Until then, we encourage you to call Via Benefits at 1-866-322-2824 (#711) to speak to one of our expert benefit advisors. Reimbursement Request Deadlines Health Coverage Simplified (Copy) Dental and Vision Plans Shop and Enroll Individual and Family Your Individual and Family Enrollment Call Preparing for Your Enrollment Call Individual Health Plan Enrollment Optional Benefits Basic About Optional Benefits Hospital Indemnity Dental Insurance Funding Manage Your Account Denied Reimbursement Claim Got Questions About Medicare? PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Phone: Contact Us Speed up your businesss document workflow by creating the professional online forms and legally-binding electronic signatures. Your Reimbursement Guide provides more details on reimbursable expenses. * Save Username on this Browser - Do not check the Save Username option if you are using a public computer, for example in a Library. Read Authorize Others to Access Your Account for more information. If you receive a loss of funding notification from Via Benefits, and the loss of funding wasn't intentional or you believe it has occurred in error, please contact us. Check the Status of Your Reimbursement Request. The signNow application is equally as productive and powerful as the online app is. Health Reimbursement Arrangement | University of Rochester 4. Your direct deposit takes effect once your banking information is validated. Open the email you received with the documents that need signing. All of the contributed funds for both you and your spouse, if applicable, go into this shared account. Read Automatic Premium Reimbursementto learn more. For the previous years Part B premium, the IRS Form 1099 can be used as documentation for the year shown on the form. With signNow, you can eSign as many papers in a day as you need at a reasonable price. The annual policy statement or billing statement, sent to you by your insurance carrier, usually provides the required information. If youre paying an Income Related Monthly Adjustment Amount (IRMAA) surcharge or a late enrollment penalty, you need to submit a request to be reimbursed for the surcharge or penalty amount. On the Dashboard, select your name and then select Banking Information.5. We want to be sure the process of securing high-quality health benefits through the State of Nevada is as easy as possible. Payments by check are held until the amount is greater than $25; however, if you establish direct deposit, the minimum payment is $1. TM signNow makes signing easier and more convenient since it provides users with numerous extra features like Merge Documents, Invite to Sign, Add Fields, and so on. View Via Benefits (formerly Towers Watson's OneExchange) HRA Presentation (PDF) A Recurring Premium Reimbursement request needs to be submitted once each calendar year to be reimbursed monthly, or you can submit for a one-time reimbursement of quarterly Medicare Part B payments. A message appears confirming your bank account has been deleted. There are 3 types of reimbursement options: automatic premium reimbursements, recurring pre- There are three variants; a typed, drawn or uploaded signature. You can also submit a reimbursement request if you provided payment information for aninitial payment with your application. Refer to IRS issues standard mileage rates for 2022 for more details. Include documents from your bank with routing and account numbers. Benefits Administration Vendors Transition | 3M United States If your plan doesn'tparticipate in Automatic Premium Reimbursement, consider activating Recurring Premium Reimbursement, which requires you to submit only one reimbursement request each calendar yearunless your premium changes. Please attach all receipts that apply to requested reimbursements. Any payments made during this time area paper check. Once youve finished putting your signature on your my via benefits funds forms, decide what you wish to do next - save it or share the file with other parties involved. Contact us - Via Benefits A practical dashboard provides a quick summary of all your account information, making it easy to review expenses . You can request reimbursement by submitting a reimbursement request on the Via Benefits Accounts mobile app, the website, or a Reimbursement Request Form. Additional Employee Benefits May Include the following: Company Paid Retirement Benefit, Employee Stock Purchase Plan, Paid Holidays, Flexible Spending Accounts (FSAs), Health Savings Account (HSA), Time Off and Flexible Days, Group Legal Plan, Group Home Auto Insurance, Pet Insurance, Employee Discounts, Adoption Reimbursement, Tuition Reimbursement and Student Loans, Well-Being Programs, etc Select Yes, Delete Account. PDF Making Your Via Benefits Reimbursements Easier - ACERA Any approved reimbursements for either you or your spouse are taken from your joint funds until they're exhausted. Begin automating your signature workflows right now. Complete the Direct Deposit Authorization Form. Your browser is currently set to block cookies. Select Add Bank Account. Use a via benefits reimbursement request form 0 template to make your