HRA Guide for AT&T Retirees and Dependents - Aon Retiree Health Exchange (2024)

HRA Guidefor AT&T Retireesand Dependents

Welcome to your HealthReimbursem*nt AccountAT&T has established a Health Reimbursem*nt Account (HRA) to help you payfor individual insurance coverage and eligible out-of-pocket expenses.Your account under the AT&T Medicare-Eligible usually the Accountholder. However, if you are aHealth Reimbursem*nt Account Program is surviving dependent or participating throughadministered by Your Spending Account™ COBRA, you are the Accountholder.(YSA), a company of Alight Solutions. This HRAGuide contains important information about • HRA provisions are governed by the termsyour HRA, including: of the AT&T Medicare-Eligible Health Reimbursem*nt Account Program and may• How the HRA works change from time to time. Please refer to the Program Summary Plan Description (SPD) for• The reimbursem*nt process more information. This SPD can be found on• The catastrophic prescription drug benefit the AT&T Benefits Center website through www.att.com/benefitscenter. From the home• Where to go for help page, click on Plan Docs and Legal Notices, then the Health and Welfare Summaries and LegalIMPORTANT: Information tile. To request a free printed copy• Regarding the phrases “your Health of the SPD, you may call the AT&T Benefits Reimbursem*nt Account,” “your HRA,” and “your Center toll-free at 877-722-0020. account” in this document, “your” refers to the Accountholder. Because the HRA is generally established in the name of the AT&T Medicare- eligible retiree, the Medicare-eligible retiree is

How do I access my HRA?Log on to retiree.aon.com/att and follow the steps below.Important: Use the Accountholder’s Aon Retiree Exchange ID to access the HRA online.If you have any questions about this information, please call 800-928-8027 (TTY 711). 1 Log on to retiree.aon.com/att 2 Click on the HRA tab at the top of the page. 3 Select Manage My HRA to be directed to the Your Spending Account web page.ON THE YOUR SPENDING ACCOUNT WEB PAGE, YOU CAN:• Obtain an account balance • Sign up for text message alerts to inform you of account activity• Check claim status • Read detailed instructions for• Learn more about expenses downloading and using YSA’s eligible for reimbursem*nt “Reimburse Me” mobile application• Set up or edit direct deposit • Send questions to YSA• Submit claims for reimbursem*nt representatives through the secure mailbox DID YOU KNOW? If you have an AT&T Health Reimbursem*nt Account (HRA) and become eligible to enroll for benefits through Aon Retiree Health Exchange, your AT&T HRA balance may be automatically transferred to your Medicare Exchange HRA. You will be eligible for this balance transfer if you enroll in the Medicare Exchange and are eligible to receive a Medicare Exchange HRA credit. If you have questions about balance transfers, contact Your Spending Account at 877-722-0020. Representatives are available 7 a.m. to 7 p.m., Central time, Monday through Friday. retiree.aon.com/att | 800-928-8027 1

how your HRA worksAn HRA is used to reimburse you for eligible healthcare expenses,as described below. HRA PROCESS 1 2 3 4 You get Individuals with more AT&T reimbursed for than $7,050 in You pay for actual out-of-pocket establishes healthcare eligible healthcare an HRA expenses, including drug expenses may premiums, from be eligible for up the HRA to $100,000 in supplemental HRA credits for those expensesFor more information about the HRA process, visit myexchangeconnection.com/ATT to view videosand guides about your coverage options.What expenses are eligible for reimbursem*nt?The HRA can only be used to reimburse eligible following the four steps outlined earlier in thisexpenses incurred by an individual enrolled in a guide, which navigates you to the YSA website.medical, prescription drug, dental and/or vision On the YSA website, you can view the eligiblepolicy purchased through Aon Retiree Health expense list on the Reimbursem*nt AccountsExchange. When submitting a claim for tile.reimbursem*nt, you will be required to attestthat your claim only includes expenses that You must submit all your claims for the currentmeet this requirement. year by March 31 of the following year. For example, you must submit claims for 2022 by• Generally, premiums and other out-of-pocket March 31, 2023. healthcare expenses are eligible for reimbursem*nt. Each time a claim is processed, you will receive a notification1 on the status of your claim to include• Eligible expenses that are unrelated to the any amounts paid. If you have a remaining credit policies purchased through Aon Retiree Health amount in your HRA during the fourth quarter of Exchange may also be reimbursed. the year, you will receive a statement1 from YSA as a reminder to file claims for unused funds. Regular• To view a guide of eligible healthcare expenses monthly statements are not provided. Any generally allowed by the IRS, please visit the unused balance will roll over to the following year. YSA web page through retiree.aon.com/att by 1 You will receive electronic notifications and statements to the email address on file, unless you specify otherwise. If you would like to add or change your email address, please visit the AT&T Benefits Center website through www.att.com/benefitscenter. From the home page, click on the Your Profile link and select the Personal Information option. You can also call the AT&T Benefits Center at 877-722-0020. If you would like to change your mailing preference, please contact the service representatives at 800-928-8027 (TTY 711).2 HRA Guide for AT&T Medicare-Eligible Retirees and Medicare-Eligible Dependents

