Client Information Form - Benefit Strategies · Web viewOnce the feed is received at Benefit...

HEALTH REIMBURSEMENT ARRANGEMENTS

Client Information Form and Administration Guide

For: (Client Name)

Table of Contents

Client Information Form........................................................................................................................................................3

Health Reimbursement Arrangement (HRA) Implementation Form.....................................................................................5

HRA Plan Designs..................................................................................................................................................................8

Standard Plan Design Options..................................................................................................................................8 Custom HRA Plan Design*.....................................................................................................................................10

Enrollment Method.............................................................................................................................................................12

Health Reimbursement (HRA) Administration Guide..........................................................................................................14

Timing of Claim Payments..................................................................................................................................14

Claim Adjustments Received on Carrier Claims Feed.........................................................................................15

Non-Discrimination Testing................................................................................................................................15

Funding Process..................................................................................................................................................................16

Overview................................................................................................................................................................16Claims Funding and Maintenance Deposit.........................................................................................................16

Check Information.............................................................................................................................................16

Unclaimed Checks..............................................................................................................................................16

Funding Reports..................................................................................................................................................................17

Division Subtotals..............................................................................................................................................17

Enrollment and Eligibility....................................................................................................................................................17

Initial Enrollment Census...................................................................................................................................17

Ongoing Eligibility Method.................................................................................................................................17

Carrier Feed Enrollment.....................................................................................................................................17

Plan Specifics.......................................................................................................................................................................18

Participant Pay...................................................................................................................................................18

Provider Pay.......................................................................................................................................................18

Explanation of Plan Design Option Components:................................................................................................................19

Employer Reports..................................................................................................................................................20Employer Portal.....................................................................................................................................................20Users and Access Levels.........................................................................................................................................20

Participant Communications...............................................................................................................................................21

Participant Forms...................................................................................................................................................21Health Reimbursement Arrangement Reimbursement Form:...........................................................................21

Direct Deposit Authorization Form:...................................................................................................................21

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Client Information FormClient Information

Client’s Legal Name: Click here to enter text.

Client's DBA or AKA Name: Click here to enter text.

Mailing Address: Click here to enter text.

Physical Address: Click here to enter text.

Main Phone Number: Click here to enter text. Fax Number: Click here to enter text.

Tax ID: Click here to enter text.

Tax Year End Month and Day: Click here to enter text.

Total Number of Employees: Number of Benefit Eligible: State Organized: Industry: Click here to enter text.

Entity Type(C-Corp, S-Corp, etc.): Click here to enter text.

Controlled Group? Yes NoIf yes, list Affiliates including Tax ID#: Click here to enter text. Click here to enter text.

Click here to enter text. Click here to enter text.

Point of Contact InformationSigning Authority Contact Primary Contact for HRA? Yes No

Name: Click here to enter text.Title: Click here to enter text.

Email Address: Click here to enter text.Telephone: Click here to enter text.

Primary Client Contact Employer Portal Access? Yes NoName: Click here to enter text.

Title: Click here to enter text.Email Address: Click here to enter text.

Telephone: Click here to enter text.Secondary Client Contact Employer Portal Access? Yes No



Broker Contact Employer Portal Access? Yes NoName: Click here to enter text.

Agency: Click here to enter text.Email Address: Click here to enter text.

Telephone: Click here to enter text.Broker will be copied on all implementation, renewal and escalated emails

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Check this box if broker should not be copied on these emails: Finance Contact Employer Portal Access? Yes No



Meeting/Benefit Fair Attendance and Employee HandoutsDo you need Benefit Strategies

representation for a Benefit Fair, employee meeting or webinar*?

Yes No

If yes, list the dates, times, locations: Click here to enter text.Click here to enter text.

Click here to enter text.*Please note, Representation is based on first come first serve and BSL requires 2 weeks notice to attend.

BSL will send an electronic version of standard handouts to the client point of contact. Are hard copies also needed*? Yes No

*Please note, additional fees may apply. If yes, list how many, by what date, who to send to:Click here to enter text.

Click here to enter text.


Plan InformationCurrent BSL Service(s): Click here to enter text.

New BSL Plan(s) to Implement: Click here to enter text.

Do you have an Existing HRA: Yes NoBSL Effective Date(s): Click here to enter text.

Plan Year (ex. January 1 – December 31): Click here to enter text.

Running Short Plan Year?: Yes NoNumber of Projected Participants: Click here to enter text.