document workflow more streamlined. There are three variants; a typed, drawn or uploaded signature. You need to allow cookies to use this service. If you need an item or service Original Medicare doesn't cover, you're responsible for the full cost unless you have additional insurance that offers appropriate coverage. Sign In Help. You need to submit a new Recurring Premium Reimbursement request each time your plan renews, which is typically 12 months after the plan went into effect. You want to be reimbursed for premiums paid under COBRA. Create your eSignature, and apply it to the page. *Via Benefits reimbursement accounts are administered by Extend Health, LLC. Whether you set up direct deposit on the website, on the mobile app or on a paper form, you can updateyour banking information on the websitewhenever you want. You may also submit a reimbursement request on the website, on theVia Benefits Accounts mobile app, or on a Reimbursement Request Form. Forms received between January 1 and March 31 can take up to 45 calendar days to be processed and validated. Social Security Number Enter only the last four digits of your Social Security number Download your copy, save it to the cloud, print it, or share it right from the editor. View HRA contributions. A printout from the SSA may also have the required information, including your name. Via Benefits - This way to personalized benefits This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement).*. After its signed its up to you on how to export your my via benefits funds forms: download it to your mobile device, upload it to the cloud or send it to another party via email. Automatic Premium Reimbursement only reimburses you for the standard Part B premium. Provide all of the requested information and selectAdd Bank Account. Read Recurring Premium Reimbursement to learn more. Contact us! Account Holder Date of Birth Enter your date of birth using format MM/DD/YYYY The primary participant is the account holder. Learn About the Basics of Individual and Family Coverage. 3. Medical Expense Reimbursement Health Coverage Simplified The Via Benefits program allows flexibility for retirees to customize their Medicare supplemental coverage. A Recurring Premium Reimbursement request needs to be submitted once each calendar year to be reimbursed monthly, or you can submit for a one-time reimbursement of quarterly Medicare Part B payments. If you submit a bill from midyear, only the earliest statement month forward will be approved. We can't sign you in. Install the signNow application on your iOS device. You can download the signed [Form] to your device or share it with other parties involved with a link or by email, as a result. The signNow application is just as productive and powerful as the online app is. 3. All communications regarding your reimbursement account are addressed in the name of the account holder. Note: If your former employer has a direct deposit requirement, the trash can icon isn't available to you. Tumawag sa 1-800-326-5496 (TTY: 1-800-545-8279) These alerts don't prevent you from using your account. The alertpersists until you sign up for text alerts, but it doesn'tprevent you from using your account. *Via Benefits reimbursementaccounts are administered by Extend Health, LLC. *Via Benefits reimbursement accounts are administered by Extend Health, LLC. You must be enrolled in a Medicare Advantage or a Medicare Supplement Insurance (Medigap) plan through Via Benefits Insurance Services to qualify for Part B Automatic Premium Reimbursement. Welcome to Via Benefits This way to personalized benefits for a more secure life for you and your family. Via Benefits administers the HRA for my former employer Northrop Grumman and other corporations. If you choose not to take advantage of automatic reimbursement, or if your insurance carrier does not offer automatic reimbursement, you may send your Read Submit or Cancel a Reimbursement Request for instructions. If you've chosen people to manage your affairs or help you in the event you become incapacitated or pass away, add them to your Via Benefits profile as authorized representatives. Use professional pre-built templates to fill in and sign documents online faster. What is Via Benefits? Current UMC retirees and their spouses have selected over 1,000 different plans that meet their individual needs. It employs 251-500 people and has $25M-$50M of revenue. Your proof of mileage must be kept in a mileage log or similar document. Safe and secure: * Simple user login and registration. We recommend setting up direct deposit on the website or on the mobile app. Your reimbursement request must be submitted with third-party documents that include: When Part B premiums are an eligible expense, the standard Part B premium is reimbursed monthly, dependent on your enrollment in a Medicare medical plan with Via Benefits. You can do the translation and currency conversion yourself. Upload a form. With over 15 years of experience working with 700+ companies and over two million retirees enrolled, Via Benefits provides expert personalized support to help retirees understand and enroll in