the reimbursem*ntprocessThere are different ways to be reimbursed for eligible healthcare expenses, andthe process differs based on the type of expense and the carrier you choose.You may submit claims for reimbursem*nt online, by mobile device, by fax, or by mail. Approvedclaims can be reimbursed by check or direct deposit. FOR ELIGIBLE FOR MEDICARE HEALTHCARE FOR INSURANCE PREMIUMS2 PART B PREMIUMS EXPENSES How do Your Spending Account Your Spending Account has a Submit a I get has a feature called feature called “premium claim for started? “premium auto- auto-reimbursem*nt.” This service reimbursem*nt reimbursem*nt.” This automatically reimburses you each in one of three service automatically month after you pay your Medicare ways: online, reimburses you each month Part B premium. paper, or mobile after you pay the selected application. See carrier premium. The service Each year, Social Security will page 6 to learn is available for individual provide you a statement in more. medical, prescription drug, December indicating the monthly dental and vision insurance Medicare Part B premium that will policies that are purchased be deducted from your Social through Aon Retiree Health Security check in the upcoming Exchange. year. This statement, or your first bill for Medicare Part B if you do not For eligible expenses that receive a deduction from a Social are unrelated to the policies Security check, can be submitted purchased through Aon, with an HRA Claim Form, triggering you must submit claims for you to receive this reimbursem*nt reimbursem*nt online, by every month. There is no need to mobile device, by fax, or submit it again until your monthly by mail. amount changes.2 A small number of insurance carriers do not offer premium auto-reimbursem*nt through YSA. If this applies to your policy, you need to follow these steps to set up auto-reimbursem*nt:• Set-up Premium Auto- • If completing a paper claim • Note: Setting up premium Reimbursem*nt on the YSA form, fax or mail your HRA auto-reimbursem*nt online will website. See page 6 to learn Claim Form, along with proof result in faster reimbursem*nt. more, or you can complete of premium payment (e.g., bank Your claim will be reviewed and and sign an HRA Claim Form. statement, canceled check processed upon receipt. You To obtain a paper claim or statement from your will then receive an Explanation form, contact the service insurance carrier) and the of Benefits (EOB) and representatives at effective date of coverage, reimbursem*nt (if applicable) 800-928-8027 (TTY 711). to YSA. The fax number and via check or direct deposit. 3 mailing address are provided on the form. retiree.aon.com/att | 800-928-8027

FOR ELIGIBLE FOR INSURANCE FOR MEDICARE HEALTHCARE PREMIUMS PART B PREMIUMS EXPENSESWhen and Ongoing monthly premiums You will be You musthow will I be are sent to retirees by the fifth reimbursed based submit a claimreimbursed? business day of each month. on the monthly to YSA for EXCEPTION: Your first premium premium amount reimbursem*nt reimbursem*nt may take up to you pay, which is of eligible 60 days to receive after the reported back to healthcare effective date of your coverage. YSA. If you expenses. You can file an online claim to determine that you Auto- set up your recurring premiums. prefer to be reimbursem*nt Note: By law, reimbursem*nts reimbursed at a is not available. from your HRA cannot be made lower monthly until after the effective date of amount or would Generally, all your coverage. prefer to stop auto- reimbursem*nt reimbursem*nt, claims are After accessing the Claims processed Overview page on the YSA contact the service representatives at within website, follow these five 3 business days simple steps: 800-928-8027 (TTY 711). of receipt. 1. Choose Get Reimbursed. If your claim 2. E nter the information for the Generally, all is approved, premium you’d like set up for reimbursem*nt you can expect auto-reimbursem*nt, making claims are payment within sure to: processed within 2 business days • Select a monthly frequency. 3 business days of via direct • Enter your monthly receipt. If your claim deposit or premium payment amount. is approved, you can 7 to 10 business • Select Yes for “Set-up expect payment for days if you Auto-Reimbursem*nt.” reimbursem*nt of opt to be 3. S elect method of sending your initial Medicare reimbursed receipts or documentation to Part B premium by check. YSA for your claim. within two business 4. Review claim details and click days via direct Submit. deposit or 7 to 10 5. R eview Summary of Request business days if and What Happens Next. you opt to be reimbursed by You will be reimbursed based on check. Ongoing, the monthly premium amount your Medicare you pay, which is reported back Part B premium to YSA. If you prefer to be reimbursem*nt reimbursed at a lower monthly request will be amount or would prefer to stop processed by the auto-reimbursem*nt, this can be 5th business day done on the YSA website. You of the month. can also contact the service representatives at 800-928-8027 (TTY 711).4 HRA Guide for AT&T Medicare-Eligible Retirees and Medicare-Eligible Dependents

