Health Care
Paying for Health Care Services and Filing Claims
Submitting Claims for Expenses
Medical (including Preventive Care, Mental Health and Substance Abuse, Out-of-Network Retail Pharmacies), Vision Exams and Dental
For the most part, your provider will submit your claims for you. However, in those situations where you must submit a claim
(for example, if you use an out-of-network provider), here’s a quick rundown on what to do:
-
Complete and sign the claim form, if needed. Your provider may need to
complete part of the form for you.
-
Include documentation with the claim form such as itemized bills and/or receipts. If no claim form is required, simply submit
receipts with your Kraft account number, employee name, Social Security number and patient name.
-
After making copies, mail all materials to your Network for medical and dental, or Caremark for prescription drug claims.
-
Claims must be submitted within one year of the date of service. However, if accompanied by an explanation satisfactory to the claims administrator, claims submitted later than one year after the date of service are paid.
If you participate in the Account Plan, you can use your HRA to pay for your deductible and your co-insurance.
In most cases these medical expenses, including mental health and substance abuse, are automatically submitted.
You can also use your HRA to pay your prescription drug costs. These expenses are not automatically submitted to your HRA; you need to submit receipts to receive prescription drug reimbursement from your HRA.
Unreimbursed dental and vision expenses are not eligible for reimbursement through the HRA.
Vision Materials (Glasses and Contact Lenses) and Laser Surgery Discounts
To receive the discount on lenses, frames and laser surgery through Aetna Vision Discounts (formerly Vision One), you must visit a participating provider and present your Aetna medical or dental ID card at the time of purchase. No discounts are available for out-of-network vision materials or laser surgery.
For Local Network Options/HMOs; contact your plan for details.
Health Care FSA
Most eligible medical, mental health and substance abuse, and dental expenses processed by Aetna — including prescription drugs from all Network retail pharmacies and mail-order service — will be automatically reimbursed.
You only have to submit Health Care FSA claims for over-the-counter medications, vision materials (glasses, frames and contact lenses) and laser surgery expenses. You have until June 30 of the following calendar year to file claims for reimbursement of Health Care FSA expenses. For 2009, any unused contributions will be forfeited if not submitted for reimbursement by June 30, 2010.
You can submit your Health Care FSA Claim Form or Over-the Counter Medications Reimbursement Form to Aetna:
If you’re enrolled in the Account Plan and contribute to the Health Care FSA, you must use all the money in your Health Reimbursement Account (HRA) first to cover any Medical Plan deductibles and co-insurance amounts before you can use your Health Care FSA. The exception is prescription drug expenses.
-
Health Care FSA is used first for prescription drug expenses: You are automatically reimbursed for your prescription drug expenses through your Health Care FSA until you use up your entire balance in this account. After your Health Care FSA dollars are used up, you can submit prescription drug expenses through your HRA.
OR
-
You can request to use your HRA first for prescription drug expenses: If you want prescription drug expenses reimbursed through your HRA first, you must opt out of the Aetna FSA automatic claim filing (streamline cancellation). After your HRA dollars are used up, you can start submitting prescription drug expenses to your Health Care FSA.
IMPORTANT: If you opt out of automatic FSA claim filing, that election applies to all health claims: medical, dental and prescription drugs.
Dependent Day Care FSA
You have until June 30 of the following calendar year to file claims for reimbursement of Dependent Day Care FSA
expenses. For 2009, any unused contributions will be forfeited if not submitted for reimbursement by June 30, 2010.
You can submit your Dependent Day Care FSA Claim Form to Aetna:
You can find more details on submitting claims and how to obtain claim forms in MyBenefits Online.
Protecting the Privacy of Patient Information
To comply with the Health Insurance Portability and Accountability Act (HIPAA), the medical vendors have
put measures in place to protect the privacy of patient information. As a result, access to most individualized medical claims
information (including prescription drug claims) will be password-protected for each covered individual age 18 or older.
Also consider …
If You Have Other Medical or Dental Coverage
Step 1: When You Receive a Service or Make a Purchase
Step 3: Reviewing Your Explanation of Benefits (EOB) Form