Non-Medicare health insurance and Medicare supplemental insurance options. A reimbursement account is set up by your former employer or benefits provider with a specific contribution of funds that can be used to reimburse you for qualified health care expenses. Use a via benefits reimbursement request form template to make your document workflow more streamlined. Learn more: Submitting or Cancelling a Reimbursement. Via Benefits Ibm Reimbursement Request Form - pdfFiller 4. You can be reimbursed for your standard Medicare Part B premium amount if its allowed by your former employer or benefits provider. Create an account using your email or sign in via Google or Facebook. Via Benefits has a few suggestions to improve your experience while using your reimbursement account, such as updating your notification settings on the website for email and text, automating your premium reimbursement (if it's offered by your plan), and setting up direct deposit. : 1-800-326-5496 (TTY: 1-800-545-8279) This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement).*. The signNow extension gives you a selection of features (merging PDFs, including multiple signers, and many others) for a much better signing experience. TM Welcome to Via Benefits This way to benefits that fit your needs, with support and advocacy you can trust. Solution Benefits Accounts WTW's Benefits Accounts empower employees and retirees to determine how to use their benefit dollars through flexible, tax-advantaged medical spending and savings accounts, including health savings accounts (HSAs), flexible savings accounts (FSAs) and health reimbursement arrangements (HRAs). To get to your reimbursement account, follow these steps: Sign in to your Via Benefits account. Via Benefits Recurring Reimbursement Form - signNow Manage Your Communications What solutions are included in the Via Benefits solution suite? You may see alerts reminding youto setup direct deposit or text alerts. Because the funds are in a reimbursement account managed by a third party (e.g., Via Benefits) and used only for qualified medical expenses, you don't have to pay any additional taxes on your annual return. We need the first month's bill for which you want to be reimbursed. Select Yes, Delete Account in the Delete Bank Account box. Use professional pre-built templates to fill in and sign documents online faster. 9. Find the extension in the Web Store and push, Click on the link to the document you want to design and select. PDF Frequently Asked my.viabenefi ts.com/gw Questions Select the area you want to sign and click. Depending on the situation, funding that has already been placed in your account may also be reversed. After you'veset updirect deposit for your reimbursement account, please allow up to three business days after a reimbursement request is approved to receive your funds. Access Your Reimbursement Account on the Website We notify you when you're at risk of losing funding. 1. Here are some of the features of the Via Benefits Accounts mobile app. 5. We believe the name Via Benefits is a door opener and sets the stage much more effectively for clients to appreciate the full scope of our offerings and the value of our approach. Associate Director of Strategy @ Willis Towers Watson > Benefits, Delivery, & Administration > Individual Marketplace, Monday Friday, 8 a.m. 7 p.m. Eastern Time, Copyright 2022 Extend Health, LLC All Rights Reserved. Once youve finished signing your via benefits reimbursement, choose what you want to do next save it or share the doc with other people. STEP 2: Under Insurance Premium Expenses, complete the following fields. Need help? Use signNow to electronically sign and send out My via benefits reimbursement form for collecting e-signatures. The signNow extension provides you with a variety of features (merging PDFs, adding several signers, and so on) for a much better signing experience. 2023 airSlate Inc. All rights reserved. 2. Forms without a barcode aren't processed. Install the signNow application on your iOS device. PDF 2021 Retiree Reimbursement Account Summary Plan Description - Via Benefits Via Benefits - Health Reimbursement Arrangement (HRA) You cansign into your account at any time to review your reimbursement account activity. Eligible retirees may use the HRA money for reimbursement of the following: HRA funds may be used to reimburse health care expenses (including medical, dental, vision, and Medicare Part B premiums) for both the retiree and their eligible tax dependents as defined by IRS Publication 502 available atwww.irs.gov. Get Form How to create an eSignature for the via benefits reimbursement form 2021 1-866-322-2824 (TTY: 711) Mon-Fri 8am - 7pm Eastern Direct Deposit Health Coverage Simplified (Copy) The balance reflects the current available funds for both of you together. If not, lets us know and we will get it added. 