Member FAQ

You’ve got questions. We have answers.

OEBB Enrollment

 

Yes, COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, are determined by Social Security Administration (SSA) to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months. The law specifies that you must provide a copy of the disability determination (Notice of Award) before the end of the original 18-month period that applies to the qualifying event. This letter must include the actual date the SSA deems you disabled according to their rules. BenefitHelp Solutions must receive the Notice of Award within 60 days of the date of the letter.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

You have the right to continue both coverages if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA and BenefitHelp Solutions is notified, your COBRA coverage will terminate as of the effective date of your new coverage. A written notification of the new coverage must be submitted to BenefitHelp Solutions, preferably before the effective date of the coverage.

OEBB Benefits


Yes. You must notify BenefitHelp Solutions within 31 days of the date of birth.

If your former employer offers an insurance option other than HMO, you are eligible to switch to the other plan due to your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan, even if it is of limited value.

Yes, you have a 30-day grace period to pay your COBRA premiums, but your insurance carrier may suspend claims payments if your premium is not paid by the first of the month.

Your COBRA insurance will terminate on the first day of the month you become entitled to Medicare. If you become entitled to Medicare prior to turning 65 years old, you must notify BenefitHelp Solutions as soon as possible in order to insure timely transition to your other coverage options and correct payment to your providers.

Yes, if your dependents are qualified beneficiaries, their COBRA coverage may be extended. The length of continued COBRA coverage is determined by the individual circumstances.

PEBB Enrollment

 

Yes, COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, are determined by Social Security Administration (SSA) to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months. The law specifies that you must provide a copy of the disability determination (Notice of Award) before the end of the original 18-month period that applies to the qualifying event. This letter must include the actual date the SSA deems you disabled according to their rules. BenefitHelp Solutions must receive the Notice of Award within 60 days of the date of the letter.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

PEBB Benefits

 

Yes. You must notify BenefitHelp Solutions within 31 days of the date of birth.

You have the right to continue both coverages if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA and BenefitHelp Solutions is notified, your COBRA coverage will terminate as of the effective date of your new coverage. A written notification of the new coverage must be submitted to BenefitHelp Solutions, preferably before the effective date of the coverage.

If your former employer offers an insurance option other than HMO, you are eligible to switch to the other plan due to your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan, even if it is of limited value.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

Your COBRA insurance will terminate on the first day of the month you become entitled to Medicare. If you become entitled to Medicare prior to turning 65 years old, you must notify BenefitHelp Solutions as soon as possible in order to insure timely transition to your other coverage options and correct payment to your providers.

Yes, if your dependents are qualified beneficiaries, their COBRA coverage may be extended. The length of continued COBRA coverage is determined by the individual circumstances.

PEBB Retiree

 

No, most retiree plans have specific regulations regarding changing plans, adding or deleting plans, or adding dependents. Dependents can only be added when you initially enroll in the retirement plan or if there is a family status change, such as marriage or birth of a child. Please contact BenefitHelp Solutions regarding your specific situation.

Entitlement to Medicare occurs if you have Part A. Once you or one of your dependents become entitled to Medicare (age in at 65 or Disability Medicare), retiree coverage ends. Dependents can stay on the early retiree plan until they become entitled to Medicare or otherwise lose eligibility. Call BenefitHelp Solutions right away if you or one of your dependents has or is about to have Medicare coverage.

Flexible Spending Accounts (FSA)

 

To view your balance, log in to your member portal. You'll have the option to choose between reviewing your 2018 benefits and creating a login for your 2019 plan. If you do not utilize online account access, contact our Customer Service team at 888-398-8057. Customer Service is available to assist you Monday - Friday, 7:30 a.m. - 5:30 p.m.

IRS Code 213D requires all claims be substantiated to ensure reimbursement occurs only for eligible expenses. To view eligible expenses, log in to your member portal.

You will have 45 days in which to submit documentation before the benefit card(s) is deactivated. Your Benefit Cards will be reactivated once the transaction has been resolved.

No. A benefit card may only be used for current plan year expenses per IRS Code 213D.

FSA funds may only be utilized for eligible FSA expenses during the specific plan year per IRS Code 213D. A LOMN must be valid for current for the plan year and on the date of service/purchase of the FSA eligible expense/item in order to be compliant with IRS regulations.

Benefit Cards are not issued for Dependent Care Accounts.

