STEPS FOR a SUCCESSFUL CLAIM reimbursement submission
Our objective is to assist you in getting reimbursed for your eligible expenses as quickly and easily as possible. Below are the steps to follow so each claim you submit has all of the necessary components and supporting documentation. Please review your Reimbursement Instructional Guide for additional information.
You pay for your eligible insurance premiums or health expenses to your insurance carrier or healthcare provider
- Remember, you first pay your premiums to your insurance carrier(s) and healthcare expenses as they are incurred, and then are reimbursed for your eligible expenses.
- You arrange the method and frequency of premium payments directly with your insurance company.
- For all eligible expenses, save all receipts and supporting documentation to include with your reimbursement claim. To learn which expenses are eligible, please refer to the Reimbursement Instructional Guide.
You determine how you want to receive your reimbursements
- Direct Deposit:
- You may enroll in direct deposit online by visiting the subsidy portal or by completing the Direct Deposit Form.
- Direct Deposit is faster and more convenient -- your reimbursements will be sent directly to your designated banking account.
- NOTE: Direct deposit may take up to 30 days to activate, which means your first reimbursement after enrolling in direct deposit may be mailed in the form of a check.
- Physical Check:
- If you do not enroll in direct deposit, you will receive a mailed physical check to the address we have on file.
- Direct Deposit:
You request reimbursement from your subsidy account
You request reimbursement from your subsidy account with supporting documentation.
For eligible premium expenses, you may have the option of Automatic Premium Reimbursement, depending on your insurance carrier and always have the option of Recurring Premium Reimbursement.
Below are more details on the reimbursement types and supporting documentation required for each option:
AUTOMATIC PREMIUM REIMBURSEMENT
When to use: You have this option for your medical and/or prescription drug premium reimbursement if:
- You have enrolled in a qualifying plan through Mercer Marketplace 365+ Retiree.
- Your carrier allows for Automatic Premium Reimbursement; see the list of participating carriers and plans on the online portal or contact Mercer Marketplace 365+ Retiree via phone to inquire.
How it works: You must opt-in to Automatic Premium Reimbursement by phone with the help of a benefits counselor
Mercer Marketplace 365+ Retiree receives confirmation from your carrier that you have paid your premiums
After this confirmation, you are automatically issued a reimbursement for your paid premiums on the next available payment date
Your opt-in election applies for as long as you remain enrolled in your eligible plan, even if your rate changes
There is no need to file a reimbursement claim unless you dis-enroll from the eligible plan either voluntarily or involuntarily, OR the carrier no longer allows for Automatic Premium Reimbursement
How to opt-in: You may establish your Automatic Premium Reimbursement Election by phone with the help of a benefits counselor. Once you have opted in, there are no forms to complete. If you later choose to opt-out of this reimbursement type for any reason, you must do so over the phone through a benefits counselor.
When to expect reimbursements: Reimbursement timing may vary and depends on when you pay your premium and when your carrier reports that information to Mercer. Your first reimbursement may take 6 to 8 weeks to arrive but that time frame is not guaranteed. The timing generally becomes more regular after your first reimbursement. The reimbursement that you are eligible to receive is based on your available account balance at that time.
Keep in mind: This option does not provide the fastest method of reimbursement, but it provides the convenience of being automatically reimbursed without submitting any documentation and continues as long as you remain enrolled in your plan with no required action on your part.
Automatic Premium Reimbursement is available only for certain carriers and plans.
If you have elected to have your premium deducted from your Social Security check, Automatic Premium Reimbursement is not advisable.
If you have selected Automatic Premium Reimbursement as your reimbursement type, please DO NOT send in a request for a different type of reimbursement for the same claim -- this may cause additional delays. You must first opt-out on the phone with a benefits counselor before selecting a different reimbursement type.
RECURRING PREMIUM REIMBURSEMENT
When to use: This option is available for any eligible premium expense.
You should only choose this option for your premium reimbursement if you have NOT established an Automatic Premium Reimbursement claim for the premium expense.
