Frequently Asked Questions

Below are a multitude of questions categorized into four categories:


GENERAL INSURANCE QUESTIONS

When is Open Enrollment?

Open Enrollment is around May to June every year. You will receive an email from benefits once that time period comes closer with a specific date range for Open Enrollment and the effective date of the change, if any along with other important information.

When does the insurance year start and end?
The insurance year runs July 1st to June 30th every year.

How do I find out what prescriptions are covered with my insurance?
Go to myCigna.com, they have a search for drug cost.  Cigna also show possible alternatives to what you are searching for and at different pharmacies in your area as well.

You can also call the customer service number on the back of your insurance card.

What happens if a claim is denied?
If you receive notice that your claim under Cigna Anthem or Stirling (HRA) plans was denied, go to the appropriate website to go through the correct claims process.

Note: This process is through Cigna, Anthem, or Stirling not the BOE. Contact the appropriate provider with questions about denials. Only contact the BOE benefits if the reason states you are not covered/do not have insurance coverage.

I just got married, how do I add my new spouse to my insurance?
Fill out the appropriate enrollment form(s) and return it to benefits with a copy of your marriage certificate.  You have 30 days from the date of your marriage certificate to sign your spouse up for insurance.  If you do not add your spouse with the 30 day window you will have to wait until the Open Enrollment period.

How do I cancel my insurance if I am going on my spouse’s insurance?
Have your spouse’s employer write a letter of when the insurance.. Please write that you would like to cancel your coverage insurance. You can write that on the letter or a separate piece of paper/email.

Along with this letter, fill out the appropriate enrollment/change form(s) (Anthem, Cigna), check off on the form that you are cancelling insurance (as opposed to enrolling or changing) and send it back to benefits.  If you are cancelling medical insurance please also fill out the insurance waiver form.

I only want to sign up for dental, do I have to sign up for medical too?
No, you can enroll in just dental. Just fill out the Anthem enrollment form, fill out the insurance waiver form and send both to benefits

I only want to sign up for medical, do I have to sign up for dental too?
No, you can enroll in just medical. All you have to do is fill out the Cigna enrollment form and send into benefits. 


HSA INSURANCE QUESTIONS

What does HSA stand for?
HSA stands for Health Savings Account. An HSA is a tax-advantaged account created for individuals who are covered under high-deductible health plans (HDHPs) to save for medical expenses that HDHPs do not cover.

Note: The term "HSA" is used interchangeably with HDHP when referring to the type of insurance an individual has. When a person says "I have HSA insurance", they (usually) mean they have a HDHP with an HSA, but this is understood.


How much will the Torrington BOE contribute to my HSA?
For an active employee, Torrington has committed to contribute towards the prorated annual deductible.  Contributions will not be taxable to the participant.  The HDHP plan has an annual single deductible of $2,000 and an annual deductible of $4,000

Torrington will contribute 50% of the prorated deductible.  For a single coverage that is $1,000. For an individual with family coverage that will be $2,000.

When do I receive the BOE HSA contribution?
You will receive your BOE contribution in two equal payments.  One at the beginning of the school year and the second at the beginning of the calendar year.  Please refer to your contract for more specifics.

How much can I contribute to my HSA?
Active employees can contribute any amount they choose as long as total combined (BOE and employee) deposits do not exceed the Federal Maximum HSA Deposit Limits.

For 2017, employees electing to contribute to the full federal maximum may contribute the following amount:

            Single Coverage: $2,400*

            Family Coverage: $4,500*

*Employees 55 years or older are permitted to make an additional $1,000 contribution annually.

Employee contributions to their HSA bank accounts are tax advantaged.  Contributions will be made on a pre-tax basis for those employees choosing to make contributions via payroll deduction.  Contributions may also be made outside of payroll and would be deductible from income.

Do I have to make a contribution?
No, individuals are not required to make any contributions into their HSA.  However, it is advisable that you prepare and save for any out-of-pocket expenses you may incur, now or in the future. Please consult banking materials for account fees and requirements.

Can lump sum contributions be made to my HSA?
Yes, but remember total contributions (employee and BOE) cannot exceed the Federal Maximum HSA Deposit Limits. Any contribution cover the Federal Limits will be treated as an excess contribution and subject to tax and potential penalty.

Note: The timing of a lump sum contribution may have tax implications if you cease to be employed in an HDHP during the year.  Consult your tax advisor for advice.

