A Medical Reimbursement Plan is a fully insured reimbursement plan that allows an employer to reimburse key employees for most medical, vision, hearing and dental expenses not otherwise covered by their existing benefit plan.
BeniComp Select allows employers to reimburse their key employees for most medical expenses not otherwise covered by their base health insurance plan. Rather than reward all employees at a company, the employer is able to reward individual employees or groups of employees by class. For example, an employer could create three classes:
These "classes" are created by the employer.
An employer pays a $250 annual premium for each of the executive participants. When a participant has eligible reimbursable expenses, they are submitted to BeniComp Select for reimbursement. The approved claim + 11% is paid by the employer, and BeniComp Select reimburses the key executive directly if they have signed up for direct deposit.
No. The underlying plan can be an employer group plan, individual policy, spousal policy or Medicare.
The employer selects the desired benefit level for each of the classes designated to the participating employees from the plan maximum schedule.
Plan Maximums: $10,000, $15,000, $20,000, $25,000, $35,000, $50,000, $75,000, $100,000, $200,000
Accidental Death Benefit: Included with each BeniComp Select policy equal to the plan maximum up to $100,000
The policy covers the participant and any qualified dependents, and is based on specific state mandates.
Some plans have an expanded definition for dependents between ages 19-26. How does a BeniComp Select policy manage these dependents?
BeniComp Select follows the primary plan. If the primary plan allows for dependents up to the age of 26, then so does the BeniComp Select policy.
*The following individuals are ineligible to participate in a Cafeteria Plan, including a Premium Only Plan (POP) or any of its qualified benefits, which include FSAs and HRAs:
No, this policy can be placed on as few or as many employees, based on class, as the company chooses. Further, the company has the option of choosing different benefit levels on different classes of employees. Classes are determined by the company. If a policy is being offered to a class, everyone eligible for the designated class must be offered the plan.
A BeniComp Select policy does not have an age limit or a waiting period.
Concerning the use of a Health Savings Account (HSA) on a high deductible primary health plan (HDHP) that also has BeniComp Select supplementing the HDHP, it is our belief that you should seek the advice of your HSA advisor or tax adviser on the tax implications to also use an HSA when BeniComp Select supplements the primary plan. BeniComp’s underwriting only considers the primary plan to determine the eligibility for BeniComp Select to be an eligible supplement to the base medical plan. BeniComp makes no representations about other ancillary products or services not under our control.
A BeniComp Select policy reimburses eligible medical expenses not otherwise covered by health insurance.
Generally, if an expense is medically necessary and qualifies under Section 213(d) of the Internal Revenue Code, it would be eligible for reimbursement under this insurance plan. Some covered charges include, but are not limited to:
No benefits are payable unless the individual is under the direct care of a legally qualified physician for reasonable and necessary treatment.
Any premiums including, but not limited to Base Plan (or Cobra Continuation of the Base Plan), Medicare Part B, Medicare Part D, Prescription Drug Plans
Losses due to war
Expenses the individual is not legally obligated to pay in the absence of insurance
Charges for appointments not kept
Hospitalization, services, treatments or supplies furnished by the U.S. or foreign government agency, unless otherwise prohibited by law
Service contracts or warranties relating to vision care
Accident or illness for which the individual is entitled to benefits under any worker’s compensation or occupational disease law
Health club dues or exercise equipment
Hospital charges for confinement in a long-term care unit or skilled nursing facility unless confinement commences within 14 days after discharge from a qualifying hospital confinement
Baby sitting, childcare, and/or nursing services for a healthy child. You cannot include any amount paid for childcare even if this enables you, your spouse, and/or dependent(s) to receive medical treatment.
Must the underlying plan include vision, dental and hearing for BeniComp Select to cover the charges?
No. If vision, dental, and hearing are not covered by the underlying plan; BeniComp Select will reimburse the charges.
Master Social Workers and Family Counselors are excluded under some medical plans (currently they only allow Psychologists or Psychiatrists). Will these be covered under BeniComp Select?
Yes, master social services and psychologists are covered by BeniComp Select, even if the services are not covered by the underlying plan.
