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TRS-HRAccount Powered By Docstoc

        September 2004
What is TRS-HRAccount?

   Health Reimbursement Arrangement account that is
    state funded on a monthly basis
   Changes the flow of funds for the state supplemental
    compensation (used to flow to the district and to the employee’s
    checks and now will go directly into an account for the employee)
   Changes how the funds can be used
   Used for qualified health care expenses or certain
   Allows participants the option to accumulated funds
    for future use.

Who is eligible?

   To be eligible for the state funding provided
    for the TRS-HRAccount program and
    employee must be:
    –   An active contributing TRS member
    –   Employed by a school district, participating
        charter school, regional education service center,
        or other educational district whose employees are
        TRS members
    –   A full-time or part-time non-professional employee

Who is eligible?

   Eligibility for the state funding provided for the TRS-
    HRAccount program is basically the same as eligibility
    for the current supplemental compensation
   90 day waiting period for new hires to the TRS system
   If on leave without pay – NOT eligible – unless on FMLA

Who is eligible?

   Full-time employees that are currently
    receiving a supplement from TRS of $41.66
    per month (Teachers, librarians, counselors,
    custodians, other non – administrators)
   Part-time employees that are currently
    receiving a TRS supplement of $10.83 per
    month (cafeteria workers)

Whose expenses are eligible?

   Yours and your eligible dependents
   Eligible dependents include
    –   Spouse of a participant
    –   The following individuals if you provide more than
        half of their support
            An unmarried child under 25 years, to include an
             adopted child, a stepchild, a foster child a recognized
             natural child
            A mentally or physically handicapped child, adopted
             child, stepchild or foster child regardless of age

What are eligible expenses?

   Pharmacy copays and coinsurance
   Medical copays, coinsurance and
   Vision expenses
   Dental copays, coinsurance and deductibles
   Certain health insurance premiums not
    subject to Section 125 premium conversion

   Examples of what funds can be used for

 Deductible                Co-payments/Coinsurance
 Eye Exams                 Eyeglasses
 Contact lenses            Lasik eye surgery
 Prescriptions             Routine physicals
 Dental work               Hearing tests and hearing aids
 COBRA premiums            Over the counter medications

Detailed list of eligible expenses
at                  TRS-HRAccount
How and When will Participant
Accounts be Funded?

   Districts submit a monthly eligibility file to AETNA
   Participant accounts are credited monthly upon receipt of
    the eligibility file
   Full-time non-professionals, credited $41.66 per month
   Part-time non-professionals, credited $20.83 per month
    –   Remember – Non-professionals = Not an administrator – this is
        TRS’s definition (A teacher WILL receive the $41.66 per month)
   A monthly administration fee will be deducted from each
    participant account
Administrative Fee?

   What is the monthly fee?
    –   $2.50 per month will be deducted from each TRS-
        HRAccount (may find other funds)
    –   $1.00 per month (additional) will be deducted if the
        participant elects to take advantage of the debit card
   Why a fee?
    –   Legislation authorizes TRS to pay an administrator to
        manage the program
    –   TRS-HRAccount is a stand-alone program – not combined
        with another program which may have a fee

How to Access Account Funds

   Participants will be able to access their funds
    using one of four methods:
    –   Their TRS-HRAccount Card (Remember $1.00
        per month charge)
    –   Direct submission by the provider (certain Health
    –   An on-line premium payment tool
    –   Submitting paper claims

How to activate the Debit Card

   Two Debit cards automatically mailed to participants
    once eligibility and account has been established
   Participant calls toll-free number to activate debit
    card (Toll-free phone number to call will be on a
    sticker attached to your card)
   If you don’t activate within 90 days, and decide to
    activate later, you’ll need to get a new card
   Can deactivate later

Method 1
Debit Card Submissions

   TRS-HRAccount debit card swiped in reader – Choose
   Account verified much like a personal bank debit or
    credit card
   Payment authorized or declined
   If debit card transaction is authorized, participant
    account is charged and the funds disbursed to the

Debit Card Transaction

   For non-prescription medications, receipt
    should clearly indicate the product name,
    date of purchase and amount paid
   If declined, pay for the transaction and
    submit a paper claim

