Proposal to Implement
for
Group Name
A Health Reimbursement Arrangement (HRA)
with a Claim Data Feed from MVP
Health Reimbursement Arrangements - Introduction
Health Reimbursement Arrangements (HRAs) are a popular method to help employers
control the cost of their health insurance plan while still providing coverage to
employees.
Typically, an HRA is used in conjunction with a less expensive higher deductible or copay health plan. The higher deductible health care plan provides coverage in the event
of a major illness or condition while the HRA provides employees some of the funds
necessary to cover routine out of pocket expenses.
Features of an HRA
 HRA utilization is tax deductible to the employer
 HRA funds are tax-free to the employee
 Employer can determine fund availability for specific benefits: medical, Rx,
dental, vision, etc.
 Unused funds can roll-over at the employer’s discretion
 There is no pre-funding requirement – an HRA is a pay as you go plan
The Advantages of an HRA
 Implementation of an HRA with a higher deductible health plan will help
reduce costs
 Creates awareness of the cost of health care
 Helps to control utilization
 Provides the employer with a long term health care plan strategy
 Allows customizable design to meet business needs of employers
Overview
Choice Strategies is a heath care debit card that can be used for HRA administration.
The Choice Strategies is recognized as both a pioneer and leader in debit card
administration. We have been implementing and managing HRAs in this unique
program since 2001. Choice Strategies debit card and administration service will
include:
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Industry leading service and support
The Choice Strategies card for the payment of providers and other
vendors
Substantiation of card transactions
Processing of manually submitted claims
Manual claim payments by check or direct deposit
Automated reporting functionality
Enrollment materials
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Web site access for employees and employers
Plan document production
Operation and Functionality of the Choice Strategies Card
1. Submission of Master Application: Installation
The first step to implementing Choice Strategies begins with the submission of a
Master Application. Once we are in receipt of the Master Application, an installation
confirmation is sent to the employer and producing broker.
Once installation is complete, employers and brokers receive an email containing
contact information, administrative access to the website, plan documents and
participant hand outs.
2. The Choice Strategies plan configuration
The Choice Strategies plan will be configured based on employer decisions made
during the installation process. For example, the employer may choose to allow
HRA funds to be used for only medical services or medical and Rx services.
MVP Data feed Configurations
Choice Strategies has partnered with MVP Healthcare to receive a regularly
scheduled data-feed of medical and Rx claim data for all of our members enrolled in
an MVP health plan. Essentially, the data-feed provides Choice Strategies with all of
the information found on our members’ Explanation of Benefits (EOB) Statements.
This direct link with MVP allows us to successfully administer our HRA plans in
several unique configurations:
Debit-Card Based Plans with Automatic Substantiation
For debit card based HRA plans, this condensed claim data allows Choice
Strategies to adjudicate many debit card purchases without requiring the member to
submit documentation. Standard receipt requests are still sent to members for
expenses that are not processed through the health carrier or if the amount paid on
the debit card exceeds the member’s responsibility according to the claim data.
This configuration works best for clients enrolled in a High Deductible Health Plan
(HDHP) and employers who wish to keep their employees involved in the process of
managing their health care costs may prefer a debit card based program as well.
Member-Pay Plan
With Member-Pay HRA plans, Choice Strategies reimburses members automatically
from the medical claim data. Employees will not need to submit claims to Choice
Strategies. Instead checks and direct deposits will be issued to members directly
from the medical claim data-feed. MVP currently sends Rx claim data on a monthly
basis offset by 15 days. For example, January Rx expenses will be sent to Choice
Strategies around February 15th and processed within 2-3 business days. Medical
claim data is sent and processed on a weekly basis.
These configurations work well for clients who wish to design an HRA plan that
reimburses a portion of each deductible expense. For example, a client may wish
the HRA to reimburse medical deductible expenses minus $30, in essence creating
co-pays for their employees within the deductible. Similarly, a client may choose to
reimburse deductible expenses at 50% or 75%. These “coinsurance” HRA plans
work very well on a Member-Pay configuration. Members will not need to submit
claims. Instead reimbursements will be made to the members or payments made to
the providers automatically every week based on the claim data received from MVP.