TakeoverAre you requesting a takeover implementation? Yes - continue below No

What is the current plan year end date? Click here to enter text.

Will the takeover plan year and the new plan year requirements be the same? Yes No*

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*If no, include the current summary plan description

DivisionsDo you need Divisions set up for reporting or billing

purposes? Yes No

If yes, list Divisions: Click here to enter text.(BSL will need to know who belongs in each division) Click here to enter text.



Health Reimbursement Arrangement (HRA) Implementation FormEligibility Information

Do you offer group health insurance to HRA Eligible employees? Yes NoWho is your Medical Carrier? Click here to enter text.

Waiting period for new eligible employees:

Date of Hire 1st of month following date of hire 1st of month following 30 days

Other (cannot exceed 90 days)

When does coverage end after employee termination?

Date of Event End of Month

Other: Click here to enter text.

A self-employed individual, partner or person who owns more than 2% of the outstanding stock of the company is not eligible for HRA enrollment.

If this applies to your organization, are these HRA-ineligible people enrolled in the health plan coverage that goes with the HRA?

Yes No

If yes, please provide us with the list of the individuals so BSL can flag them as ineligible: Click here to enter text.




Non-Discrimination Testing

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Will you be using the BSL non-discrimination testing service for this plan? Yes No

Plan Document Benefit Strategies provides new plan document:

Plan Name: Use standard naming convention (Client Name HRA Plan Document)

Other Name: Click here to enter text.

Plan Number: Use standard Plan number: 502

Other Number: Click here to enter text.

Benefit Strategies provides re-stated plan document:Effective date of current plan document: Click here to enter text.

Name of current plan document: Click here to enter text.

Current Plan Number : Click here to enter text.

Benefit Strategies is not responsible for the plan document.

Benefit Strategies is not responsible for the Summary Plan Description (SPD).

Will HRA eligible employees also be offered a Health Savings Account (HSA)? Yes No

If yes, will they be able to be enrolled in both the HRA and HSA? Yes No

Will HRA eligible employees also be offered a Flexible Spending Account (FSA)? Yes No

Will the employer allow an employee to drop employer health coverage when the employee experiences a reduction of hours

(mid-year) and still maintain eligibility in the group health plan? Yes No

May an employee who experiences a mid-year qualifying event be permitted to drop group health plan coverage in order to

obtain coverage through the Marketplace? Yes No

List the names of all medical plans tied to the HRA:Click here to enter text.


Please note: Summaries and/or SBCs are required for all plans.



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Will domestic partners be eligible for the HRA? Yes No

When does a covered dependent age off the plan?

The final day of the month of the Dependent’s 26 birthday

The end of the calendar year of the Dependent’s 26 birthday

Other:

HRA Reimbursement Method:#1: Carrier Claims Feed

BCBSMA Anthem ME Anthem NH Aetna*

Tufts HPHC NHP*please note: additional fees may apply

Are you aware of how repayments are handled if the carrier adjusts a claim that results in the HRA having overpaid? Yes No

Who will receive payment?

Participant Pay Provider Pay** ** Not eligible with Anthem ME or Anthem NH

If Provider Pay:Please confirm awareness of the MA Health Safety Net Surcharge. Yes NoPlease confirm awareness of our incomplete billing address process. Yes No

List all medical plan group numbers and/or sub group numbers that are ineligible for the HRA:




#2: Participant Submission

#3: Debit Card Submission:* *debit card option only available for non-complex HRA plan designs

Rx Only 213d expenses

Would you like a custom logo for the Debit Card?* Yes No*please note, additional fees may apply

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HRA Plan DesignsClients have the option of 3 standard HRA plan designs to choose from. In addition, clients with 500 or more benefit eligible employees can instead choose a custom plan design.

Standard Plan Design Options:Eligible Expenses: Medical plan deductible expenses

HRA Pays: Choose one of the below:

HRA Pays First: 50%Participant Responsibility: Second 50% of medical plan deductible expensesHRA Responsibility: First 50% of medical plan deductible expenses

HRA Pays Second: 50%Participant Responsibility: First 50% of medical plan deductible expensesHRA Responsibility: Second 50% of medical plan deductible expenses

If the HRA pays second, please

choose:(Click or hover over the

plan types for more information)

Option 1 No per person maximum.

Option 2 Per person maximum, any combination can meet the family responsibility.

Option 3 Per person max, two family members must meet their per person responsibility.

Option 4 Strict per person maximum.