It's easy. First, log in to your member portal. Then click on the Forgot Password link. Or contact our BenefitHelp Solutions Consumer Services team at 855-378-0197, Monday - Friday, 7:00 a.m. to 7:00 p.m. CST.

Forms can be downloaded in the Resources section of the BenefitHelp Solutions site.

In order to change your healthcare or dependent care election, you must first experience an IRS Qualified Life Event. Qualified Life Events include certain changes in family or work status. Please contact your employer to determine if you have experienced a Qualified Life Event.

Examples of Qualified Life Event Changes:

  • Marriage
  • Divorce
  • Birth or adoption of child
  • Death
  • Change in employment status for you, your spouse or tax dependent
  • Change in dependent care provider
  • Increase or decrease in dependent care provider charges

NOTE: Your election change must be consistent with the Qualified Event.

Please refer to your Summary Plan Description for more details.

Health Reimbursement Accounts (HRA)

 

Our claims processors make decisions about whether a service is reimbursable, and if we need additional documents to reimburse your claim. Check the eligible expenses list for more info.

Log in to your member portal and file a claim. If the dates of service, member and amount are all eligible for reimbursement, BHS looks at the service description. Some services or supplies are always eligible for reimbursement, but others are potentially eligible and require additional documents to establish medical necessity. Other services are never eligible, even if prescribed by your health care provider.

Your employer keeps unused funds unless they’re paid from a trust.

Dependent Care Account (DCA)

 

Child must be younger than the taxpayer and the child must be unmarried.

Typically only the Custodial parent can treat a child as a dependent in the event of divorce, legal separation, or have lived apart at all times during the last 6 months.

Custodial Parent: If parents do not file a joint federal income tax return, the child can only be claimed by one parent; the Custodial Parent. How to determine the Custodial Parent:*

  1. Whom child resides with for more than half of the year
  2. The custodial parent is the one with whom the child resided with for the greater number of nights during the calendar year.
  3. If the child resides with both parents for the same amount of time, the parent with the highest adjusted gross income may claim the child as a dependent.

*Exception: If it is stated in a divorce decree that the non-custodial parent can to claim the child as a dependent, then the decree must be upheld, and the above does not apply. They will need to attach a signed declaration from the Custodial Parent when filing their taxes.

Non-Custodial Parent: A non-custodial parent may claim a child as a qualifying child if;

  1. The parents of the child provide more than half the child support for the calendar year,
  2. The child is in the custody of one or both parents for half the calendar year,
  3. The parents are divorced, legally separated, or have lived apart at all times for the last 6 months,
  4. The custodial parent does not claim the child as a dependent.

Yes, you must complete the Reimbursement Request Form and attach a receipt of payment indicating the dates of service. (Please see Instructions and Tips for Filing Claim Forms)

Yes, as long as the family member is not a dependent of the member. The definition of a dependent is either a minor child or an adult living in the member’s household receiving 50% of support from the member.

The IRS has made the determination that a 5-year-old child in school is considered to be in a kindergarten level class. The cost of the services for instructional education is not reimbursable. If a 5-year-old child or younger does not receive instructional education for a full day, but instead receives daycare services for a portion of that day, the provider must itemize a receipt with the hours of education and the hours of daycare services. The cost for the hours of daycare is reimbursable under your Flexible Spending Account. The cost for the hours of educational instruction is not reimbursable.

If you have set aside dollars through salary reduction, and you do not use those dollars by the end of the plan year, you will lose those dollars. The IRS requires that all funds that have been deducted from your paychecks and placed in the Dependent Care Account must be used during the plan year. It is important to deduct from your salary only the amount that you are sure you will incur as expenses during the plan year. Therefore, it is important to deduct from your salary only the amount that you are sure you will incur as expenses during the plan year.

Contributions allocated to one benefit account can only be used to pay a claim from that benefit program. For example, your contributions to your Dependent Care Account cannot be used to pay a medical care expense claim.

Changes to the amounts deducted from your salary and deposited into your Dependent Care Account can be made if any of the following qualifying events occur:

  • A change in the cost of dependent care.
  • Employment status
    • Any employment status change for the employee, spouse or dependent
    • Termination or commencement of employment, strike or lockout
    • Return from unpaid leave of absence
    • Change in worksite
  • Dependent eligibility
    • A change in dependent eligibility that causes the dependent to satisfy or cease to satisfy requirement due to: age, marriage, or any similar circumstances
  • A change in family status caused by:
    • Change in number of dependents
    • Change in legal marital status
    • An unpaid leave of absence by you or your spouse

In order to change your healthcare or dependent care election, you must first experience an IRS Qualified Life Event. Qualified Life Events include certain changes in family or work status. Please contact your employer to determine if you have experienced a Qualified Life Event.

