Monday, June 17, 2019

Frequently Asked Flex Benefit Plan Questions

 

What benefits can I use the Premium Reserve Account for?
The Premium Reserve Account is used to make Premium payments for either continuation for Harrison Health and Welfare coverage or yearly Group Term Life Insurance premium payments.


How do I use my Premium Reserve to make partial/COBRA payments for my Harrison health insurance premiums?
Complete a claim form. Check the box numbered 336 and write the amount requested where indicated. Mail in the form. Funds will be transferred from you Flex Premium Reserve to your Harrison Health and Welfare account. There is no need to mail a check.


What is the deadline for submitting Premium payment claims?
The time lines for submission follow the same rules as Harrison Health and Welfare. Partial payments must be post marked no later than the 10th of the month. COBRA payments are due the first of each coverage month, with a 30-day grace period.


How do I enroll in the additional Group Term Life Insurance plan?
Within 31 days of reaching the required $400 of contributions to your Flex account you can enroll on a guarantee issue basis (no health questionnaire). If applying beyond the 31 days of eligibility, you will need to complete a health questionnaire (available at the Trust Office), which will be submitted to Standard Insurance Company for approval.


­How often are premiums deducted for Group Term Life Insurance and how much does it cost?
Premiums are deducted in February of each year from your Premium Reserve Account. The rates are based on your age on January 1 of each year and can be found on page 11 of your Flex benefit booklet. Premiums for life insurance are deducted before we process your semi-annual election form with the exception of February transfers. This way you don't have to worry about having enough money in your Premium Reserve Account if you transfer funds to the medical or dependent care account during open election period. You may refer to your quarterly Flex statement for verification of the yearly deduction from your Premium Reserve Account.


How often should I submit claims for medical reimbursement?
It is recommended that you submit a request for reimbursement at least every six months. Remember, you must submit the request within 12 months of service rendered.


 

What do I need to do to get reimbursed for my medical copays and deductibles?
Submit a Flex claim form and provide the Explanation of Benefits you receive from your medical plan or bills/statements from your provider's office. Claims are processed faster when submitting the Explanation of Benefits because the medical plan has already determined your out-of-pocket expenses.


When can I expect payment after filing a claim for medical reimbursement?
It takes approximately three weeks to receive your check. This time could be shorter or longer depending on the time of year. Claims submitted during an Open Election Period (Jan/Feb & Jul/Aug) may take longer to process than claims submitted following an Open Election Period.


What types of services are reimbursable under the Medical Reimbursement Account?
In general, any medical or dental expense that is not reimbursed or reimbursable by an employer provided health plan, or any other group or individual health or accident insurance; and that you haven't claimed the expense as a deductible on your federal income tax return. See IRS Publication 502 for a complete listing.


May I submit claims for Over-the-Counter (OTC) medications?
Yes, under certain circumstances. Eligible expenses must alleviate or treat personal injuries or sickness. Expenditures merely benefit the general health of an individual are not covered.

Who can seek reimbursement?
Section 152 of the code states: The taxpayer, spouse, or dependents are eligible.

What are the quantity limits?
Only amounts that can be used within the plan year by the taxpayer, spouse, or dependent are to be included.

Claims must be properly substantiated. What does this mean?
You must submit a complete and signed Flex Plan claim form with receipts attached. Additionally, effective for purchases beginning January 1, 2011, the Flexible Benefits Plan will not reimburse you for most over-the-counter medications. This change is required by the 2010 healthcare reform legislation (the Patient Protection and Affordable Care Act). You can continue to receive reimbursement for insulin and over-the-counter medications for which you have a prescription. You can also continue to receive reimbursement for items such as crutches, bandages and diagnostic devices such as blood sugar test kits.

You may also view the IRS information Revenue Rule 2003-102.


What is the best thing to submit to get reimbursed for orthodontic expenses?
Since you must have funds in your medical reimbursement account prior to receiving services, long-term orthodontic care payments must be reimbursed monthly, at the time you receive adjustments and/or orthodontic maintenance. However, if you have your orthodontist apportion your claim, you can receive full reimbursement of your out-of-pocket expenses when making a large down payment for these services.


How far back can I submit claims for reimbursement?
Within 12 months of the date services were rendered. Remember funds must be in your medical reimbursement account prior to receiving services. Since you only transfer money twice yearly it is important to check your quarterly statement for account activity. The fund transfer amounts are shown on your statements for periods ending March 31 and September 30 each year.