Can others make contributions on my behalf?
In addition to yourself and the BOE, other individuals may make contributions into your HSA.  Such additional contributions are subject to the stated limits.  Please consult banking materials for contribution methods available to individuals and your tax advisor for tax advice.

How do I make HSA contributions through payroll?
You fill out the HSA deduction form and send it to payroll.  With that form, payroll will enter in the new deduction for your paycheck. Download the form here.

Are there fees associated with the HSA bank account?
Yes, as with many bank-established accounts, there are account fees (such as an overdraft fee). Fees will vary based on how you decide to use your HSA bank account.  Please contact the Torrington Municipal and Teachers Federal Credit Union for specifics. Their contact information can be found on their website.

Who “owns” the funds in the HSA?
Any funds in the HSA, including the funds contributed by the Torrington BOE, are owned by the member.  Unused balances may be rolled over to subsequent plan years.

How do I access funds in my HSA?
You will have access to funds in your HSA via a debit card and a check book.  Refer to banking materials for any applicable banking fees or contact the Torrington Municipal and Teachers Federal Credit Union for specifics.

What can HSA funds be used for?
HSA funds can be used for qualified medical expenses (as defined by the IRS) for you and you tax qualified dependents on a tax free basis.  Qualified medical expenses include both services covered by your medical plan portion of your HDHP as well as other qualified expenses outside of the medical plan.

You may also use your HSA funds for non-qualified expenses however those funds will be subject to ax and penalty.

If 65 years or older and HSA funds are used for non-qualified expenses, the penalty is waived and those funds will be subject only to tax.

As the “owner” of the account it is the member’s responsibility to substantiate HSA expenditures in the event of an IRA audit.

What are the medical expenses the IRS has defined as “qualified”?
For a complete list, please visit the IRS’s website; you can find it here under the What Medical Expenses are Includible subsection.

What expenses go towards my HDHP deductible?
Only those services covered by and reimbursable under the medical plan portion of your HDHP will accumulate towards the deductible.

You can open a myCigna account at mycigna.com, Cigna keeps track of your deductible for you and is an easy way to see how much of your deductible has been used and how much you have until you reach your deductible.

Am I required to use the money in my HSA?
No, you may choose to use non-tax advantaged funds.  There is no requirement to use the monies in your HSA for your qualified medical expenses.  Monies in your HSA account are owned by you and will roll over annually.

At a future date you may decide to reimburse yourself with HSA funds for qualified expenses that were incurred after your initial enrollment date in the HSA PPO plan.  Please consult your tax advisor for tax advice.

I am used to seeing deductibles and coinsurance stated as single, two person, or family, but now I’m only seeing single and family.  What happens if I have a two person policy?
For purposes of the HSA PPO, deductibles and coinsurance are set as Single and Family only. Two person contracts will be subject to the family deductible and coinsurance levels.  A two person policy is also allowed total HSA contributions (BOE and employee combined) not to exceed the 100% of the Federal Family Limit.

Note: Monthly premium rate contributions will continue to reflect single, two person, and family coverage.

How does the family deductible work?
For purposes of the HSA PPO, the full family deductible must be met before the health plan assumes any coverage.  With the Torrington BOE, the plan will not provide coverage until one or any combination of family members incur deductible expenses equal to $4,000.

Do we have separate In and Out-of-Network deductibles?
No, the deductible can be met with any combination of In and Out-of-Network services.  With the Torrington BOE insurance, Out-of-Network claims will be subject to coinsurance and the Cigna’s approved pricing.

Prior to meeting my deductible, am I paying the full provider price or carrier’s negotiated discount?
For In-Network services, HSA PPO members are provided with the carrier’s network negotiated discounted pricing. Out-of-Network providers are not required to comply with the Cigna’s negotiated pricing schedules and member reimbursement will be subject to approved pricing (“Reasonable & Customary”).

What services are covered as preventive and not subject to the medical plan deductible?
Annual In-Network preventive exams including screenings, immunizations and other services to detect medical conditions in advance. Screening examples include: Cholesterol screenings, preventive colonoscopy, and preventive mammography.  See Preventive Health Care for a more complete listing.

Note: Screenings performed for diagnostic purposes (when symptoms present) would apply to the plan deductible and coinsurance.

Note: Out-of-Network preventive services are subject to the plan deductible and coinsurance.