HRA Pays First: 100%**Subject to carrier rules. Please contact your carrier rep to confirm eligibility and forward the confirmation to BSL.

Participant Responsibility: NoneHRA Responsibility: 100% of medical plan deductible expenses

HRA Funds Available: Whole amount available on first day of plan year

HRA Funds Available for Mid-Year Adds: Whole amount available on participant effective date

Run-out Period After Plan Year Ends: 90 daysRun-out Period For Participants Terminated From Plan: 90-days from termination date

HRA Funds Rollover: No

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Deductible InformationDeductible runs: Plan Year Calendar Year*

*If Calendar Year, what is your medical policy year renewal? Click here to enter text.

Deductible Amounts:Single: $Click here to enter text.

2-Person: $Click here to enter text.Family: $Click here to enter text.

Are prescriptions subject to deductible? Yes NoCan any number of family members combine to meet the

family deductible? Yes No

Is there a per person deductible limit for Family coverage? Yes No

If yes, what is the amount? $Click here to enter text.

Does the medical plan have a 4th quarter deductible carryover provision? Yes No

If yes, whose responsibility will the carryover funds reduce? Participant HRA

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Custom HRA Plan Design**(Only available for clients with 500 or more benefit eligible)

Responsible for first portion of deductible:

Participant HRA

If the HRA pays second, please choose:

There is no per person maximum on the deductible. One family member or a combination of family members must meet the full participant responsibility before the HRA will pay any claims.

There is a per person maximum on the deductible. Each family member must meet the full per person responsibility before the HRA will pay any claims for that family member. In addition, once any combination of family members has met the full family responsibility, the HRA will begin paying for all family members.

There is a per person maximum on the deductible. Each family member must meet the full per person responsibility before the HRA will pay any claims for that family member. In addition, once two family members have met the per person responsibility, the HRA will begin paying for all family members.

There is a strict per person maximum on the deductible. Each family member must meet the per person responsibility before the HRA will pay any claims for that family member.

Other - Please explain: (ie: multiple tiers, percentage of claim paid, etc.)Click here to enter text.

Will the HRA reimburse expenses other than the deductible? Yes NoAre prescriptions subject to deductible? Yes No

Eligible Expenses:




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Participant Responsibility:Single: $Click here to enter text.

2-Person: $Click here to enter text.

Family: $Click here to enter text.

HRA Responsibility:NOTE: Verify with your carrier that your HRA

plan design is permitted to be paired with the medical plan(s)

Single: $Click here to enter text.

2-Person: $Click here to enter text.

Family: $Click here to enter text.

Is there a per member maximum reimbursement amount? No Yes, Amount: $Click here to enter text.

HRA Funds Available:Choose an item.




HRA Funds Available for Mid-Year Adds:

Whole amount up front

Pro-rated:

Monthly: Eligible in month of hire? No Yes, regardless of effective date

Yes if effective date is on or before 15th of month

Quarterly Defined After Date:

Pro-ration will start on: Click here to enter text.

Participant will receive $

Run-out Period After Plan Year Ends: 90 days

Other: Click here to enter text.

Run-out Period For Participants Terminated From Plan: 90 days from termination date

Other*: Click here to enter text.

*please note, fees will apply

Rollover of HRA Funds: No

Yes, provide specifics: Choose an item. Click here to enter text.

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Choose an item. Click here to enter text.

Enrollment MethodHow will we receive the initial enrollment information?

Benefit Strategies file spec will be completed and sent

From Vendor From Client

Client direct entry in administrator portal

Carrier Eligibility File*: HPHC NHP*Please note that enrollment information will not be received for 7-10 business days after the plan effective date.

Ongoing EligibilityHow will we be receiving on-going eligibility? (Additions, Terminations, Changes)

Claims feed clients, please check this box as on-going eligibility will be sent to Benefit Strategies from your carrier:

HPHC NHP Tufts* (new and changes, no terms)

Client direct entry in administrator portal

Benefit Strategies file spec will be completed and sent

From Vendor From Client

Frequency: Click here to enter text.

File Contact Name: Click here to enter text.

File Contact Phone: Click here to enter text.

File Contact Email: Click here to enter text.

FTP Address: Click here to enter text.

HRA Continuation Coverage InformationIs your company subject to FMLA? Yes No

Is your company subject to COBRA? Yes NoAre you aware that HRAs are COBRA eligible plans and that

the HRA needs to be a separate COBRA election? Yes No

Is COBRA administration handled in-house, by Benefit Strategies, or other? Choose an item.