FOR MEDICARE FOR ELIGIBLE FOR INSURANCE PREMIUMS PART B HEALTHCARE PREMIUMS EXPENSESWhat If your insurance carrier See “How do I You must submitdocumentation is participates in premium get started?” your HRA Claimrequired to support auto-reimbursem*nt you on page 3. Reimbursem*ntmy claim for do not need to submit any Form and documentation. itemized receiptsreimbursem*nt? containing the If you set up your recurring premium claims via the YSA following: website or on a paper claim • Service form, your documentation provider’s name needs to include the following information: • Date of service • Name of insurance carrier • Description of • N ame of insured (you or service your dependent) • Who the service • M onthly premium was for amount you have paid • The • S tart and end dates of out-of-pocket coverage amount you are • P roof of payment (see claiming for below) reimbursem*nt • Insured’s date of birth Explanation of Common documents that Benefit (EOB) are acceptable as proof of statements from payment include: your carrier are also acceptable • Bank statements forms of • Copies of canceled checks documentation • S tatements provided by for out-of-pocket your insurance carrier expenses. retiree.aon.com/att | 800-928-8027 5

How do I submit a claim for reimbursem*nt of healthcare premiums and expenses?There are three options. 1 ONLINE - Go to the AT&T Benefits Center 2 PAPER - You can also enter your information website by logging on to aon.retiree.com/att on a paper HRA Claim Reimbursem*nt Form. and clicking on Manage My ATT Account. Paper forms are available by calling 800-928-8027 (TTY 711). Completed forms Once on the AT&T Benefits Center website, can be faxed or mailed to YSA, along with click on the Reimbursem*nt Account tile > appropriate receipts or documentation. Get Reimbursed and follow the five easy steps. The YSA fax number and mailing address are provided on the Claim Form.Other information about filing claims and reimbursem*ntCAN I SAVE MY CLAIMS AND FILE • Dentist appointment – date of the visitTHEM ALL AT ONCE? • Eyeglass purchase – date of purchaseYes. You can file claims at your convenience(monthly, quarterly, etc.). However, generally, you HOW CAN I SET UP DIRECT DEPOSIT TOmust submit all claims for the year by March 31 of RECEIVE MY REIMBURsem*nTS FASTER?the following year. For example, you would need to Direct deposit allows for your reimbursem*nt tosubmit 2022 claims by March 31, 2023. Amounts be deposited directly into your bank account,remaining in your HRA after March 31 can be used rather than waiting for a mailed check to arrive.to reimburse eligible expenses incurred in You can sign up for direct deposit through retiree.subsequent calendar years while you are a aon.com/att or by calling 800-928-8027 (TTY 711).participant in the HRA. Method 1: Sign up online throughHOW LONG DOES REIMBURsem*nT retiree.aon.com/attTAKE ONCE MY CLAIM AND THE REQUIREDDOCUMENTS HAVE BEEN FILED? − Follow the instructions on page 1 to log onGenerally, all reimbursem*nt claims are processed to retiree.aon.com/att and click on Managewithin 3 business days of receipt. If your claim is My HRA.approved, you can expect payment within 2 − Once on the AT&T Benefits Center website,business days via direct deposit or 7 to ten business select the Your Profile link at the top right ofdays if you opt to be reimbursed via check. As the page. Select Financial Institutions and thendescribed previously in this document, receipt of click on the Spending Accounts tab. You’ll beyour first premium auto-reimbursem*nt can take asked to enter your direct deposit information.up to 60 days after the effective date of yourcoverage. After that, your reimbursem*nts will be − Enter your bank information (bankingprocessed automatically by the 5th business day of institution name, account type, routingeach month. number, and account number) in the appropriate fields. Your bank’s routing andWHAT DATE SHOULD I USE ON A account numbers can be found on theREIMBURsem*nT CLAIM? bottom of your checks.When submitting a claim, use the date on whichthe expense was incurred. Examples: • Method 2: Sign up by phone• Prescription drug purchase – date of purchase − Call 800-928-8027 (TTY 711).• Doctor’s office visit – date of the visit6 HRA Guide for AT&T Medicare-Eligible Retirees and Medicare-Eligible Dependents

