How Does the Reimbursement Process Work in Take Command?
Take Command provides a streamlined platform for managing Individual Coverage Health Reimbursement Arrangements (ICHRA). While Take Command does not directly handle reimbursements, it facilitates the process by tracking expenses, verifying eligibility, and generating reports for employers. Below is a detailed explanation of how the reimbursement process works for both employers and employees.
Overview of Reimbursement Operations
Take Command's Role: Take Command tracks submitted expenses, verifies their eligibility, and maintains notional ledgers for each employee. It generates monthly reimbursement reports that guide employers on how much to reimburse their employees. Most employers process claims through their payroll or checking accounts.
Employer's Role: Employers are responsible for reimbursing employees directly, using the reports provided by Take Command. Payment methods can include payroll, checks, or electronic transfers.
Employer Responsibilities
Reimbursement Reports: Employers receive monthly reports detailing the reimbursement amounts for each employee. These reports are available in the Admin Portal and can be downloaded as .csv or .pdf files.
Payment Methods: Employers can choose to reimburse employees through payroll systems, checks, or other methods.
Timing: Reimbursements are typically processed monthly, based on the reporting schedule chosen by the employer. For example, reports may be generated on the first day of each month.
Employee Responsibilities
Submitting Proof of Coverage: Employees must submit proof of their insurance premiums or eligible expenses to qualify for reimbursements. Proof of Coverage (POC) documentation must include:
The employee's name (or their status as a covered dependent if not the primary insured).
The premium amount (if claiming reimbursement for premiums).
A current date (documents dated within the last 3 days are considered current).
A statement of backdated coverage (if claiming premiums from past months).
The name of the plan and provider (e.g., "Gold/Silver/Bronze 1234" with the insurance company's logo). A monthly bill or an Elections of Benefits document is often sufficient.
Recurring Expenses: Once proof of coverage is approved, employees can set up recurring expenses in the platform to automate monthly reimbursements. Employees must complete onboarding in the Take Command portal by selecting a health plan and uploading proof of coverage to set up recurring premium claims.- Non-Qualifying Plans: Memberships with local doctors are generally not recognized as qualifying health plans. Employees must select a qualifying plan and upload proof of coverage, including details like the premium amount, plan name, and insurance company logo.
Plan Eligibility: To qualify for ICHRA reimbursements, employees must select a health plan that meets eligibility criteria. For example, plans like the Silver 203 with Ambetter are eligible.
Reimbursement Timing and Processes
Approval and Reporting: If required documents are approved before the next reimbursement report is generated, employees will receive their reimbursement at the end of the current month.
Backdated Reimbursements: For delays in document approval, backdated reimbursements aggregate multiple months’ allowances into one payout.
Outstanding Amounts: Any portion of claims exceeding the employee’s allowance is marked as "outstanding" and is not reimbursed within that period.
Handling Employee Status Changes
Full-Month Reimbursement: Terminated employees are eligible for the full month's reimbursement if they worked at least one day during that month. For example, if an employee is terminated on October 1, they are still eligible for the October reimbursement.
Severance Periods: If benefits are extended through a severance agreement, reimbursements should cover premiums or expenses incurred during the severance period. If no severance benefits are provided, reimbursements are limited to the months when the employee was actively employed.
Portal Access: Terminated employees retain access to their Take Command portal for a defined period post-termination to submit eligible claims:
9-Day Access: Employees can submit claims for expenses incurred while employed during the first 9 days post-termination.
90-Day Access: Employees may appear on reimbursement reports for up to 90 days post-termination, during which they can submit claims for eligible expenses. After this period, their account moves to the "former" section, and access ends.
Reimbursement Reports: Terminated employees will appear in reimbursement reports for the month of their termination and during their post-termination access period. This ensures that any eligible claims submitted during this time are processed.
Late Termination Updates: If a termination is updated late, the employee may appear on the reimbursement report for the month following the updated termination date.
Reactivating Suspended Employees: If an employee appears as "suspended" or "former" in the system, reactivate them from the respective section rather than adding them as a new employee.
Common Issues and Resolutions
Incorrect Reimbursement Amounts: If an employee’s reimbursement shows as $1, it may be due to an incorrect class assignment. Admins can update the employee’s class in the Admin Portal to resolve this.
Zero Reimbursements: A zero in the reimbursement report may indicate incomplete onboarding or missing documentation. Admins can review the report details to identify the issue. Employees who have not completed onboarding will not be included in the system for reimbursement tracking.
Processing Status: The status "Processing / Sending to Employer" means the reimbursement has been approved and sent to the employer for payment. No further action is required in the portal.- Verifying Reimbursement Eligibility for Terminated Employees: To confirm whether a terminated employee had approved coverage and a scheduled reimbursement for a given month:
Check the employee’s Take Command account history for Proof of Coverage (POC) status.
If POC is denied or not approved, no reimbursement will be scheduled for that month.
FAQs on Specific Scenarios
What does "reimbursement amount" mean?: It is the total dollar value your employer can reimburse for eligible expenses under your HRA plan.
How does the self-enroll model work?: Employees pay their premiums directly to the carrier, and employers reimburse the eligible amount based on monthly reports.
What does "outstanding reimbursements" mean?: It reflects approved claims exceeding the employee’s allowance, which are not reimbursed within the allowance period.
By understanding these processes and responsibilities, both employers and employees can effectively manage their reimbursement operations through Take Command.