Understanding and Resolving Missing or Incorrect Reimbursement Amounts
Reimbursement operations can sometimes lead to confusion when amounts are missing or incorrect. This guide explains common reasons for such issues and provides actionable steps to resolve them.
Overview of Reimbursement Operations
Reimbursements are tied to the start date of an employee’s health plan. Until the plan becomes active, no reimbursement amounts will appear in the system. For example, if a plan starts in October, reimbursements for September will show as $0. Similarly, updated allowances or changes in reimbursement-eligible expenses will only reflect in reports after the new period begins or the changes are processed.
Common Issues and Resolutions
1. Missing Reimbursement Amounts
Plan Start Date: If the plan has a future start date, reimbursements cannot be processed until the effective date. Once active, approved claims will flow through the monthly report.
Pending Documentation: If proof of coverage is uploaded but still under review, reimbursements will not display until the documentation is approved. Once verified, reimbursements will apply retroactively to the coverage start date.
Reporting Errors: Occasionally, reimbursement amounts may be missing due to reporting errors. In such cases, the report should be reviewed and regenerated.- Active but Unenrolled/Shopping Expired Status: This status occurs when the platform’s data does not fully reflect an employee’s enrollment or eligibility details. Missing or outdated elements, such as enrollment status, proof-of-coverage approvals, or year-to-date adjustments, can lead to this discrepancy.
No Reimbursements Despite Compliance: Employees marked as compliant but not receiving reimbursements often have not submitted their premium amounts. Without a recurring premium setup, reimbursements cannot process.
2. Incorrect Reimbursement Amounts
Premium Tax Credits: Employees claiming premium tax credits on marketplace plans are ineligible for ICHRA reimbursements. To resolve this, the employee must remove the tax credits and submit updated proof of premium.
Incorrect Submission: If an employee submits a reimbursement request with $0 or an incorrect amount, they must resubmit with accurate documentation showing the premium amount.
3. Employees Missing from Reports
Lack of Documentation: Employees without current-year insurance documentation will be excluded from reports. Documentation must confirm the plan is active, paid, and include the start date.
Timing of Reports: Reimbursement reports are typically generated at the end of each month. For example, an August report will only be available at the end of August.- Employees Appearing Despite Non-Payment: Employees who fail to notify Take Command of coverage changes may continue to appear on reports. The system reflects the latest information provided, so timely updates are crucial.
Employer and Payroll Responsibilities
Employers play a crucial role in ensuring reimbursements are processed correctly. They must:
Verify that employees are active and enrolled for the current plan year with a monthly allowance set up.
Use employer/admin portals to pull reimbursement details and add them as tax-appropriate line items in payroll.3. Verify that proof of coverage is current (dated within the last 30 days), active, paid, and includes the start date.
Encourage employees to set up recurring premium submissions for the year.
Communicate coverage changes promptly to the platform, including terminations, and upload updated proof of coverage.
Review reimbursement reports regularly to identify discrepancies and address them proactively.
Guidelines for Accurate Report Generation
Ensure all employee data, including proof of coverage and premium submissions, is up-to-date.
Encourage employees to maintain accurate records and promptly address any system notifications regarding missing or outdated information.
Use the platform’s tools to verify compliance and eligibility details before generating reports.
Why does an employee show $0 reimbursements on a report? This often occurs if the plan start date is after the report month (e.g., February 1 for a January report) or if documentation is pending approval.
When will updated allowances be visible? Updated allowances apply with the new period and will reflect in reports once the previous period’s reimbursements are processed.
What if an employee stops appearing on reports? Ensure they have uploaded proof of coverage for the current plan year.
By understanding these common issues and their resolutions, employees and employers can ensure smoother reimbursement operations.