Know Your Insurance Plan

Insurance benefits for clergy on Medical Leave will be calculated as if you had retired on the first of the month in which you turn age 65. Your coverage under the NC Conference Blue Cross Blue Shield medical plan will end on the last day of the prior month. In the 90-day period prior to the month this change takes effect, you will need to coordinate with your Social Security office to set up your Medicare Parts A & B benefits effective the first of the month in which you turn age 65. You will also work with Via Benefits in this 90-day period to establish your Health Reimbursement Account (HRA) funding from the Conference which will help offset your continued out-of-pocket health care expenses. This change in primary insurance coverage will not impact your conference relationship nor your appointment to Medical Leave. You will receive correspondence from the Conference Benefits Team in advance of this change which will provide your specific details and next action steps.

Your post-retirement health plan funding has been determined using years of NC pension credit accrued through June 30, 2009 plus the number of months of active enrollment in the Conference insurance plan between July 1, 2009 and your retirement date. Retirees must have a minimum of 180 months of combined credit over the course of their career to receive the minimum funding in retirement. Refer to the Board of Pension report in the Conference Journal for more details.
Upon attaining age 65, Medicare will become your primary insurance carrier and the NC Conference will begin funding your Health Reimbursement Account (HRA) administered through Via Benefits. This account is used to aid in the purchase of individual plans or Medicare supplemental plans on the open market and to offset your out-of-pocket health care expenses. You may consult a Via Benefits advisor for assistance in choosing a plan. Within 90 days prior to the first of the month in which you turn age 65, you must contact Medicare to sign up for Parts A & B. Also during this time participants and their eligible spouses must both contact Via Benefits at 855-801-9759 to activate both of their HRAs in a timely manner.

The NC Board of Pension established a Health Reimbursement Account arrangement effective January 1, 2014, for eligible participants. Each plan year (which is January – December), funding is provided based on the retiree’s specific retirement criteria. This funding is to be used to reimburse participants for eligible medical expenses with no tax implication to the participant. Via Benefits is the vendor chosen by the Conference to administer your HRA. This is a reimbursement account. You must provide proof that you have paid the eligible expense in order to be reimbursed.

Visit the Retiree Health page for current funding amounts.

How Do I Get My Money?

• Premium reimbursements can be handled by:
  • Completing and submitting a paper claim form each month, or
  • Your insurance company may be willing to submit an electronic payment file on your behalf
• Out of Pocket Expenses may be filed using a paper claim form or through your online account at my.viabenefits.com/nccumc
• You can receive your HRA reimbursements by check or direct bank deposit

What Do I Need To File A Claim?

• If you are filing a claim for premium reimbursement, you must provide documentation (such as your monthly payment invoice) from your insurance carrier that provides:
  • The covered participant’s name. The document must show each covered person’s name
  • The name of the insurance carrier
  • The date range of the coverage (effective date, end date)
  • A description of the type of coverage
  • The premium amount you paid for each person
• If you are filing a claim for out of pocket expenses, you must provide documentation that shows:
  • The name of the patient
  • The name of the doctor or medical facility
  • The date of service
  • The type of service
  • The amount you paid
• Helpful documents to include with your out of pocket expense claim:
  • The discharge document that is provided to you at the time you leave the doctor’s office. If you are not offered a copy at the time that you check out, simply ask for a copy.
  • The Explanation of Benefits that Medicare or your insurance carrier provides showing the amount that was not covered by insurance
  • Proof of payment such as a canceled check, credit card receipt, or receipt from the provider stating the amount that you paid for your service
  • Documents that indicate that insurance is pending are not acceptable

What Other Helpful Tips Do You Recommend?

• Sign and date all claim forms.
• Keep a copy of everything you submit.
• Submit legible copies of your receipts (retain the originals for your records).

What Is An HRA Eligible Reimbursable Expense?

• Premiums paid for medical insurance plans such as:
  • Medicare Supplement, Medigap, Medicare Advantage, Medicare D pharmacy plans
  • Medicare Part B (this is withheld from your Social Security each month)
  • Vision plans or Dental plans
• Out of Pocket expenses such as:
  • Doctor’s office visit co-pays
  • Deductibles
  • Eyeglasses or contacts
• IRS qualified expenses (see IRS Publication 502 for more details) such as, but not limited to:
  • Abdominal supports • Acupuncture • Air conditioner (when necessary for relief from difficulty in breathing) • Alcoholism treatment • Ambulance • Anesthetist • Arch supports • Artificial limbs • Autoette (when used for relief of sickness/disability) • Birth Control Pills (by prescription) • Blood tests • Blood transfusions • Braces • Cardiographs • Chiropractor • Christian Science Practitioner • Contact Lenses • Contraceptive devices (by prescription) • Convalescent home (for medical treatment only) • Crutches • Dental Treatment • Dental X-rays • Dentures • Dermatologist • Diagnostic fees • Diathermy • Drug addiction therapy • Drugs (prescription) • Elastic hosiery (prescription) • Eyeglasses • Fees paid to health institute prescribed by a doctor • FICA and FUTA tax paid for medical care service • Fluoridation unit • Guide dog • Gum treatment • Gynecologist • Healing services • Hearing aids and batteries • Hospital bills • Hydrotherapy • Insulin treatment • Lab tests • Lead paint removal • Legal fees • Lodging (away from home for outpatient care) • Metabolism tests • Neurologist • Nursing (including board and meals) • Obstetrician • Operating room costs • Ophthalmologist • Optician • Optometrist • Oral surgery • Organ transplant (including donor’s expenses) • Orthopedic shoes • Orthopedist • Osteopath • Oxygen and oxygen equipment • Pediatrician • Physician • Physiotherapist • Podiatrist • Postnatal treatments • Practical nurse for medical services • Prenatal care • Prescription medicines • Psychiatrist • Psychoanalyst • Psychologist • Psychotherapy • Radium Therapy • Registered nurse • Special school costs for the handicapped • Spinal fluid test • Splints • Sterilization • Surgeon • Telephone or TV equipment to assist the hard-of-hearing • Therapy equipment • Transportation expenses (relative to health care) • Ultra-violet ray treatment • Vaccines • Vasectomy • Vitamins (if prescribed) • Wheelchair • X-rays

Who Can I Call For More Help?

• Via Benefits Customer Support: 855-801-9759 or my.viabenefits.com/nccumc
• NC Conference Benefits Team: 800-849-4433 or benefitsteam@nccumc.org

Learn more about The Shepherd’s Fund, a benevolent grant to assist retirees and their spouses as well as medical leave members and their spouses. There is a broad list of qualifiying expenses such as medical, dental, hearing aids, funeral expenses and more!

The NC Conference offers a wellness program to support retired clergy and their spouses in making their personal wellness a priority. The programs described on our Wellness webpage are offered as resources on your journey towards healthy living.