If Rx is eligible and the HRA covers the full cost of a prescription, we recommend
offering the Choice Strategies MasterCard to participants for payment of
prescriptions only. Choice Strategies would reimburse medical expenses from the
data feed following the parameters elected by the employer while participants could
use their Choice Strategies debit cards to pay providers directly with the card. If as
an employer you prefer to pay Rx expenses from the MVP claims data feed instead,
it is important to note that Choice Strategies receives Rx data from MVP on a
monthly basis.
3. Plan Document Production
The plan documents will be produced according to the parameters established in the
Master Application. These documents include an Adoption Agreement (Outline), a
Plan Document (for employer reference), and a Summary Plan Description (to hand
out to all participants). All documents are posted in the Administrative Guide under
the employer section of our website.
4. Enrollment Process
Once we receive the initial enrollment forms or templates, employee accounts are
established in our system and welcome brochures are emailed or mailed. Accounts
are updated when new enrollments, changes in status or employee terminations are
sent to Choice Strategies.
5. Choice Strategies production and distribution
Cards will be produced and mailed to each participating employee (and spouse if
appropriate). Cards will be mailed to the member’s home address provided on the
enrollment form. The card is activated automatically at first use.
6. Web Seminars
Employers are invited to attend orientation webinars. During the webinar, the
website, reporting tools, the Admin Guide, as well as the administrative procedures
and details of the program, are all reviewed. Furthermore, Choice Strategies offers
plan specific webinars for employees by appointment. Employers can sign up for
web seminars at any time by checking the monthly schedule posted to our website.
7. Member Service
All member service calls are handled though our toll free service line. Member
Service representatives assist employees with their benefits and are available in
English and Spanish. They will assist members to reconcile billing with providers and
retrieve required information from carriers. The Member Service department is open
from 8:00 AM to 7:00 PM Eastern Time, Monday through Thursday and until 5:00
PM Eastern Time on Friday. You can contact Member Services by phone at 1-888278-2555 ext 2, by email at memberservices@choice-strategies.com, or chat live
with a representative by going to our website, www.choice-strategies.com, and
selecting the “Live Help” icon. Choice Strategies provides members 24/7 access to
account balances through our website.
Access to data regarding account
information is completely secure.
8. Client Service
Each employer is assigned a client service team. Each team works with the
employer closely to answer questions regarding the administration of the plan, make
plan design changes and provide general consultative guidance. Client Service
Representatives are available from 8:00 AM to 5:00 PM Eastern Time, Monday
through Friday.
9. Substantiation Process
The IRS stipulates that the plan sponsor (employer) ensure that HRA, FSA, DCAP,
Transit/Parking plans are properly substantiated. In other words, purchases made
with the Choice Strategies debit card must be proven to be eligible under the plan.
Choice Strategies substantiates purchases made with the Choice Strategies debit
card via the following methods.
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MVP Data-Feed
For debit card based HRA plans, the condensed claim data Choice Strategies
receives from MVP allows the adjudication of many debit card purchases without
requiring the member to submit documentation. Standard receipt requests are still
sent to members for expenses that are not processed through the health carrier or if
the amount paid on the debit card exceeds the member’s responsibility according to
the claim data.
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Co-Pay Matching
The Choice Strategies debit card can be set to match the co-pay(s) of the
underlying plan design. Receipt requests are not generated for transactions in
which co-pay have been matched as the expense has been deemed
substantiated.
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IIAS (Inventory Information Approval System)
Under this inventory control system merchants such as grocery stores, discount
stores, pharmacies, department stores, etc. must be able to differentiate between
eligible and ineligible items at the point of purchase. Simply put, the Choice
Strategies card only works for eligible prescriptions and OTC medication
purchases at participating retailers. Ineligible purchases will be denied at the
cash register. This system eliminates the need to request receipts for point of
sale pharmacy purchases.
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Receipt Notification Process
Receipt requests are generated and sent weekly to employees for those
transactions that cannot be substantiated automatically through any of the above.
Employees are requested to provide the necessary documentation (generally
EOBs or provider statements) for substantiation.
