Group NamePlan Year : 1/1/12-12/31/12

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Find and Replace ( to be edited)

Getting Started: Enrollment presentations can be shown to your employees to help explain how to use their Choice Strategies card in conjunction with their health insurance plan. Before distributing this handout to employees, please find and edit the following:

• Group Name : Group Name• Health Insurance Carrier : Carrier• Plan Year : 1/1/12-12/31/12• Plan Start Date : 1/1/12• HRA Single Deductible : $$$• HRA Family Deductible : $$$$• Carrier Single Deductible : $$$$$• Carrier Single Deductible : $$$$$$• FSA Maximum : $2500

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New Health Plan

• Health Plan Deductible:– Single : $$$$$– Family : $$$$$$

• Effective 1/1/12, Choice Strategies will be administering:– Health Reimbursement Arrangement (HRA) – Flexible Spending Account (FSA)– Dependent Care Account (DCA)

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Split Co-pay Plan

Group Name’s plan

• Plan Year: 1/1/11 – 12/31/11•The following chart indicates the only expenses for which your Choice Strategies card can be used:

Member PaysChoice Strategies

Pays (Split Co-pay)

Total

HIP Cost

Primary Care $ $ $

Specialist $ $ $

Emergency Room $ $ $

In-Network Deductible

$ $ $

Out-of-Network $ $ $

Prescription Drugs $/ $ / $ $ / $ / $ $ / $ / $

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Flexible Spending Account (FSA)

• You can elect up to $2500• Plan Year: 1/1/12 – 12/31/12• Pre-tax money, contributed through payroll

deductions• “Use it or Lose it”• Eligible expenses:

– Medical & Rx expenses– Dental Expenses– Vision Expenses– Limited OTC

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Dependent Care Account (DCA)

• You can elect up to:– $2500 if single, or married filing separately– $5000 if married filing jointly

• Plan Year: 1/1/11 – 12/31/11• Pre-tax money, contributed

through payroll deductions• Pay as you go, can only spend

what you have contributed• “Use it or Lose it”• Eligible Expenses : Custodial Care of dependents

while employee is at work

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Savings Example

Without FSA/DCA Gross Monthly Salary $2,500.00 Less:   Federal Income Tax $333.61 State Income Tax $174.79 Social Security Tax $191.25 Net Income $1,800.35 Less:   Health Care Expenses $200.00 Dependent Care $400.00 Spendable Income $1,200.35

With FSA/DCA Gross Monthly Salary $2,500.00 Less:   Health Care Expenses $200.00 Dependent Care $400.00 Taxable Income $1,900.00 Less:   Federal Income Tax $253.54 State Income Tax $132.84 Social Security Tax $145.35 Spendable Income $1,368.27 Monthly Savings $167.92 Annual Savings $2,015.04

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About Your Choice Strategies Card

• It is a MasterCard• Restricted to eligible

vendors / providers• Must be swiped as a

Credit Card

• Cards arrive in a plain white envelope• Spouses automatically get a card• Additional cards can be issued upon request

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Using Card for Medical Co-Pays

Reminders :• Always give your provider your Carrier ID card and

ask your provider to submit to insurance

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Using Card at Pharmacy

Reminders :• Check to make sure the pharmacy has your current

insurance information• Use as credit card• Request that your card be run for $10 for a Generic drug and

$20 for a Brand name drug with your Choice Strategies card and pay the remaining cost out-of-pocket.

• Keep the detailed receipt as you will be asked to validate the purchase by Choice Strategies.

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Substantiation

Group Name is required by Federal Law to substantiate all claims. In other words, the plan must prove that the purchases made with the Choice Strategies card were for eligible expenses.

Keep all receipts when the Choice Strategies card is used

• Receipt Notification Process• Employees are sent requests via mail or email to provide the

documentation for substantiation of transactions and claims• Documentation

*EOBs *Rx Receipts*Provider Bills• IIAS (Inventory Information Approval System)

• Merchants such as grocery stores, and pharmacies must be able to differentiate between health eligible and

ineligible items at the point of purchase• No Request for documentation if IIAS Approved

Pharmacy (List available on website)

Substantiation Service

• Voluntary Service that allows Choice Strategies to view Employees’ Explanation of Benefits from their online accounts with their Carrier.

• Employees set-up online account with Carrier

• Employee fills out HIPAA Release form with User ID and Password

• When Employee uses Debit Card for a transaction, Choice Strategies logs in to Carrier Website and matches charge to Explanation of Benefits

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End of Plan Year

Plan Year: 1/1/12-12/31/12• Run-out Period - You have 3 months after the plan year

ends, to submit all outstanding claims for expenses that occurred during the plan year.

Reimbursement for these expenses must submitted manually through the claim process.

• Example: If the plan year ends 12/31/12, you have until 3/31/13 to submit manual claims for dates of service that occurred during your 2012 plan year. Do not charge your Choice Strategies card. If you charge your card, it will pull from current plan year funding. The IRS does not allow previous plan year expenses to be paid with current year funding.

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Contacting Member Services

• Toll Free Phone : 1-(888)-278-2555– Mon-Thurs 8:00 am – 7:00 pm EST– Friday 8:00 am – 5:00 pm EST

• Email : memberservices@choice-strategies.com• Live Chat : www.choice-strategies.com

– Mon-Thurs 8:00 am – 4:45 pm EST– Friday 9:00 am – 4:45 pm EST

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Online Account

• Check Account Balances• Submit Claims Online• Edit Direct Deposit Info

• View Transaction History• Upload Documentation• Report Card Lost/Stolen

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How to Submit a Claim Manually

• Online– Login to Online Account– Select “Request

Reimbursement”– Fill out required fields– Upload Documentation– Select “Submit”

• Email, Fax, or Mail– Fill out a Claim Form (available on website or by

contacting Member Services)– Attach Documentation

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Questions?