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MAKING THE MOST OF MY BENEFITS

Your health benefits are designed to help you pay for the care you need to stay healthy and treat any illnesses or injuries you experience. Learn more about how your benefits work so you can use them effectively.
HEALTH INSURANCE 101
CONSUMER DIRECTED HEALTH PLAN (CDHP)
TALK THE TALK
IT PAYS TO UNDERSTAND HSAs AND FSAs
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What Is Supplemental Medical Insurance?

Your employer may give you the option of enrolling in supplemental medical insurance. But what is it exactly — and how is it different from primary medical insurance?

A primary medical plan provides coverage for a wide range of services, from annual checkups to specialist visits and hospital care. These plans are designed to provide comprehensive coverage as required by the health care reform law.

Supplemental medical plans are intended to supplement your primary medical plan. They provide an additional layer of protection from major expenses not covered by your primary medical plan. On their own, they don’t provide the level of medical coverage required by the health care reform law.

Three common types of supplemental medical plans include:

Is Supplemental Insurance Right For You?
You may want to consider enrolling in one or more supplemental medical plans if you:

Who Pays For Coverage?
You pay the full cost of supplemental coverage, typically through after-tax payroll contributions. Primary medical coverage, on the other hand, is paid for by you and your employer — with your employer paying a larger portion of the cost.

Learn More
Refer to your company’s benefits guide or website to see if supplemental insurance is available and when you may enroll.

Copyright 2016 Mercer LLC. All Rights Reserved.

It Pays to Understand HSAs and FSAs

Health Savings Accounts (HSAs) and Health Care Flexible Spending Accounts (FSAs) are both great ways to save money by using before-tax money to pay for eligible medical expenses — everything from prescription drugs to surgery. Because the money is deducted from your income before it’s taxed, you could save up to 20% to 30% or more, depending on your income tax rate.

Who can participate?
HSA
You’re eligible if you’re enrolled in the high deductible health plan, also known as a consumer directed health plan.
Health Care FSA
You can choose a traditional Health Care FSA as long as you aren’t enrolled in an HSA. Sometimes, a Limited Purpose FSA is available along with an HSA. This type of FSA is usually limited to dental and vision expenses. Check your plan information for details.
How much can I contribute?
HSA
The IRS sets contribution limits for HSAs each year. For 2016, the limits are:
  • Individual coverage: $3,350.
  • Family coverage: $6,650.

If you’re 55 or older, you can deposit up to an additional $1,000. Contributions are made on a before-tax basis.

Health Care FSA
You can contribute any amount up to $2,550 annually (and some FSAs have a minimum contribution, as well). Deductions are taken from each paycheck on a before-tax basis.
Who can contribute to the account?
HSA
You can fund your HSA through payroll deductions; your employer or anyone else can also contribute to your account.
Health Care FSA
You are the only person who can contribute to your Health Care FSA.
Who owns the account?
HSA
One of the key advantages of an HSA is that you own it 100%. You can even take the account with you when you retire or if you leave your employer.
Health Care FSA
Your employer owns your account. If you leave the company, the account doesn’t go with you.
When can I access the account contributions?
HSA
Similar to other bank accounts, you can only use money from your HSA that’s actually been deposited in your account.
Health Care FSA
Unlike an HSA, your entire annual Health Care FSA election amount is available from the beginning of the plan year, even if the entire amount hasn’t been deducted from your paychecks.
Do all of my remaining funds roll over?
HSA
Yes, any unused funds at year-end roll over to the next year for you to use and remain in your account indefinitely until you spend them.
Health Care FSA
No, in most cases you will forfeit all remaining funds at year end. Some plans may allow you to roll over $500 to use during the following year. Others may provide a grace period instead of a rollover feature. Check your plan to learn more.
Can I change contribution amounts?
HSA
Yes, you can change your contribution amount, or stop contributions, anytime during the year.
Health Care FSA
You can only change your contribution amount during the year if you experience a life event, such as a birth, marriage or change in employment status.
Can I invest the funds in my account?
HSA
Maybe. Many HSAs allow you to choose from a variety of investment options for your account (sometimes only if the account balance reaches a certain limit — e.g., $2,000).
Health Care FSA
No, you cannot invest the money in a Health Care FSA.
What are the deadlines to request a reimbursement?
HSA
You can request a reimbursement from your HSA at any time, as long as the money is available in your account.
Health Care FSA
Some plans allow you to submit expense claims after the plan year ends for a specified period of time. Check your plan to learn more.

Using an HSA or Health Care FSA is like getting a discount on eligible health care expenses, because you use tax-free money to pay for those costs. Your choice of medical plan will determine the account(s) for which you are eligible. Use the information in this chart to help you decide which one may be right for you.


Copyright 2016 Mercer LLC. All Rights Reserved.

Can You Trust Your Medical Bill?

Errors are a lot more common than you might think. Here's how to weed out mistakes — and keep costs down.