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Enforcement of Substantiation Requirements
Occasionally a member will disregard our letters or forget to send in requested
documentation. To protect employer money, member’s Choice Strategies cards
are automatically deactivated in cases in which participants do not send in
requested documentation. They are once again reactivated upon receipt of
requested documentation. Employers may choose to waive this feature on the
Master Application, however, employers should note that in the event of an IRS
audit the plan may be found to be non-compliant.
10. Claims payment/ reimbursement process/Direct Deposit
If a debit card program is elected by the employer, most transactions will be cardbased and paid to the provider at the time of service through the card transaction.
However, some health care and dependent care providers may not accept debit
cards for their services. In these cases, reimbursement requests can be submitted
with a claim form. These claims will be adjudicated, checks will be cut and mailed to
the member or, if preferred, the employee may elect direct deposit.
For Direct-Pay programs, claim checks and direct deposits will be issued to the
member or provider automatically from the data-feed without requiring members to
submit claims.
11. Website: Account Information, Functionality, and Reporting
The Choice Strategies card allows website access to both the employee and the
employer through at www.choice-strategies.com. Our website also contains a
multitude of useful forms, presentations and tools for employers and employees.
Employee Online Accounts Features:
 Account Balances
 YTD Statements
 Transaction History
 Online Claims Submission
 Upload Requested Documentation
 Forms and News
Employer Online Accounts
Employers can access specific account information at any time. The employer
has password protected access to:
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General Account Information
Employee Account Status
Employee Account Balances
Plan Documents
Invoices
Employer Funding Report – This report must be scheduled for
email delivery
Enrollee Account Balance Report – This report indicates YTD
usage on employer plan(s)
Reports are generally scheduled for weekly or monthly delivery but can also be sent
with more or less frequency. Additionally, the employer can use the online
reporting system to generate other reports on an as needed basis.
12. Administrative Standards
Choice Strategies has established administrative standards for our processes.
These standards reflect an annual average of our processing times. Standards for
seven categories are discussed below.
a. Claim Processing
Claims are processed daily. Our average turnaround time to process a claim
submitted online is 1-3 business days. Our average turnaround time to process
a paper claim form is 3-5 business days. Checks are mailed and direct deposits
are generated to employee accounts (for submitted claims) daily.
b. Member Services
Most calls and emails are handled on a real time basis. For those that are not,
Choice Strategies responds to member service voice messages generally within
two business hours and at most 24 hours of having left a message. If a
participant prefers, they can email our Member Service department. Inquiries
received via email are usually responded to same day and at most 48 hours.
c. Client Services
Most calls and emails are handled on a real time basis. For those that are not,
Choice Strategies usually responds to employer voicemails and emails on the
same day and at most up to 24-48 hours.
d. New Card Issuance
Cards for new employees of existing clients are usually issued within five
business days of the receipt of a completed enrollment form. New groups’ cards
are usually issued within four days of receipt of completed enrollment forms and
bank settlement. Cards are delivered to the employee’s home generally within 710 business days of the issue date
e. Renewals
Renewal information is emailed to employer groups approximately 45 days in
advance of the plan renewal date. HRA renewals are automatic, meaning only
changes to plans or participants need to be communicated to Choice Strategies.
f. Billing
Invoices are created and sent on or about the first week of each month for that
month’s administrative fees. Administrative fee funds are drawn on or about the
13th of the month in which the fees are due.
Fees
Pricing of Choice Strategies consists of three components. Each is outlined below. The
fees are inclusive of HRA debit card administration.
Groups with 1 – 99 Employees
Initial Setup Fee
1 - 24 employees
25 - 49 employees
50 - 99 employees
$250 plus $5 per participating employee
$500 plus $5 per participating employee
$750 plus $5 per participating employee
Monthly Administrative Fee
HRA
$8.50 per participating employee
Renewal Fee
$100 plus $5.00 per participating employee
HSA Pricing
Pricing for an HSA is the same as the above with the exception of the per employee
start up fee. For HSAs, the per employee component of the startup is $25. This fee is
charged at implementation and each time a new HSA employee is added.
Groups with 100+ Employees
Contact Sales for custom quote:
888-278-2555 x3
Sales@choice-strategies.com