Examples of Qualified Life Event Changes:

  • Marriage
  • Divorce
  • Birth or adoption of child
  • Death
  • Change in employment status for you, your spouse or tax dependent
  • Change in dependent care provider
  • Increase or decrease in dependent care provider charges

NOTE: Your election change must be consistent with the Qualified Event.

Please refer to your Summary Plan Description for more details.

COBRA

 

Yes, COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

If you, or a dependent who is a qualified beneficiary, is determined by Social Security to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months. The law specifies that you must provide a copy of the disability determination within 60 days after the date of the Social Security determination and before the end of the original 18-month period that applies to the qualifying event. However, some employers have elected to extend the 60 days time period for submitting the disability extension. Contact BenefitHelp Solutions if you have questions regarding this provision.

The COBRA premiums during an 11-month disability extension are increased to 150% of the regular premium rate.

No. You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

You have the right to continue both coverages if you had other group coverage before electing COBRA. However, if you obtain new coverage after electing COBRA and BenefitHelp Solutions is notified, your COBRA coverage will terminate as of the effective date of your new coverage. A written notification of the new coverage must be submitted to BenefitHelp Solutions, preferably before the effective date of the coverage.

Yes. You must notify BenefitHelp Solutions within 31 days of the date of birth.

If your former employer offers an insurance option other than HMO, you are eligible to switch to the other plan due to your move. If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan, even if it is of limited value.

Yes, you have a 30-day grace period to pay your COBRA premiums, but your insurance carrier may suspend claims payments if your premium is not paid by the first of the month.

Your COBRA insurance will terminate on the first day of the month you become entitled to Medicare. If you become entitled to Medicare prior to turning 65 years old, you must notify BenefitHelp Solutions as soon as possible in order to insure timely transition to your other coverage options and correct payment to your providers.

Yes, if your dependents are qualified beneficiaries, their COBRA coverage may be extended. The length of continued COBRA coverage is determined by the individual circumstances.

Medicare before and after COBRA coverage begins:

Qualified beneficiaries who are entitled to elect COBRA may do so even if they have other group health plan coverage or are entitled to Medicare benefits on or before the date on which COBRA is elected. Medicare becomes the primary payer for an age-based or disability-based Medicare beneficiary who also has COBRA coverage.

If Medicare entitlement is based on ESRD, then Medicare is the secondary payer for the first 30 months of the Medicare entitlement.

Retiree

 

Federal law mandates that you be offered COBRA at the time of your retirement. Under the federal COBRA guidelines, loss of coverage due to retirement is a qualifying event.

If you or any dependents are on Medicare prior to the qualifying event, you might want to take the COBRA coverage as you cannot be on the retiree plan if you are entitled to Medicare unless your Retiree plan has over-65 coverage.

Yes, as long as you maintain continuous coverage and you were covered under a public employer retiree plan. In some plans, if you do not choose the retiree plan from the original loss of coverage date, you may be opting out of your retiree coverage and may not pick it up later. Please contact BenefitHelp Solutions if you have questions regarding this.

No, dependents can only be added when you initially enroll in the retirement plan or if there is a family status change, such as marriage or birth of a child.

If you receive a PERS Pension check and your premium amount is less than the amount of the check, you can have your premium deducted from your pension check. If you do not receive a PERS pension check or do not want to have your premium deducted from your pension check, you can remit your premium via Electronic Funds Transfer (EFT) or by sending a check directly to BenefitHelp Solutions.

Yes, your spouse can stay on the early retiree plan until he or she becomes entitled to Medicare or otherwise loses eligibility.

Yes, once it has been identified that your automatic payment was not processed, we will send you a bill.

No, most retiree plans have specific regulations regarding changing plans or adding and deleting plans. Please contact BenefitHelp Solutions regarding your specific situation.

Yes, BenefitHelp Solutions will send you a confirmation letter anytime there is a change that affects your premiums.