3 MOBILE APPLICATION - Search for the “Reimburse Me” application (for Apple or Android devices) in the App Store. After you have downloaded the App, enter ATT in the company search field and then select AT&T Medicare-Eligible HRA. Then use your Accountholder Aon Retiree Exchange User ID and Password to log on and select Submit Claim on the bottom of the Accounts screen. 1 Click Get Reimbursed to create a new claim 2 Complete the 5 simple steps to add a claim for reimbursem*nt 3 To set-up a recurring claim, ensure you select monthly as the frequency and “Yes” retiree.aon.com/att | 800-928-8027 7

the catastrophicprescription drugbenefitAT&T recognizes that unexpected How much can I receive under thecirc*mstances can arise. A change in catastrophic prescription drug benefit?your health can result in changes to your AT&T will provide up to $100,000 per individual inprescription drug cost. supplemental HRA credits for actual out-of-pocket drug expenses when an individual exceeds theWhile most individuals will not need this coverage, $7,050 threshold. The supplemental amounts area catastrophic prescription drug benefit has been added to your HRA and are in addition to theestablished under the AT&T Medicare-Eligible amount credited when your HRA was established.Health Reimbursem*nt Account Program to offer For example, if you pay $7,350 in personal out-of-additional protection to you and your dependents pocket drug expenses in 2022, your HRA will beenrolled in coverage through Aon Retiree Health credited with an additional $300 for theExchange. calendar year.Who is eligible for the catastrophic What can I use the credits for?prescription drug benefit? Credits provided through the catastrophicRetirees, eligible dependents, and surviving prescription drug benefit can be used forspouses of AT&T retirees are eligible for the reimbursem*nt of any eligible healthcare expenses.catastrophic prescription drug benefit if they: How frequently can I request credits?• Are eligible to obtain reimbursem*nt from an Participants can request credits under the AT&T Medicare-Eligible Health Reimbursem*nt catastrophic prescription drug benefit all at Account and receive an HRA credit in the current once or throughout the calendar year. However, calendar year; all credit requests must be submitted by March 31• Enroll in a Medicare Part D plan (or a Medicare of the following calendar year. Keep in mind, that if Advantage plan with Prescription Drug you want to use the additional credit for other component); and healthcare claims incurred in the current calendar year, you need to apply for the additional credit in• Incur actual out-of-pocket expenses for eligible advance of the March 31 deadline so you have time prescription drugs that exceed $7,050 (individual to submit your claims per the usual YSA claims threshold) in the current calendar year. submission process.8 HRA Guide for AT&T Medicare-Eligible Retirees and Medicare-Eligible Dependents

How do I receive incremental credits After receiving the Catastrophic Prescription Drugfor the catastrophic prescription drug Credit Request Form, you will need to:benefit? • Complete all required fields;Once your actual out-of-pocket expenses for • Obtain your Monthly Prescription Drug Summaryeligible prescription drugs exceed $7,050 (individual showing your actual out-of-pocket expense forthreshold) in the current calendar year, you are the year. You can request this summary fromeligible for incremental HRA crediting. your prescription drug carrier.To obtain additional credits, you must complete Note: This summary is also known as anand send the Catastrophic Prescription Drug Credit Explanation of Benefits (EOB).Request Form to YSA. You can access the form in • Send the form to YSA, according to thetwo ways: instructions on the form.1. On the YSA web page through After YSA reviews your form and documentation, retiree.aon.com/att or if approved, your HRA will be credited with the amount spent for actual out-of-pocket2. By calling 800-928-8027 (TTY 711). prescription drugs in excess of $7,050 up to $100,000 per individual. retiree.aon.com/att | 800-928-8027 9

where to go for help ONLINE Visit the YSA web page through retiree.aon.com/att. 1. Log on to retiree.aon.com/att using the Accountholder’s Aon Retiree Health Exchange ID. 2. Click on the HRA tab at the top of screen. 3. Click on Manage My HRA. PHONE Call the service representatives at 800-928-8027 (TTY 711).Your Spending Account is a trademark of Alight Solutions LLC. H000234347