How are prescription drug claims processed?
Prescription drugs are paid as any other service and are subject to the annual deductible.  In-Network pharmacies will process the claim at point of sale.  If the member as not yet met the annual deductible, the cost of the prescription (up to the annual deductible) will be required before the prescription will be dispensed.  If the deductible has been met the member will pay a copay of $0 for generic, $15 for preferred brands and $30 for non-preferred brands.

If I elect the HDHP plan, can I also be covered by another traditional (non-HDHP) plan (e.g. my spouse’s copay PPO plan)?
No, there are two components to the HDHP plan. The HDHP and the HSA tax advantaged bank account.  While there are no regulations that limit your ability to have dual coverage with the HSHP, Federal regulations will not allow tax advantaged contributions into an HSA if you have any coverage that does not meet the HDHP requirement.  For 2017, qualified HDHP’s must have an annual single deductible of $1,300 and an annual family deductible of $2,600.

Note: Contributions to an HSA while enrolled in a qualified HDHP are owned by the individual and can be used in the future regardless of your or your dependents health plan status.  Additionally, you can use monies in your HSA for tax dependents even if they are covered under a non-qualified health plan.  Potential tax and penalties could apply if used for non-qualified expenses.

The rules above apply to health and drug coverage only. Traditional dental and vision plan coverage is allowed and is not required to meet the HDHP requirement.

I am on Medicare or will be eligible for Medicare, can I stay on my HDHP & HSA plan?
Medicare coverage would constitute other non-HDHP coverage and thus make the member ineligible to make HSA contributions

Unused HSA funds contributed prior to Medicare enrollment may still be used tax free to pay for qualified medical expenses.

Unused HSA funds contributed prior to Medicare enrollment may still be used for non-qualified expenses.  Tax would apply but the penalty is waived for those over 65 years of age.

I’m turning  65 soon, what happens with my HSA insurance?
If you are 65 or old, you must change from the HSA to the HRA if you are collecting Social Security or enrolled in Medicare Part A or B.

A few months before you turn 65 years old you will receive the “HRA packet.” This includes the HRA enrollment form, HRA information and the Medicare & Social Security Deferment Form.

If you do not collect Social Security and you do not get enrolled in Medicare Part A or Part B, you can stay on the HSA insurance and everything remains the same. You only need to return the Deferment Form stating this and your insurance will not be changed.

If you have to switch to the HRA, you will enroll in the HRA administered by Stirling. Your coverage will still be through Cigna and will remain the same. The difference between the two comes with the financial part not the coverage.



HRA INSURANCE QUESTIONS

What does HRA stand for?
HRA stands for Health Reimbursement Arrangement. An HRA is an IRS-approved, employer-funded, tax-advantaged employer health benefit plan that reimburses employees for out-of-pocket medical expenses and individual health insurance premiums.

What is the purpose of the HRA?
The purpose of the plan is to supplement the out-of-pocket expenses required under the medical insurance plan by reimbursing eligible employees, up to a certain limit, for their own and their dependents' expenses that are applied to the medical deductible.  Reimbursements for health care expenses paid by the plan are generally excludable from taxable income.

Who is the HRA benefits claims processor and what do they do?
The benefits claims processor is:
Stirling Benefits Inc.
20 Armory Lane
Milford, CT 06460

Phone: (203)-876-1660

The benefits claims processor maintains the records for the plan and is responsible for processing claims.  They will also answer any questions you may have about the plan.  Please contact them at the above listed address should you require further assistance. 

What are eligible expenses?
Eligible expenses of a participant are those incurred at a medical provider's facility covered by the employer's medical plan.  Secondary coverage(ex. through a spouse's plan) must pay its share before this plan makes a payment.

What is not an eligible expense?
Unless otherwise specifically provided, there will be no benefit coverage reimbursing any of the following:

  • Expenses that an eligible person is entitled to receive without charge under any worker's compensation laws, or any municipal, state, or federal program.
  • Expenses for which there is no approval or coverage under the terms of the regular medical plan.

When must the expense be incurred?
An eligible expense is considered "incurred" on the date the individual receives the service from the provider or facility for the claimed expense.  Expenses are not eligible if incurred or arising before the plan became effective and before you become a participant, any expenses incurred after a separation from employment with the employer.

Can I make a contribution to the HRA?
No, employee contributions cannot be made to the HRA account.  Only the BOE can make contributions to the HRA.