What do I need to do to get reimbursed for my dependent care expenses?
Submit a Flex claim form and provide a receipt which reflects the date of service, amount paid, name, address, and tax ID of person performing the service.


When can I expect payment after filing a claim for Dependent Care reimbursement?
Processing time is approximately three weeks. This could be shorter or longer depending on the time of year. Claims submitted during an Open Election Period (Jan/Feb & Jul/Aug) may take longer to process than claims submitted following an Open Election Period.


When should I submit requests for reimbursement?
You may submit a claim at any time during the year services were rendered. However, you must submit your claim by January 15th for services rendered the previous year.


How can I access my Wage Replacement Account?
You need to complete a claim form and qualify for one of the four benefits outlined below:

Supplemental Workers Compensation

    You must provide proof of Workers' Compensation. For each week you receive Workers' Compensation you will receive $300 from your Wage Replacement Account, until your account is depleted. Within four weeks of the week that you meet the eligibility requirements, you should complete a claim form to receive benefits.  You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for supplemental compensation benefits in 2004, you must submit the completed claim form by January 15, 2005.

    Supplemental Unemployment Compensation

      You must provide proof of unemployment payment (check stubs or statement from Unemployment office showing weeks paid). For each week you receive an unemployment check you will receive $300 from your Wage Replacement account, until your account is depleted. Within four weeks of the week that you meet the eligibility requirements, you should complete a claim form to receive benefits.  You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for supplemental unemployment benefits in 2004, you must submit the completed claim form by January 15, 2005.

      Economic Dislocation Benefit

        Intend to travel to an IBEW Local Union headquartered outside the jurisdiction of the Union. If you are a member of Local 48, receive a travel letter. If you are not a member of Local 48, sign the out-of-work list. The Union will provide verification to the Administrator. Fill out a claim form. Submit your claim within four weeks of receiving travel letter or signing the books. You have 15 days after the end of the Plan Year to submit a completed  claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for economic dislocation benefits in 2004, you must submit the completed claim form by January 15, 2005. 50% of your account balance will be paid out.

                Once your arrive in the new Local,

          Sign the out-of-work list. Fill out a claim form. The Local will provide verification that you are working in that jurisdiction. The remainder of your wage replacement account will be paid out.

          Submit your claim within four weeks of signing the books. You have 15 days after the end of the Plan Year to submit a completed claim form. The Plan Year ends on December 31. For example, if you meet the eligibility requirements for economic dislocation benefits in 2004, you must submit the completed claim form by January 15, 2005.

          Supplemental Short-term Disability Participants who receive the Harrison Timeloss benefit will automatically be issued $300 for each week Harrison issues payment of Timeloss benefits, provided there are funds available in the Wage Replacement Account. You do not need to apply for this.


          Do I need to complete a W-4, and if so, where do I get one?
          You will be taxed as married and two unless you complete a Form W-4 indicating otherwise. You can call the Trust office for the form.


          How long does it take to get payment when submitting a claim for the Wage Replacement Account?
          For the Workers' Compensation, Supplemental Unemployment, and Dislocation benefits, your first payment is usually paid within three weeks. Timeloss payments are paid approximately two weeks after each payment from Harrison health & welfare.


          How often can I transfer money from my Premium Reserve Account to the Medical and/or Dependent Care Account?
          Open Election Periods are held Jan/Feb & Jul/Aug each year. Statements and Election forms are mailed out by January 31 and July 31. Please call the Trust office if you do not receive this information.

          During the Open Election period, you can designate money to be placed monthly in Medical Reimbursement. At the same time, you can move any existing money in Premium Reserve into Medical Reimbursement and/or Dependent Care Reimbursement.


          When is my transfer effective?
          Your transfer is effective for services incurred the first of the month following receipt of your election form in the Trust office. (See also automatic election).


          How do I know what amount was transferred?
          The amount of fund transfers is shown on your statements for periods ending March 31 and September 30 each year.


          Why can't I transfer funds out of the Wage Replacement Account?
          This is due to the tax rules associated with the Plan. The IRS requires that once you have allocated funds into the Wage Replacement account, such funds must remain in this account until you use them.


          What is an automatic election and how does it work?
          Many participants requested the Trust to allow their funds to transfer to the Medical Reimbursement account automatically because they didn’t want to complete an election form every six months. The Trust provides participants with the option of electing their transfers to be automatically transferred every six months as noted on the election form. To allow participants time to change an automatic election, transfers do not become effective until March 1 & September 1 of each year regardless of the date your election form is received in the Trust office.