If other administrator:Name: Click here to enter text.

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Address: Click here to enter text.

Telephone: Click here to enter text.

FeesSet Up Fee: $Click here to enter text. Invoiced To: Choose an item.

Renewal Fee: $Click here to enter text. Invoiced To: Choose an item.

Plan Takeover Fee: $Click here to enter text. Invoiced To: Choose an item.Monthly Admin Fee and Minimum

Monthly Invoiced Amount: $Click here to enter text.Invoiced To:

Choose an item.

Initial Card Fees: $Click here to enter text. Invoiced To: Choose an item.

Replacement/Additional Card Fees: $Click here to enter text. Invoiced To: Choose an item.Non-Discrimination Testing Per Plan

Per Test (done upon request): $Click here to enter text.Invoiced To:

Choose an item.

Claims Funding Invoicing Method: Choose an item.

Fee Invoicing Method: Choose an item.

Maintenance Deposit Information: Click here to enter text.

Special Notes: Click here to enter text.

NotesClick here to enter text.

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Please only return pages 3-13 to Benefit Strategies when completed. The remaining pages are yours to keep as a reference guide.

Health Reimbursement (HRA) Administration Guide

Timing of Claim Payments For Participant Submitted Claims

Mailed or faxed claims are scanned and queued for processing within 1-3 business days of receipt. Claims uploaded to the consumer portal are immediately available for processing. Claims are typically approved or denied within 2-4 business days.

Notifications for denied claims and for claims where more information is required are sent for claims processed the prior day.

Check and direct deposit files are created three times per week for claims approved as of the prior business day.

Checks are mailed next day. Direct deposits are posted same day and available to participants within 1-2 business

days after files are loaded.

Timing of Claim Payments For Claims Received on Carrier Claims Feed

Most carriers send a weekly claims feed. The timing of claims that are captured on the weekly feed varies based on the carrier’s processes. Once the feed is received at Benefit Strategies, claims are processed within 3-5 business days.

Check (whether to participant or provider) and direct deposit files are created three times per week for claims approved as of the prior business day.

Checks are mailed next day. Direct deposits are posted same day and available to participants within 1-2 business

days after files are loaded.

Eligible Expenses

Clients determine eligible expenses as a part of the plan design.

Claim Requirements for Participant Submitted Claims

Claims may be filed through the participant’s online portal, the Benefit Strategies mobile app, or by submitting a paper claim form via secure email, fax or mail. Certain HRA plan designs may not be compatible with online or mobile filing. Claims must include only expenses eligible for reimbursement as defined by the HRA plan design.

Documentation supporting the claim must be included with each claim filed that indicates the claim was for an eligible expense. The carrier’s Explanation of Benefits (EOB) or Activity Summary (must provide the below information) provides the best information.

Patient or dependent name Date of service Description of service Expenses incurred Indication of how the expense matches the HRA plan design (for example an

indication that the expense was subject to the deductible)

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Claim Adjustments Received on Carrier Claims Feed

Occasionally, a medical plan claim is adjusted at a later date by the insurance carrier. The carrier will notify the participant, the provider and Benefit Strategies of the adjustment. If the adjustment results in the HRA needing to pay out additional dollars, BSL will process the additional payment.

If the adjustment results in the HRA having overpaid, Benefit Strategies will send you a Repayment Request Form to the participant as they will need to reimburse the HRA for the overpayment.

Note: If the participant has paid the provider in full for the original claim, once the provider processes the carrier adjustment a credit should show on the patient account for the claim. The participant may need to contact the provider to arrange for the credit to be sent to them. Unlike medical carriers, Benefit Strategies does not have a business relationship with the providers. Instead, Benefit Strategies is simply mailing a payment to the provider on the patient’s behalf. Due to patient privacy laws, providers typically will not speak with Benefit Strategies about a patient account and will not send a credit on an account directly to Benefit Strategies.

Non-Discrimination Testing

Non-discrimination testing is available upon request and subject to a fee. Upon request, the client is sent information and forms to complete, including providing census information on all employees.

Administering Run Out From Current TPA

If an HRA is already in place and you are changing administration to Benefit Strategies with the start of the new plan year, the outgoing administrator should handle the outgoing plan year run-out.

Takeover From Current TPA

A takeover implementation means Benefit Strategies will take over the administration of your current plan year. Because BSL will have taken over the administration mid-year, BSL will then handle the run-out at plan year end.