2. Your Reimbursement Guide provides more details on reimbursable expenses. Via Benefits is not an insurance company; it is a resource that gives you access to a state-of-the-art Medicare exchange (sometimes referred to as a marketplace) containing a wide Via Benefits - Account Management. It may take up to 20 business days to receive and validate your Direct Deposit Authorization Form. Following fields. Automatic Premium Reimbursement Health Coverage Simplified (Copy) If you've chosen people to manage your affairs or help you in the event you become incapacitated or pass away, add them to your Via Benefits account as authorized representatives. Search for the document you need to electronically sign on your device and upload it. Employer Name Enter your employer name We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our 3rd party partners) and for other business use. * There isn't a deadline for you to submit reimbursement requests for the prior year if your former employer allows unused funds to rollover to the next plan year or if new funds can be used to pay for previous year's expenses. Via Benefits Accounts - Apps on Google Play Read Update your Reimbursement Notification Settings to learn more. Loading For example, your former employer may require you be enrolled in a medical plan or prescription drug plan through Via Benefits Insurance Services. 1-800-326-5496 (TTY: 1-800-545-8279) . Via Benefits is a company that is experienced in helping retirees evaluate and enroll in Medicare supplemental insurance. Typically, Via Benefits reaches out to retirees 6-9 months before turning 65. * Fingerprint or Touch ID Authentication. This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement).*. How to Navigate Your Via Benefits Dashboard 3,150 views Jan 5, 2021 13 Dislike Share Save OhioPERS1 1.56K subscribers This video is a short tutorial of how to navigate the Via Benefits. Create your signature and click Ok. The account may be used to pay insurance premiums, Medicare Part B premiums and other health care expenses not . Select Reimbursement Center on the Funds and Reimbursements page.4. Read Reimbursement Request Deadlines Explained to learn more. Reimbursement Request Select Delete Account or select the trash can icon.7. Open Enrollment October 15 December 7, 2022, Medicare Advantage (MA) and Prescription Drug plan (PDP) October 15 December 7, 2022, Medicare Supplemental Insurance (Medigap), dental, and vision anytime of the year; recommended changing after Open Enrollment. Individual and Family Plan Premium Reimbursement (Copy) PDF Which Expenses Are Eligible? - Via Benefits Browse the board meeting section to view details, download documents and find remote site information. Individuals can't add funds to their accounts. Some former employers require that direct deposit is set up before you can be reimbursed for your expenses. After its signed its up to you on how to export your via benefits reimbursement: download it to your mobile device, upload it to the cloud or send it to another party via email. Look through the document several times and make sure that all fields are completed with the correct information. Note: If you receive your Reimbursement Guide and can't see your funding information on the mobile app or website, please contact us. Associate Director of Strategy @ Willis Towers Watson > Benefits, Delivery, & Administration > Individual Marketplace, Monday Friday, 8 a.m. 7 p.m. Eastern Time, Copyright 2022 Extend Health, LLC All Rights Reserved. Not sure where to get started? Follow the step-by-step instructions below to design your my viabenefits com funds direct deposit form: Select the document you want to sign and click Upload. Health Reimbursement Account (HRA) FAQs - Optum Financial Printing and scanning is no longer the best way to manage documents. Get connected to a strong web connection and begin executing forms with a fully legitimate signature within a few minutes. Selecting email reduces the amount of paper you receive. The amount of the expense must be converted from the foreign currency to US dollars. If you and your spouse have separate reimbursement accounts, you both need to set up direct deposit. Once you receive your Via Benefits Reimbursement Guide, take the following actions to prepare for when your reimbursement account becomes effective. Monthly HRA contributions are based on the retirees worked years of service credits and date of retirement. If you need to set up direct deposit, you can do soon the Via Benefits Accounts mobile app or on the website. Via Benefits has a few suggestions to improve your experience while using your reimbursement account, such as updating yournotification settings on the website for email and text, automating your premium reimbursement (if it's offered by your plan), and setting up direct deposit. If you wish to share the my via benefits funds forms with other parties, you can send the file by e-mail. Ibm Health Reimbursement Account Retiree * Use your Via Benefits website login and password. Via Benefits Reimbursement Request Form - signNow Your options for setting up direct deposit are described below. Alliant Retirees - Turning 65 For COBRA, you can submit your COBRA Premium Statement showing insurance details and covered participants. To getto your reimbursement account on the website,follow these steps: 1. Only your former employer can contribute funds to this