TRSHRAccount

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TRS-HRAccount

• September 2004

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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 employees 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 premiums
• Allows participants the option to accumulated
  funds for future use.

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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

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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

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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)

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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

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What are eligible expenses?

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

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Examples of what funds can be used for
Detailed list of eligible expenses at
www.tra.state.tx.us
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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 TRSs definition (A
  teacher WILL receive the 41.66 per month)
• A monthly administration fee will be deducted
  from each participant account

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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

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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
  plans)
• An on-line premium payment tool
• Submitting paper claims

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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 dont activate within 90 days, and decide
  to activate later, youll need to get a new card
• Can deactivate later

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Method 1Debit Card Submissions

• TRS-HRAccount debit card swiped in reader
  Choose Credit
• 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 provider
• ALWAYS KEEP COPIES OF THE DOCUMENTATION FOR YOUR
  FILES

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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

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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
• Pharmacist swipes Joes card and validates
  eligibility
• Pharmacist receives real-time authorization
• 20 is deducted from Joes TRS-HRAccount

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Debit Card Denials

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

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Method 2Streamline Method

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

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Method 3Online Premium Reimbursement Method

• What types of premiums are reimbursable under the
  TRS-HRAccount
• 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
  reimbursement

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Online Premium Reimbursement Method Sample

• Janes 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 at www.trs.state.tx.us
• 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, youll have to
  request reimbursement each time)
• If there arent enough funds, the balance will be
  pended and will be sent to you when your
  account is credited with more funds.

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Method 4Paper Claim Submission

• Claim forms are on line at www.trs.state.tx.us
• Claim forms in payroll office
• Two forms are available for reimbursement
• General Claims
• Over-the-counter (OTC) medications
• Also available in Spanish

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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

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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
  reimbursement
• If OTC need a receipt that shows product name,
  date and amount paid

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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

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Claim Reimbursement Options

• Direct deposit to a checking or savings account
• Check mailed directly to participants home
• Direct payment through debit card
• Funds disbursed to provider and participant
  account immediately charged

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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 www.trs.state.tx.us
• Call Participant Services 1-800-437-3666 and
  follow the prompts

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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 EOPs

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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

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Theyre asking me for information Now what?

• RESPOND
• Verifying eligible expense
• If not eligible, you will need to repay
• Remember KEEP DOCUMENTATION
• If you dont repay, it will be treated as income
  to you

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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

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What happens to unused funds

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

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What if I leave?

• Its still yours!
• Still have a monthly fee
• No additional contributions
• If you should die, it goes to your surviving
  dependents
• Reimbursements made to the estate

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Where to get more information

• Booklet Information Guide
• Online www.trs.state.tx.us
• By phone [phone]

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Questions and Answers?
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