. Where can I find it in print that the Letter of Necessity is not longer needed, so I can send a copy to Via Benefits & resubmit my claim?
Melody,
Please contact Via Benefits at 844-287-9945 for additional assistance.
Thanks MS