Takeovers can be done at any point in the plan year, up to 31 days prior to the plan year end date. Example: If plan year ends December 31, takeover must happen December 1 or earlier.

Typically, the outgoing administrator will want a claim filing black out period so all in-house claims can be settled and final balances provided to Benefit Strategies.

Benefit Strategies must be provided with the following information using the attached template in order to do a takeover:

• Enrollment Census

• Current Balances

• Claim History (if this can’t be provided, BSL is unable to prevent a claim previously paid by the prior TPA from being submitted to Benefit Strategies and paid out again.)

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https://www.benstrat.com/downloads/NDT-information.pdf

Funding Process

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OverviewBenefit Strategies pays claims three times per week. Claims are paid in advance and clients are invoiced weekly for claims paid the prior week.

Claims Funding and Maintenance DepositPlease complete the Claims Funding Agreement and EFT Form (if applicable) and return with this document.

Checks and direct deposit payments are drawn against a Benefit Strategies, LLC bank account.

Check and direct deposit files are created three times per week for claims approved as of the prior business day and sent to fulfillment.

A Claims Funding Request report (invoice for claims paid) is emailed to clients weekly for the prior week’s claims reimbursements.

Funding amounts are due within 2 business days after receipt of the funding request. Payment is made to Benefit Strategies, LLC either by check (Manual Invoice), ACH payment, or EFT debit.

A Maintenance Deposit is required to mitigate the risk of Benefit Strategies paying claims in advance. The Maintenance Deposit is determined by looking at the total HRA exposure and multiplying that amount by 40% to arrive at estimated utilization. BSL will then divide that by 26 to arrive at two weeks worth of anticipated utilization.

The Maintenance Deposit amount is revisited only when a new plan is added or a current plan is dropped, or there is a significant change in enrollment.

The Maintenance Deposit is returned at the time the service is no longer offered.

Check Information

A brief explanation is included with each claim payment check.

The participant pay check includes more information on accounts and current year balances whereas the provider pay check only includes payment details for that provider’s payment.

Participants may contact Customer Service to request a claim payment check be voided and reissued if the check is lost and has not yet been cashed.

All claim payment checks indicate “Void after 180 Days”.

o In our experience, banks will still cash checks after the 180 days

Unclaimed Checks

Clients will address the escheatment and/or other handling of unclaimed checks that have reached the 180 day expiration date.

A report of unclaimed checks will be provided upon request.

Funding Reports18 | P a g e

A claims funding invoice and claims funding report will be emailed weekly to the financial contact(s) you indicated on the Client Information Form. The invoice provides notification of the amount required for funding claims paid the prior week as well as any adjustments, and debit card fees (if applicable). The report provides the details to support the invoice.

Division Subtotals

Funding invoices and/or reports will contain divisional subtotals if applicable.

Enrollment and Eligibility

Initial Enrollment Census

The attached census should be used to provide Benefit Strategies, LLC with HRA enrollment information. Enrollment information is due to Benefit Strategies, LLC by the below time frame:January effective dates: No later than December 1st. All other months: At least 20 days prior to the plan start date.

Ongoing Eligibility Method

IMPORTANT: Testing needs to be completed with Benefit Strategies prior to the Go Live date. Vendors sending files often require a long lead time. Please send the eligibility file spec to your vendor immediately, and confirm their ability to comply with the testing timeline. For additional details on eligibility file testing or specifications, please contact [email protected] for assistance.Per ACA requirements, a stand alone HRA for medical expenses is not permitted. It must be attached to a group medical plan.

Carrier Feed Enrollment

Harvard Pilgrim - Full eligibility sent can be used for initial enrollment and mid year additions and changesNeighborhood Health Plan - Full eligibility sent can be used for initial enrollment and mid year additions and changesTufts - Partial eligibility sent, which is used for mid year additions and changes. Terminations will need to be communicated as well as a initial file to start the yearAnthem NH - no eligibilityAnthem ME - no eligibility

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mailto:[email protected]

Plan Specifics

Email plan summaries for all medical plans tied to the HRA.

Health Reimbursement Arrangement Payments Made to Domestic Partners

Participant PayWhen carrier processes a claim adjustment that results in the HRA having overpaid, participant is responsible for sending the overpayment to Benefit Strategies.