Generally, if an expense is medically necessary and qualifies under Section 213 (d) of the Internal Revenue Code, it is eligible for reimbursement. Elective procedures that are not medically necessary are not covered by BeniComp Select.
You cannot include membership dues in a gym, health club, or spa as medical expenses, but you can include separate fees charged there for weight loss activities.
You cannot include the cost of diet food or beverages in medical expenses because the diet food and beverages substitute for what is normally consumed to satisfy nutritional needs. You can include the cost of special food in medical expenses only if:
The amount eligible for reimbursement is limited to the amount by which the cost of the special food exceeds the cost of a normal diet.
Due to recent IRS regulations, BeniComp Select will no longer reimburse any premiums effective January 1, 2016 including, but not limited to:
For more information and to view the revised policy form, please click here.
Interested in BeniComp Select Executive Medical Reimbursement but have questions about the application process?
Classes of eligible employees are different "levels" you have designated for the company. For example, you might create levels for:
Class 4: President
Based on the levels you designate, you assign a certain number of employees to each class.
Please refer to the chart below. Based on the number of participants you have on the total plan, you can assign the number of participants to classes with corresponding plan maximums. For example, if you have 15 employees on BeniComp Select, you might have:
Class 4: 1 President with a plan maximum of $25,000
On the application it says "Amount of premium submitted." How do I know the premium amount that needs to be submitted with the application?
The application premium is the total number of participants multiplied by $250. For example, if you have 10 participants on BeniComp Select, then the premium check submitted with the application should be $2,500.
Do you support Apple products? I'm trying to apply with my iPhone and Macbook Air using the Safari browser.
Yes, we support Apple products. By default, the Safari browser blocks pop-up windows. See below:
When you are on your iPhone, the safari browser defaults to no pop-ups.
Supporting documentation must be included with any expense submitted for reimbursement. The Explanation of Benefits (EOB) supplied by the primary plan needs to be included with every medical claim to show the services provided went through the primary plan first. If the service provided is explicitly not covered by the primary plan, please submit the Summary Plan Description explaining the service is not covered.
Further examples of supporting documentation include, but are not limited to:
All supporting documentation, including photocopies, must be legible and include the patient's name, date and type of service, and the dollar amount.
Claims cannot be processed from:
Yes. Claims can be printed when reviewing your claim by using the "Print" function in your browser.
The group name is the name of the employer submitted on the application. If you do not know your group name, please click here.
The group number is the number assigned to your group and can be found on the first page of your Certificate. If you do not know your group number, please click here.
You can submit up to 10 claim items on each claim form.
No, you do not need to upload each claim item's supporting documentation separately. You can upload all of the supporting documentation one time under Supporting Documentation Upload.
Accepted file types include pdf, png, jpg, gif. bmp, and tiff. We do not accept xls, xlsx, csv, txt, zip, or doc. Please simplify the file name of your supporting documentation and exclude special characters.
Submitting claims is based off your policy year. You have 90 days past your renewal to submit claims for the previous policy year. See below for how this affects your group:
BeniComp Select can send your reimbursement by direct deposit if you have submitted an EFT form. EFT forms can be filled out by clicking here.
Yes, when you submit your claims online they go directly into BeniComp's system for processing. This results in fewer handwritten processing errors and much faster reimbursement.
I received an email saying my Explanation of Benefits can now be viewed online; what does this mean?
When you sign up for Direct Deposit you are also enrolled in eBeniComp, which you can access by going to www.eBeniComp.com to view your Explanation of Benefits (EOBs) online. The Explanation of Benefits provides details for what claims have been processed; including both approved and denied claims. Your entire claims history is stored in eBeniComp in the form of EOBs and can be accessed at any time.
For log in information, please refer to the confirmation email you received when your Direct Deposit was initially set up. If you do not have Direct Deposit and would like to enroll, please go to www.benicompselect.com/eft to sign up.
If you cannot find your confirmation email, please call our customer service line at 866-797-3343 for assistance.
Will BeniComp Select accept and process claims for medical services rendered outside of the United States?
Yes, as long as your group is domiciled in the United States and offers a group health plan, a participant can incur a claim outside of the United States' borders. In order to process these claims, the participant is responsible for translating the supporting documentation to English and converting the funds to American Dollars.