Yes, BenefitHelp Solutions needs your current mailing address for sending you important information about the status of your medical coverage. You can submit an address change to BenefitHelp Solutions by visiting our web site (Address Change), calling our office or sending a written change of address.

No, once you or one of your dependents are covered by Medicare (age in at 65 or Disability Medicare) retiree coverage ends. Call BenefitHelp Solutions right away if you or one of your dependents has or is about to have Medicare coverage.

Yes. Federal law mandates that your dependent be offered COBRA at the time of their loss of coverage. Under the federal COBRA guidelines, loss of coverage due to loss of dependent eligibility is a qualifying event.

No, entitlement to Medicare occurs if you have only Part A.

Benefits Card

 

The Benefits Card provides direct access to Flexible Spending Account funds, allowing participants to pay for eligible health care expenses at qualified locations wherever VisaTM is accepted. The amount of the transaction will be automatically deducted from the participant’s appropriate spending account to pay the provider of service.

The primary advantage of using the Benefits Card is that you do not have to pay for eligible IRS expenses out of your own pocket, submit a claim form and wait to be reimbursed for the expense. The money is deducted directly from your flexible spending account at the time of purchase.

You can request a Benefits Card at Open Enrollment. Benefits Cards cannot be requested at any other time. If you have a card, you may request a second card for a family member at any time.

Using the Benefits Card does not eliminate the IRS requirement of submitting supporting documentation for Flexible Spending Account expenses. After using the Benefits Card for a purchase you may receive a letter from BenefitHelp Solutions requesting documentation.

The IRS does not require supporting documentation if the transaction amount matches a fixed copay on your employer’s health or dental plan, such as a $10 or $15 office co-pay, or a $10 prescription co-pay. Because of IRS requirements, co-payments charged together, such as $10 and $20, for a total of $30, cannot be matched by the Benefits Card system and you will receive a letter requesting documentation. If you are asked for supporting documentation for a fixed copay amount, please call BenefitHelp Solutions at 855-378-0197. In most instances this happens when the merchant code for your provider or place of purchase is not being recognized by the system.

The IRS requires supporting documentation that includes the name of the provider, the date of service, the type of service performed and the amount of the service. For examples, an itemized statement or receipt from your provider, or an Explanation of Benefits from your insurance company for healthcare expenses are acceptable. The receipt that you signed for the purchase, balance forward statements or balance due statements are not acceptable forms of documentation because these types of documentation usually do not list the type of service performed or the name of the product.

If you do not submit your documentation to BenefitHelp Solutions, we will send you a second request letter. If you still do not sent in your supporting documentation, you will receive a final notice and your Benefits Card will be deactivated until we receive the requested documentation.

As of January 1st, 2011 most OTC medicines and drugs require a prescription to be eligible for reimbursement under an FSA. If you have a valid prescription, and purchase the item at a grocery a store you will need to pay out of your pocket and submit a claim form along with a copy or your receipt and prescription for reimbursement. If you purchase the OTC Medicine at the pharmacy, you may use the Benefits Card and the transaction will be auto-approved.

The Benefits Card should only be used to pay for services incurred in the current plan year. You will be required to refund your account if you use the Benefits Card to pay for a service that was incurred last plan year.

The service must have been incurred on or before the payment date and the service must have been incurred within the current plan year. Contact BenefitHelp Solutions at 503-219-3679 or 888-398-8057 concerning IRS regulations and special rules for orthodontia services.

You will receive a letter from BenefitHelp Solutions for the transaction requesting supporting documentation. If the transaction was for an ineligible expense, you will need to refund your account. The IRS does not allow you to use pretax dollars to pay for ineligible expenses.

The Benefits Card is optional. You may pay for your expenses and submit them for reimbursement at any time.

The Benefits Card does not work for daycare expenses. To use your Flexible Spending Account plan for daycare expenses you will need to pay for the expense at the daycare provider and then submit a request for reimbursement with a claim form to BenefitHelp Solutions. Claim forms can be found on our website under FSA members or you can get one from your Human Resources department.

You will need to notify your employer of your name change and submit a written request for your name change to BenefitHelp Solutions. Your Benefits Card will be deactivated and cannot be used until your new card is received.

Participants can review their account balances and transactions by logging in to the member portal. The first time you log on, you will be asked to set up a sign-on and password.

For questions about your Benefits Card or your Flexible Spending Account contact BenefitHelp Solutions at 855-378-0197 or fsa@benefithelpsolutions.com

....