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Autopay Option

Not all employers offer this benefit. Please check with your employer to find out if you are eligible for AutoPay.

Autopay is an option for you to be automatically reimbursed for eligible medical and dental expenses processed by ODS Health Plans without having to submit claim forms or supporting documentation.

When ODS Health Plans receives a claim from your provider, they will process and pay the claim according to your benefit contract. Each day ODS generates an FSA AutoPay claim report listing the date of service, the provider’s name, the type of service performed and the amount you are responsible for paying. The FSA department enters the claims information provided on the AutoPay claims report and reimburses you the portion you are responsible for.

When a claim is processed by ODS Health Plans, you receive an Explanation of Benefits (EOB). The amount shown in the column called “Patient Responsibility” is the amount that is shown on the AutoPay claim report and the amount you will automatically be reimbursed. You will not be reimbursed until the provider sends in the claim and the claim is processed by ODS Health Plans.

These are the most frequently asked questions regarding the Autopay option.

 

Must I be enrolled on the ODS Health Plans health insurance policy to participate?

Yes. You must be enrolled on your employer’s ODS health insurance medical and/or dental policy to participate in AutoPay.

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Can I enroll if I am enrolled in another health plan along with ODS Health Plans?

No. You can only enroll on the AutoPay option if ODS Health Plans is your only insurance plan.

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Will my dependent’s claims be processed through AutoPay?

Yes. If your dependents are covered by your ODS health insurance policy their claims will also be reported on the AutoPay claim report and you will be reimbursed for the amount you are responsible for.

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What is considered an “eligible expense”?

Expenses that are listed under IRS Section 125d are eligible expenses. Eligible medical, dental and prescription claims (including mail order) processed by ODS Health Plans will be reimbursed.

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Are orthodontia expenses reimbursed through AutoPay?

No. Orthodontia expenses cannot be reimbursed via AutoPay. BenefitHelp Solutions requires a copy of the Orthodontia contract to be on file prior to reimbursing orthodontia expenses.

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What if a claim that has been reimbursed from my healthcare Reimbursement Account is reprocessed by ODS Health Plans resulting in additional payment to my provider?

If ODS Health Plans reprocesses a claim that you have already been reimbursed for and it results in additional payment to your provider, you will be required to send a check to BenefitHelp Solutions to reimburse your account for the amount that you were overpaid.

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Do I need to enroll in the AutoPay option each year?

No. Your enrollment will automatically be renewed each plan year. However, if you become enrolled in another health plan along with your ODS plan, you will have to disenroll in AutoPay.

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Can I disenroll in the AutoPay option at any time?

Yes. You can either call, email or fax a request to FSA Member Services to stop AutoPay reimbursements. Diserollment will be automatic, so you will need to begin sending manual claims for reimbursement.

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Is there a cost to enroll in AutoPay?

No, there is no cost to enroll in the AutoPay option.

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If I can’t wait to be reimbursed through AutoPay, can I send in a claim form and the documentation and still get reimbursed?

Yes. Our system will deny the AutoPay claim as a duplicate claim.

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If I terminate employment or discontinue participation in the FSA plan, do I need to start sending claims in manually?

No. As long as you are still enrolled in AutoPay, and you still have a balance remaining, claims incurred prior to your termination date will still be processed and reimbursed through AutoPay.

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If I elect COBRA for my medical plan and for my FSA account, will my claims be paid through AutoPay?

No. If you elect COBRA to continue your medical coverage and fund your FSA account with after-tax dollars, you will need to manually submit your claims.

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Why does the “claims paid total” field on my FSA Explanation of Benefits (EOB) include an amount that that is identified as “pending reimbursement”?

The “claims paid total” is the total amount initially approved for reimbursement and may contain an amount that requires additional review for possible duplicate payment prevention. Once it is determined that the amount difference is or is not a duplicate reimbursement request, BHS will either release the balance amount or void to correct the Employee’s account balance based on true claims paid.

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