And you thought examination gowns were scary! Consider this: Odds are, there's a mistake in that medical bill you just opened. According to a NerdWallet analysis of 2013 hospital audits by Medicare, 49% of bills contained errors, and some medical centers messed up on more than 80% of claims to Medicare. Those flubs matter to consumers more than ever, because greater health insurance cost-sharing and higher deductibles mean that a mistake can take a chomp out of your wallet. What's more, billing errors can be tough to spot and tougher to fix. Disputes can drag on, and if you don't take the right steps, your account could be put into collections. Ensure a clean bill of health with these steps.

First: Decode Your Bill

Compare Statements
Don't pay your doctor's bill until you receive an explanation of benefits (EOB) form from your insurer. Both statements tell you the amount being charged for your procedures, the amount your insurer is paying and what you owe. The totals should match — and if they don't, it's time to do some digging. (Keep in mind: Sometimes the doctor or hospital will send an invoice before receiving the full insurance payment, so the bill is for more than you actually owe. Wait until your insurance statement comes to find out what you're responsible for.)

Get an Itemized List
Some bills might list only a total amount owed, even if you underwent more than one procedure. If charges are lumped together in broad categories — "lab tests," say — call the billing department of your provider or hospital to request an itemized bill so you can see every single service for which you're being asked to pay. That makes it easier to spot errors.

Check the CPT Codes
Doctors use current procedural terminology (CPT) codes to categorize treatments and procedures. You can find those numerical codes on your EOB; google the digits to find out what they stand for.

Second: Look Closely and Ask Questions

Are There Obvious Errors?
A misspelled name, incorrect insurance policy number, the wrong procedure code — any of these things can lead to your claim being denied. Also, check for "phantom" services that weren't performed (such as tests that ended up being canceled) and duplicate charges (being billed twice for a single procedure). If you spot an error, ask your doctor to resubmit the bill.

Was Your Co-pay Applied?
If you paid at the MD's office, check to see if that amount was deducted from the bill.

Were You "Balance Billed"?
An in-network doctor's agreement with the insurance company usually requires that she accept the insurer's check — along with your co-pay or coinsurance — as payment in full, but some doctors might try to bill you for the rest. (Say the doctor billed $600 for a procedure but the insurer paid only $250. By law, the doctor can't charge you for the other $350.) Your insurance statement will confirm what your responsibility is; give a copy of that to your doctor.

Are There Unbundled Fees?
This means being billed item by item for things that should have been grouped together as part of a lower-priced package. Take, for example, the fee for delivering a baby: lab tests, IVs, the delivery itself and postnatal care are charges that should be bundled. Scan your bill for words such as kit and tray (each of these terms covers charges for multiple items).

Were You Up-coded?
If a doctor removes a splinter from your foot and bills the insurance company for surgery, your share might amount to hundreds of dollars. If charges seem unreasonable, google the CPT code. If the description of the procedure doesn't jibe with what you had done, call your provider and your insurer and ask for a correction.

Does the Timing Seem Off?
If you stayed in the hospital overnight, double-check the room-and-board charges. Although many plans don't allow hospitals to bill you for the day you were discharged, some hospitals do. And look for the time you were admitted: If you went to the ER at, say, 10 p.m. but weren't admitted to the hospital until after midnight, you shouldn't be billed for the previous day.

Third: Take Action

Go Right to the Source
Address questionable fees with your provider's billing department and your insurer, asking them to double-check the details. Write down the name of the person you spoke to and what you were told. If you're unable to resolve it with your provider, dial things up a notch: Put your concerns in writing and send them to your insurance company; the firm can work with you to file an appeal to dispute the charge. Send a copy of the dispute or appeal letter, along with any documentation you have, to your state's attorney general or the insurance commissioner. (Google "medical billing problem" and the name of your state — that should lead you to the right place.)

Move Quickly
Typically you don't have to pay disputed charges until the investigation is complete, but do pay the rest of the bill — that would show that you're not just blowing it off. (You don't want your provider to turn your debt over to a collection agency — which would slam your credit score.) Send a letter with the check, letting your provider know that your insurer is looking into things. Likewise, alert the credit bureaus to the ongoing dispute by sending a letter explaining the details of your claim. Every four weeks, update both parties on the status of your claim, and check your credit reports to make sure that the disputed bill doesn't end up on the report as an unpaid account.

Sources: Kevin Flynn, president of HealthCare Advocates in Philadelphia; Pat Palmer, CEO of Medical Billing Advocates of America in Roanoke, Virginia; Stephen T. Parente, professor at the University of Minnesota Carlson School of Management; Mark Rukavina, principal at Community Health Advisors in Boston; Erin Singleton, chief of mission delivery at the Patient Advocate Foundation in Hampton, Virginia.

The content of these articles is provided by Time, Inc. and is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Mercer is not responsible for the content. Always confer with your physician or other qualified health provider about any questions you may have regarding a medical condition or a change in lifestyle that might have an impact on your health, such as beginning a new exercise or nutrition regimen. Do not evaluate or disregard any professional advice or delay seeking such advice based on anything you have read in this article. Mercer does not recommend or endorse any specific tests, physicians, products, procedures, theories, or treatments that may be mentioned in this article.

Adapted from the September 2015 issue of All You. © 2016 Time Inc. All rights reserved.