How it works: You submit a Recurring Premium Reimbursement Claim Form request along with supporting documentation
Once your premium request is approved, you will receive recurring, monthly premium reimbursements for the calendar year
You will only submit one request for each calendar year, however, if your premium rate changes during the calendar year, you must submit a new request with new supporting documentation
If you cease making premium payments during the year, you must contact Mercer Marketplace 365+ Retiree to end the Recurring Premium Reimbursement
Submitting a claim: You may submit a Recurring Premium Reimbursement claim by using your subsidy portal or the paper form included in your Reimbursement Instructional Guide or you can download a copy under the "Forms" section of this website
Documentation required: All Recurring Premium Reimbursement claims require third-party documentation showing proof of expense and coverage, and must include the following information:
- Covered participant's name
- Premium type
- Proof of coverage, typically in the form of a letter you receive from your insurance carrier, that includes carrier name, policy effective date and monthly premium amount -- refer to the "Resource Center" tile on the online subsidy portal for tips and examples to ensure you provide the right documentation the first time to avoid any delays in reimbursement
- If Medicare Part B premiums are eligible for reimbursement and deducted from your Social Security check, you may use the Social Security Benefit Award Letter issued by the Social Security Administration (SSA) each year, typically mailed during the month of October or November, as your third-party documentation.
When to expect reimbursements: Reimbursement occurs once per month. More detail about expected reimbursement dates can be found online in your subsidy portal under the "Plan Information" tile. The reimbursement that you are eligible to receive is based on your available account balance at that time.
Keep in mind: Claim forms and all required documentation must be submitted each calendar year. You may submit your request at any time during the year; payments will commence after your documentation is processed. Recurring Premium Reimbursements are distributed according to the schedule posted in your subsidy portal. Please note that during the beginning of each calendar year, you should expect a slight delay in payments due to high claim volumes.
When to use: This option is available for any eligible expense..
While available for reimbursement of premiums, Automatic or Recurring Premium reimbursement is suggested for premiums.
How it works: You submit a One-Time Reimbursement Claim Form (with supporting documentation) for your eligible expense
Once your request is approved, you will receive one-time reimbursement of the expense on the next available payment date
You will submit a new request (with supporting documentation) each time you have an eligible expense that you would like reimbursed
Submitting a claim: You may submit a One-Time Reimbursement claim by using your subsidy portal or the paper form included in your Reimbursement Instructional Guide or you can download a copy under the "Forms" section of this website
Documentation required: All One-Time Reimbursement claims require third-party documentation showing the information outlined below:
- Covered participant's name
- Expense type (premium or out-of-pocket expense)
- Date of premium or service
- Proof of incurred expense which may include:
- Proof of coverage (for premium expenses)
- An invoice from a provider that reflects any payment made during the visit
- A prescription drug receipt from your retail or mail-order pharmacy that includes the pharmacy name, address, date of prescription, prescription number and the covered participant's name
- An Explanation of Benefits (EOB) that includes the participant's portion of the payment. Note this is required for any prescription drug copay or coinsurance expense.
- Refer to the "Resource Center" tile on the online subsidy portal for tips and examples to ensure you provide the right documentation the first time to avoid any delays in reimbursement.
When to expect reimbursements: One-Time Reimbursements are processed as soon as the request is received. Once your request is approved, you will receive a one-time reimbursement of the expense on the next available payment date. Please note that during the beginning of each calendar year, you should expect a slight delay in payments due to high claim volume.
Keep in mind: One-Time Reimbursement requests are submitted individually for each eligible expense.
Mercer reviews your claims and, if approved, reimburses you from your available subsidy account balance
Once your request has been received, Mercer Marketplace 365+ Retiree will review your legally required supporting documentation and determine if the claim is in good order.
If approved, you will receive payment by either direct deposit or a check in the mail, depending on how you elected to receive your reimbursements. Refer to your Reimbursement Instructional Guide for additional information.