Provider Pay (not available on Anthem feeds) Please be aware of the following for Provider Pay Option:MA Health Safety Net Surcharge of 1.86% of claim amount for claims paid to MA Acute Care Hospitals and Ambulatory Surgical CentersWhen carrier processes a claim adjustment that results in the HRA having overpaid, participant is responsible for contacting their provider to receive the overpayment and forwarding it to Benefit Strategies.When the carrier claims feed has an incomplete or missing provider address, payment will be made in participant’s name and mailed to participant home address.

HRAs and HSAsEmployees can’t have access to reimbursement funds through an HRA and become or remain HSA-eligible unless the HRA is a Post-Deductible HRA. In this case, the HRA doesn’t begin to reimburse any deductible expenses until the employee has incurred at least the required minimum deductible limits. In 2017, the required minimum deductible $1,300 for single coverage and $2,600 for family coverage.

A Post-Deductible HRA allows employees to remain HSA-eligible while the employer picks up some or all of any cost-sharing (deductibles and coinsurance, if applicable) above the required thresholds ($1,300/$2,600 in 2017.)

The Post-Deductible HRA also doesn’t impact contributions limits. Employees can still contribute up to the statutory maximum to their HSAs ($3,400 (single coverage or $6,750 family coverage in 2017), plus an additional $1,000 catch-up contribution if they’re age 55 or older. Note that HSA contributions limits are from all sources, including any employer contributions. Employers can, but aren’t required to, contribute to employees’ HSAs. Some generous employers contribute enough to cover much or, in some extreme cases, all of the employees’ deductible responsibility before the Post-Deductible HRA begins to reimburse claims.

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Explanation of Plan Design Option Components:Eligible Expenses:The expenses that will be eligible for reimbursed under the HRA.

Participant Responsibility:The amount the HRA participant is responsible for paying on the eligible expense; this can be a percentage of the expense category, a flat dollar amount or a percentage of each eligible claim.Examples for a $1000 deductible plan:Percentage: The participant is responsible for 50% of the deductibleFlat Dollar: The participant is responsible for $600 of the deductiblePercentage of Claim: The participant is responsible 50% of each eligible claim.

HRA Responsibility:The amount the HRA is responsible for paying on the eligible expense.

HRA Funds Available:The schedule of when HRA funds will be available for reimbursements during the plan year. Most common is to have the full amount available on the first day of the plan year.

HRA Funds Available for Mid-Year Adds:Whether the total HRA responsibility will be available for a mid-year add or if it will be a pro-rated amount.

Run-out Period After Plan Year Ends:Number of days after plan year end date in which claims incurred in the prior plan year can be submitted and/or received on claims feed.

Run-out Period For Participants Terminated From Plan:Number of days after a participant’s termination date in which claims incurred in the prior plan year can be submitted and/or received on claims feed.

HRA Funds Rollover:Refers to whether all, a portion or none of the unused HRA funds rollover to the next plan year.

HRA Plan Grouping:Refers to plan year versus calendar year deductible. Please review the attachment and return with plan design if applicable: Plan Documents:

New Plan Document - a new plan that you do not currently offer.Re-state Plan Document – a plan that is currently in place and Benefit Strategies will be the new administer of said plan.(Back to standard plan design) (Back to custom plan design)

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Employer Reports

Plan Management Reports

Account Balance Report:

Enrollment Report:

Reports are scheduled to run on a monthly basis.

Reports are posted on the Employer Portal for access by Employer Portal users with reporting permission.

Reports will be provided in an MS Excel format when this option is available, but a PDF may be requested instead if this format is required.

Employer Portal

Users and Access Levels

An email will be sent to each employer portal contact with information regarding use of the Employer Portal and log in credentials.

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Participant Communications

HRA participants include employees, COBRA participants, or terminated employees still within their run out period.

Email notifications are sent to active participants with an email address when the letters below are generated. The email notification informs the participant the associated letter is available for viewing via the Consumer Portal.

Spending Account Self Service Notifications Notice Type Email Sample Mail SampleClaim Denial Emailed Notification and Mailed Notification

Claim Denial with Repayment Required

Advice of Deposit for Claim Reimbursement (emailed only)

N/A

Participant FormsHRA Self Service Forms – all forms are located on www.benstrat.com under the HRA tab as well as within the employer and employee portals.

Health Reimbursement Arrangement Reimbursement Form: Not used for clients on claims feed.

Used for participants to submit for reimbursement from their HRA via a paper form.

Direct Deposit Authorization Form:Used if direct deposit account information is faxed or mailed instead of being entered directly in the Consumer Portal.

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