Sample Debit Card Transaction

   Joe goes to the pharmacy to pick up his prescription
   He has a $20 RX copay
   Joe presents his TRS-HRAccount debit card to the
   Pharmacist swipes Joe’s card and validates eligibility
   Pharmacist receives real-time authorization
   $20 is deducted from Joe’s TRS-HRAccount

Debit Card Denials

   When might a transaction be declined???
    –   Insufficient balance in account
    –   Unauthorized merchant category code (MCC) (ex.
        Gas Station)

Method 2
Streamline Method

   Provider Submission
   Direct Health plan submission of claim data from
    certain carriers (i.e.. TRS Active Care 1, 2, 3)
   See TRS Website – for full list
    of health plans included

Method 3
Online Premium Reimbursement Method

   What types of premiums are reimbursable under the
    –   Premiums not subject to section 125 premium conversion
        (not pretax)
            Medical Premiums
            Dental Premiums
    –   Does not include
            Life insurance premiums
            Disability premiums
   You use an online premium web tool to request
Online Premium Reimbursement
Method Sample

   Jane’s family dental premium of $31.60 is deducted from her
    check on an after-tax basis
   She has elected and registered to have her dental premium
    reimbursed from her TRS-HRAccount through the TRS web site
   Her TRS-HRAccount is reduced by the $31.60 dental premium
   Jane receives an electronic Explanation of payment
   She receives reimbursement by check or direct deposit (for
    direct deposit, you’ll have to request reimbursement each time)
   If there aren’t enough funds, the balance will be “pended” and
    will be sent to you when your account is credited with more

Method 4
Paper Claim Submission

   Claim forms are on line at
   Claim forms in payroll office
   Two forms are available for reimbursement
    –   General Claims
    –   Over-the-counter (OTC) medications
   Also available in Spanish

Sample Paper Claim

   Joe purchases Tylenol and cough syrup,
    totaling $12.41 and receives a receipt
   Joe completes an OTC claim form
   He submits a completed claim form and
    receipt to AETNA
   Joe is reimbursed

Paper Claims – Additional Info

   Required documentation may include:
    –   Explanation of Benefits from health plan
    –   Copay receipt from health care provider
    –   Itemized bill or statement from the provider
    –   Paycheck stub or invoice for after-tax premium
    –   If OTC – need a receipt that shows product name,
        date and amount paid

How often can I get my money?

   TRS-HRAccount cards are point of service
   Online premium and paper claims will be
    processed daily
   Streamline transactions are weekly
   Minimum amount is $5.00 for paper claim or
    online claim

Claim Reimbursement Options

   Direct deposit to a checking or savings
   Check mailed directly to participant’s home
   Direct payment through debit card
    –   Funds disbursed to provider and participant
        account immediately charged

How will I know what I have?

   Explanation of Payment (EOP) each time you
    receive a reimbursement or payment
   Annual account statements (September)
   Online at
   Call Participant Services 1-800-437-3666
    and follow the prompts

What can I do on the website?

   First time log-in create a password
   Manage your account
    –   Access account information
            Balance
            Payment details
            Pended Claims
    –   Register for direct deposit
    –   Register for streamline process
    –   Register for online premium reimbursement
    –   Register for Electronic EOP’s

Where else can I get information?

   Aetna Voice Advantage System
   1-800-437-3666
    –   Needed
           Social Security Number
           Date of Birth
           Home ZIP code
   Use to report stolen cards or request
    additional cards

They’re asking me for information –
Now what?

   Verifying eligible expense
   If not eligible, you will need to repay
   If you don’t repay, it will be treated as income
    to you

What if I have a flexible spending
account? (FSA)

   Use it FIRST
   Example:
    –   Employee has FSA account for $240 for the year
    –   Employee has TRS HRAccount with a balance of $50
    –   Buys glasses for $260
    –   First submit to FSA for $240
    –   Then submit to HRA for $20, will have a balance of $30 in
        HRA for other expenses
    –   If glasses had cost $220 – the entire expense would have
        come from the FSA account

What happens to unused funds

   Any unused portion is carried over
   They accumulate for future use

What if I leave?

   It’s still yours!
   Still have a monthly fee
   No additional contributions
   If you should die, it goes to your surviving
   Reimbursements made to the estate

Where to get more information

   Booklet – Information Guide
   Online –
   By phone – 1-800-437-3666

Questions and Answers?