What Will Happen To Submitted Claims Exceeding The Existing Balance of The Member’s Account?
Similar to a banking concept, maximum withdrawal/reimbursement that can be made is equivalent to the Account’s Available Balance (net of applicable taxes and fees). Any outstanding balances can be paid as soon as the employer remits its periodic contribution.
Who Are Eligible to be considered As Dependents of the Employee?
A dependent can be the employee’s spouse or any member of the employee’s household with whom the employee is connected by blood relationship, marriage or adoption who is financially dependent on the employee.
Will the contribution for succeeding year vary?
Deposits on Health Spending Account are based on the Member’s employment agreement with his employer. Previous health-related expenditures may be carefully evaluated to come up with cost-effective decision on how much funds should be made available for each employee.
How Long is the Processing For Each Submitted Claim?
All drug and dental claims will be processed and paid within 48 hours. Members will be notified within 24 hours for any claims that did not pass the adjudication process due, but not limited, to the absence of original receipt, ineligibility of the medical/dental service or lack of supporting documents.
Can contributions and expenses be monitored on-line?
Yes, Esorse developed a secured portal (www.esorse.com) where a User Id and password will be issued for the employer and all Cardholders.
Is there a facility to submit claims electronically?
To provide more convenience, members can now submit their claims through the internet where the system adjudicates in real-time, allowing the members to instantaneously determine their eligible treatments and
allowable expenses.
Are invoices and receipts prerequisites for electronically-submitted claims?
For audit purposes, Members are required to keep all original invoices for a period of seven (7) years. Note, however, that these invoices are not prerequisites for payment processing. However, at member’s sole discretion, these documents may be sent to ESORSE Corporation for safekeeping.
Will providers be allowed to submit claims, on behalf of the members?
Members may authorize their preferred Providers to directly submit claims to ESORSE Corporation through www.esorse.com. Participating Providers will be given User IDs and passwords. To add a level of security , claims submitted by the Provider are routed to the members for payment approval. However, the system also offers the flexibility for pre-approved claims. In such case, the member may create a special authorization that will allow the Providers to receive payments for adjudicated claims without going through the routing system. Such authorization will define how much, how long and how many times can a Provider submit pre-approved claims.
Does it pay for drugs and services that are not being paid for by insurance companies?
Unlike traditional insurance companies, it does not restrict the members from paying for specific services or drugs. As long as the medical expense is included in the list provided by Income Tax Act 519R2 (Medical Expense and Disability Tax Credits) and there are enough funds, it can be reimbursed using Health Spending Account. All over-the-counter drugs prescribed by a licensed medical practitioner and dispensed by a Pharmacist are qualified for reimbursement.
Does the unspent HSA funds Incur Interest?
Yes, the unspent HSA funds incur interests and these are considered taxable benefits.
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