Hra Simple
What does ICHRA stand for and what it is?
Individual Coverage Health Reimbursement Arrangement; It is an arrangement where an employer provides funding to its employees to purchase their own individual/family plans instead of having a traditional group plan.
A claim has denied for COB/other coverage. What does this mean?
The member may have other coverage and we will need to collect Other Insurance Information to determine primary/secondary and be able to process the claim. This information can be received over the phone or on the OIC Form.
Where can terminations for AS policies be requested?
Admin Portal (Dave)
A policy changing from On-Exchange to Off-Exchange, would the new policy have to be effectuated or will the member have a Grace Period since there will be no gap in coverage?
The new policy will have to be effectuated since it will be a new policy ID.
What is the process to submit a plan change for an AS member?
Send up a workflow to Enrollment with the new plan information.
What is an eligible expense that can be reimbursed by HRASimple?
Medication, glasses, contacts, paying out of pocket for medical visits (copays).
If a check is showing ACH reversal in Zellis what are the next steps?
Send a wf up to Finance> ACH reversal
What is the Grace Period for an On-Exchange policy + APTC?
3 months
What documents are accepted for a newborn to be added to a policy?
Birth confirmation letter from hospital, birth certificate
When must a member enroll by in order to have a 1/1 effective date?
12/15
An HRASimple member is calling in because their address is incorrect in the HRASimple Portal. Can they just enroll without changing their information? Who do they contact to update?
No, they should not enroll. They will need to contact their HR representative to have their information updated in the portal. Once updated, then they can enroll since a wrong address can lead to incorrect premium/funding, claim denials, policy cancellation, etc.
A member received an EOB for a denied claim needing an Accident Injury Report/Police Report from the member. She is calling in and asking what she needs to do, what do you advise?
The accident injury report can be taken over the phone, preferably, or it can be submitted on the Accident Injury Report Form.
30 days from date of invoice.
When must a qualifying member request reinstatement by?
The 15th of the month following their termination.
A member lives in Cartersville and wants to purchase a Vitruvian Health Plan, what do you advise?
This plan would not be available in their area as they are limited to residents in Gordon, Murray, Catoosa and Whitfield county.
Can a Vitruvian Health employee's spouse or dependent be covered under their plan if they are offered health insurance elsewhere?
No, they can not due to the VH carveout.
Are land ambulances covered under the No Surprise Act/SBCPA?
No, they are not. Only air/water ambulances are covered.
A current member is on ACH, their banking information has not changed but they are on a new policy ID next year. Will ACH renew into the new year?
No, the member will have to submit a new ACH Form because the policy ID number has changed.
What are the requirements to qualify for a reinstatement request?
No APTC
Never been termed before or reinstated previously in policy history
Must sign up for AutoPay
Must pay full balance due same day of request
Can we cancel passive enrollments for Market Place (TN) members?
Yes.
This policy is paid through Simple Pay meaning the employer is making the payments. Any refunds will be returned to the employer and not the employee.
What is the 4th Quarter Carry Over?
Deductible accumulations from services in Oct 1st - Dec 31st, does not apply to HDHP plans. Only deductible carries over, and does not apply to the out of pocket.
A member that has APTC, their premium is $20 and has a PTD of 08/30/2025 is calling in on 11/30 wanting to pay $50 and they state they will call in on 12/8 to pay the remainder, what do you advise?
The full balance must be paid by end of November to avoid cancellation; a partial payment would not bring them out of grace and would cause the policy to terminate back to 09/30/2025.
Member did not make their plan selection during Open Enrollment because they were out of the country for the holidays. It is now Jan 31st and they want to change their plan to something cheaper. What do you advise?
Can we cancel passive enrollments for GAA (GA) members?
No, the member will have to contact GAA or go into their Consumer Portal and cancel 2026 coverage.