Retroactive reimbursements are allowed when coverage is backdated and properly documented, but payments and allowance changes only apply once proof of coverage is submitted and approved in HRA Hub.
Retroactive Reimbursements
Eligibility and Documentation Requirements
Retroactive reimbursements are generally available as long as the coverage and service dates align fully with the backdated effective coverage period. For example, if coverage starts in February, January is not eligible for reimbursement. Retroactive claims can only apply to months when the plan was active and the employee was eligible.
To qualify:
Confirm service dates on the claims match the active coverage period, particularly the backdated effective date.
Upload all required documents to the Take Command portal, including proof of coverage that supports your claim.- Submit the official online waiver form through Take Command to request retroactive billing adjustments. Only online submissions are accepted for proper recordkeeping.
Appealing Denied Claims
If claims are denied even after the approval of backdated coverage:
Contact the insurance provider directly using your member ID.
Request a review or reprocessing of the claims.
Be prepared to file an appeal if the situation warrants further action.
Exceptions and Reconciliation
In certain situations, particularly involving errors (e.g., incorrect default allowance amounts), retroactive reimbursements may involve recalculating the difference in allowances over prior months. These "catch-up" reimbursements are paid out over subsequent reimbursement cycles. For example, if proof of coverage is submitted and approved after a reimbursement report has already been generated, the system will automatically include any missed premiums in the next reimbursement report. Additionally, if a proof of coverage upload was initially declined in error, the corrected proof will be reviewed, and retroactive adjustments will be applied to reflect the accurate premium amounts for prior periods. Once a reimbursement statement has been processed, it cannot be retroactively restated. Adjustments will only apply to future statements after new configurations are implemented.For policy reinstatements with lump-sum payments, eligible months will be reimbursed once documentation is uploaded and approved. The timing of approval affects when the reimbursement appears on reports. Updating premium amounts in the system does not automatically change previously approved reimbursements.Claims must be approved before the monthly cutoff to appear in that month's reimbursement report. Late approvals roll into the next month's report. Corrected documentation must be submitted for review to adjust reimbursement records.Submitting proof of coverage (POC) by deadlines, such as March 31, allows retroactive reimbursement back to the plan start date, provided eligibility is confirmed. Reimbursement reports cannot be adjusted retroactively for mid-month coverage losses. Employers should reimburse only the correct amounts based on actual eligible coverage for the current month.If a premium was paid directly to the carrier, the employee should request a refund from the carrier. Employer funding should proceed as usual unless the refund resolves the duplicate payment.
For example, if a premium increase takes effect in June but is not reflected until July, the July reimbursement will include the retroactive amount for June. This ensures that employees receive the full reimbursement owed.Ensure that documentation showing the correct premium is provided to process retroactive reimbursement for premium increases. The difference will be included in a future reimbursement.
Proof-of-Coverage Compliance
Employees must submit valid proof of coverage to become compliant for reimbursement. Examples of acceptable documents include a monthly premium bill or elections/benefit statements. Employees who leave the organization can still submit claims for eligible expenses incurred during their employment. A 90-day window from the termination date is provided to submit outstanding claims and compliant proof of coverage. Claims submitted within this period will be processed as usual, provided they meet eligibility criteria.During this 90-day period, terminated employees appear in the 'suspended' section of the roster. Employers must enter the employee's last day of employment in the Take Command portal to ensure the reimbursement report reflects the correct end month. After 90 days, portal access is revoked, and no further claims can be submitted.Late terminations do not support retroactive changes. Any extra reimbursements due to late updates will be reflected in end-of-year documents.
Required Elements for Proof of Coverage
Ensure the submitted document includes:
The employee’s name (or their dependent’s name, as applicable).
Insurance plan name and provider/carrier (e.g., tier with the insurance company’s name/logo).
Recurring premium amount, if requesting premium reimbursement.
A current date (a document dated within the last 30 days is considered current).
A statement of backdated coverage if retroactive reimbursement is being requested.- The premium amount must reflect the monthly premium (not bi-weekly) to ensure compliance.- Submit a statement or bill from the month the premium change took effect to validate retroactive adjustments.- Provide proof of active coverage for the dates in question and update the recurring premium claim in the Member Portal with the attached document.
An insurance member ID card alone is insufficient for reimbursement approval. Proof must be tied to the specific month's payment or coverage period, such as a receipt or invoice showing the relevant dates.
Common Reasons for Denial and Solutions
Claims may be denied for reasons such as missing carrier names. In these cases:
Missing or incomplete proof of coverage, such as a missing plan name or recurring premium amount, can also result in denial. Ensure all required details are included to avoid processing delays.
Resubmit the document with the correct information and all required elements.
If prior submissions are incomplete, address the specific reason cited in the denial before resubmitting.
Allowance Adjustments
Allowance adjustments often accompany life events like adding a dependent or changing premium tiers.
Note: Allowances cannot be used for upfront binder payments during enrollment. These payments must be made out-of-pocket, and the allowance applies only to subsequent monthly reimbursements.
Understanding Prospective and Retroactive Adjustments
If your monthly premium exceeds your employer’s allowance, only the maximum allowance amount will be reimbursed. Any excess must be paid out-of-pocket.
Allowance adjustments apply prospectively in most cases, meaning updated amounts are calculated starting from the approval date of your changes. However, certain scenarios, such as adding dependents or correcting errors in proof of coverage, may allow for retroactive adjustments to ensure employees receive the full eligible amount for past months.For example, if a spouse is added later, retroactive reimbursement at the family rate is possible once compliant documents are submitted and approved. The system will calculate and reimburse eligible prior months.
Compliance and Tax Corrections
If a claim was mistakenly marked as pre-tax and taxes were withheld, retroactive adjustments can be made. This includes updating reimbursement history, removing ineligible claims, and adjusting year-to-date reimbursements or credits. Over-collected amounts can be refunded or offset against future reimbursements.
Life Event Examples: Adding Dependents
To add a newly-born dependent and request retroactive family rate adjustments:
Update your coverage tier (e.g., from "couple" to "family"), effective from the child’s birth date.
Upload proof of the life event (e.g., birth certificate) and updated insurance documentation reflecting the new premium.
Submit a formal request for retroactive reimbursement if adjustments are not processed automatically.The system is designed to handle such adjustments automatically, ensuring that retroactive family rate changes are applied without requiring manual intervention whenever possible.If a spouse is added later, retroactive reimbursement at the family rate is possible once compliant documents are submitted and approved. This ensures eligible prior months are reimbursed accurately.
By understanding the guidelines for retroactive reimbursements, compliance with proof-of-coverage, and allowance adjustments, you can prevent issues and ensure smooth processing of reimbursements.
How can I confirm my reimbursement?Why didn’t my reimbursement appear on the report?What happens if an employee’s last day is in July?
You can confirm your reimbursement by checking the latest reimbursement report in the employer portal. This report lists all approved reimbursements for the period, including combined totals for Medicare Part B and supplemental policies.If a claim is approved after the cutoff, it will appear in the next month’s report.If the employee is not active in August, they are not eligible for August reimbursement. Ensure they are marked as terminated in the portal.
What happens if my reimbursement exceeds my monthly premium?
Reimbursements can exceed a single month’s premium due to accrued allowances or rollovers. Any excess reimbursement is credited toward future premiums, ensuring no funds are lost.