account. Save time and postage by submitting reimbursement requests on the Via Benefits Accounts mobile app or website. HRA funds may be used to reimburse health care expenses (including medical, dental, vision, and Medicare Part B premiums) for both the retiree and their eligible tax dependents as defined by IRS Publication 502 available at www.irs.gov. Taking the actions described below reduces the number of steps needed for you to receive your reimbursements and reduces the amount of mail you receive from us. They're the fastest and most secure ways to have your reimbursements processed. Learn how to create an account. Read the Setting Up or Canceling Direct Deposit on the Website section if you want to set up direct deposit on the website. Sign into your Via Benefits account.2. *Via Benefits reimbursement accounts are administered by Extend Health, LLC. And due to its cross-platform nature, signNow can be used on any device, desktop computer or smartphone, regardless of the OS. For example, Form 1099 dated 2021 can only be used to get reimbursed for 2021 Part B premiums. Read more about Reimbursement best practices: Manage Your Reimbursement Account, Understand Your Reimbursement Account, and Access Your HRA, Anytime, Anywhere. You each submit your reimbursement requests through your own account. Request a copy of this letter by contacting the Social Security Administration (SSA) at 1-800-772-1213 (TTY: 1-800-325-0778) or going to ssa.gov. . On the Dashboard, select your name and then select Banking Information. We apologize that our site is not fully accessible to customers using screen readers at this time. You also need to submit a new request if your premium changes during the year, even if you have the same plan. Via Benefits is the leading private retiree medical marketplace in the country. The whole procedure can last a few moments. There are other ways to submit a reimbursement request if Automatic Premium Reimbursement isn't available to you. Get access to a HIPAA and GDPR compliant service for maximum simpleness. Read Access Your Reimbursement Account on the Websiteto learn how. Save time and postage by submitting reimbursement requests on the Via Benefits Accounts mobile app or website. Enter your username to begin the sign in process if you have previously created a username and password. Validation takes up to seven business days if entered through the mobile app or website. Connect to a strong connection to the internet and start executing forms with a fully legitimate electronic signature within a few minutes. After that, your my via benefits funds forms is ready. 6. A joint reimbursement account means you and your spouse share one account. An health reimbursement arrangement (HRA), sometimes called a health reimbursement account, is a type of health care account, not an insurance plan, which is funded entirely by your employer; employees cannot contribute to an HRA. Documentation Requirements Expenses Incurred in a Foreign Country Transportation Expenses Ensure the security of your data and transactions Sign into Via Benefits and select the name of the family member whose information you wish to view. The annual policy statement or billing statement, sent to you by your insurance carrier, includes this information. Only your former employer can contribute funds to this account. Documentation Requirements. * Username - Enter your username. Accepted mileage documents include a printout from an online map service, such as Google Maps, a handwritten document, or an Excel or Word printout. Search for "benefit verification letter." You can manage how you receive your reimbursement account notifications, such as balance reminders and Explanations of Payment (EOPs). There are several events that can cause a loss of funding, for example: You stopped paying your premiums, and your health plan was canceled, You canceled your supplemental Medicare coverage and returned to Original Medicare Parts A and B, You enrolled in a health plan with an insurance carrier or independent agent, not Via Benefits, An error occurred with the reporting to Via Benefits, You went back to work and lost eligibility, Your employer changed the eligibility status for your reimbursement account. You need to enable JavaScript to run this app. Start completing the fillable fields and carefully type in required information. Sign into your Via Benefits account. You can be reimbursed for an out-of-pocket medical expense as long as it's an eligible expense (such as an office visit or prescription copay, dental treatment, hearing aids, etc.) 2023 airSlate Inc. All rights reserved. The form is available by calling us and using our automated voice system or by speaking with a Via Benefits representative. Monday Friday, 8 a.m. 7 p.m. Eastern Time, Copyright 2022 Extend Health, LLC All Rights Reserved. Monday Friday, 8 a.m. 7 p.m. Eastern Time, Copyright 2022 Extend Health, LLC All Rights Reserved. You may be able to use Automatic Premium Reimbursement to receive your reimbursements. This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement).*. 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