What benefits are provided by the HRA plan?
Similar to the HSA, the HRA plan will reimburse you 50% of the deductible, you are responsible or the remaining 50%.

How does the HRA work?
When you go to the doctor’s office or other medical provider, the doctor’s office/facility should not ask you for any payment at that time.  They will submit your claim to Cigna, so it can be processed for the Cigna allowable amount.  Cigna will then send you an Explanation of Benefits (EOB) for the services provided and the amount applied toward your deductible.  This will take approximately 30 days to receive in the mail.

Your provider will also send you a bill/invoice for services.  Once you have received you Cigna EOB and your provider bill/invoice…match them.  The amount that you owe should be the same.  To receive reimbursement, submit the following to Stirling Benefits:

  • Cigna Explanation of Benefits
  • Complete Health Reimbursement Arrangement-Request for Reimbursement Form

You will not have to wait for an EOB for prescription drug reimbursement.

How do I pay for prescriptions?
The pharmacy will charge you the medical allowed amount for you prescription(s).  You may use your debit card* to purchase prescription(s).  Please retain your pharmacy receipt; Stirling Benefits may request a copy to substantiate the expense. The debit card may be used for items applied to your deductible, which does not include over-the-counter items.

*New plan participants receive a new MasterCard debit card in the mail.  Existing participants should continue to use the card previously issued and the new year funds will be loaded to the existing debit card.  Debit cards are valid for a three-year period.  You may use your Plan Debit Card to pay for prescription drug purchases at the pharmacy, as the pharmacy is able to tell you the Cigna allowed amount at the point of sale.

What if I terminate my employment during the coverage period?
If your employment ends (for any reason other than retirement), you will be sent a COBRA form from Stirling.  You have the option to continue your insurance with the same coverage, but you will be responsible for paying the COBRA monthly premium and the full deductible.

What happens if a claim is denied?
If you receive notice that your claim under this HRA plan was denied, you will have 60 days to notify the plan committee of your appeal of the denial.  Your appeal should set out the reasons your claim should be approved.  You will have the opportunity to review any important documents held by the plan committee. Also, you may submit additional comments and information in support of your claim.  In most cases, a decision on your appeal will be reached within 60 days of the date of your request for a review.

Note: This process is through Stirling not the BOE. Contact Stirling with questions about denials. Only contact the BOE benefits if the reason states you are not covered/ do not have insurance coverage.


RETIREMENT QUESTIONS

I’m retiring at the end of the school year, when will my benefits end?
Teachers: The last day in the following September (ex. Retire June 2017, insurance ends September 30th, 2017)

Nurses, Paraprofessionals, & Cafeteria: The last day in the following August (ex. Retire June 2017, insurance ends August 31st, 2017)

Administrators, Secretaries, Custodians & other 12 month employees: The last day of the month you retire

What do I do for health insurance if I plan on retiring soon (under 65 years old)?
Send a retirement letter to benefits. You will receive a letter back with insurance information such as cost if you were to keep the same insurance. Send your response to benefits stating you decision on insurance. If you choose to stay on the BOE insurance you may remain so until the age of 65.

Note: Read your contract to see what health insurance you are eligible for.

I’m retiring and 65 (or older), how does this affect my insurance?
Teachers & Administrators
If you are eligible for Medicare, you can sign up for Medicare.  Contact TRB about the Medicare supplement they provide.  

If you are not eligible for Medicare, provide benefits with written proof of your ineligibility. With this proof, you are able to stay on the BOE insurance at the full cost share.

Note:You can contact TRB for a subsidy to reduce the cost.

I’m retiring and 65 (or older), how does this affect my insurance?
Non-Teachers & Non-Administrators
If you are 65 or older make sure you sign up for Medicare three months prior to turning 65. Once you turn 65 years old you can enroll in the BOE Medicare supplement.

If you are eligible for the Blue Cross Blue Shield High Option 81 Medicare supplement the BOE offers through Anthem, you will need to fill out the enrollment form and provide a copy of your Medicare card with proof of Part A and Part B coverage.  To avoid a gap in coverage, go to Medicare as early as you are able to.

Note:Anthem does not allow enrollment in the High Option supplement without proof of Medicare Part A and B coverage.

Note: Refer to your contract and the High Option rate sheet for High Option cost and eligibility.



Don't see your question above? Contact Amanda Poirier at apoirier@torrington.org for an answer and it may be added to the list!