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Employees will have until April 30, to submit reimbursement claims for health, dental or vision expenses incurred during the Plan Year. If your birthday is June 12, then your enrollment period starts on March 1. Medicare will not pay for matching shoes or for shoes that are needed for purposes other than diabetes or leg braces. The ABN form that your supplier completes for you must detail how the products differ and requires a signature to indicate that you agree to pay the difference in the retail costs between two similar items. Medicare will not allow you to purchase these items outright even if you think you will need it for a long period of time.
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In turn, Medicare will process the claim and mail you a check to cover a portion of your expenses if the charges are approved. Medicare will pay only for items that meet your basic needs. Oftentimes you will find that your supplier offers a wide selection of products that vary slightly in appearance or features. You may decide that you prefer the products that offer these additional features.
Your supplier should give you the option to allow you to privately pay a little extra money to get the product that you really want. To take advantage of this opportunity, a new form has been approved by the Centers for Medicare and Medicaid Services CMS that allows you to upgrade to a piece of equipment that you like better than the other standard option you may otherwise qualify for.
The ABN form that your supplier completes for you must detail how the products differ and requires a signature to indicate that you agree to pay the difference in the retail costs between two similar items.
Your supplier will typically accept assignment on the standard product and apply that cost toward the purchase of the fancier item, thus requiring less money out of your pocket. Purpose of ABN The Advance Beneficiary Notice of Non-Coverage will also be used to notify you ahead of time that Medicare will probably not pay for a certain item or service in a specific situation, even if Medicare might pay under different circumstances. The form should be detailed enough that you understand why Medicare will probably not pay for the item you are requesting.
The purpose of the form is to allow you to make an informed decision about whether or not to receive the item or service knowing that you may have additional out-of-pocket expenses. Medicare will pay for medical equipment when the item: You will be responsible for 20 percent of that approved amount.
This is called your coinsurance. If you have chosen to receive an upgraded, fancier product than what Medicare typically covers, you will also be responsible for any additional amounts disclosed on the Advance Beneficiary Notice that identifies the additional features and fees that you have approved.
If a supplier does not accept assignment with Medicare, you will be responsible for paying the full amount upfront. The supplier will still file a claim on your behalf and any reimbursement made by Medicare will be paid to you directly.
Suppliers must still notify you in advance, using the Advance Beneficiary Notice, when they do not believe Medicare will pay for your claim. Mandatory Submission of Claims Every supplier is required to submit a claim for covered services within one year from the date of service.
However, if the item is never covered by Medicare, your supplier is not obligated to submit a claim. The role of the physician with respect to home medical equipment: All physicians and healthcare providers have the right to refuse to complete documentation for equipment they did not order, so make sure you consult with your physician or healthcare provider about your need for medical equipment or supplies before requesting an item from a supplier.
For every new item prescribed by your physician or healthcare provider, you should have a recent office visit that documents the reasons for ordering the equipment and products. Most items require you to have an in-person office visit with your doctor or healthcare provider to discuss the need and justification for the prescription of medical equipment and even replacement equipment before a supplier can fill those orders.
For some items, Medicare requires your supplier to have completed documentation which is more than just a call-in order or a prescription from your doctor or healthcare provider before they can deliver these items to you: There are over products across multiple product categories that are affected.
Your supplier will be able to tell you if the item ordered by your doctor or healthcare provider is subject to these additional requirements. Your supplier cannot deliver these products to you without a compliant written order from your doctor or healthcare provider.
They cannot provide services and get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier when a compliant order is not secured before delivery. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider. How does Medicare pay for and allow you to use the equipment?
Typically there are four ways Medicare will pay for a covered item: Medicare will not allow you to purchase these items outright even if you think you will need it for a long period of time. This is to allow you to spread out your coinsurance instead of paying in one lump sum.
It also protects the Medicare program from paying too much should your needs change earlier than expected. If you have oxygen therapy, Medicare will make rental payments for a total of 36 months during which time this fee covers all service and accessories. Beyond the 36 months for a period of two additional years , Medicare will limit payments to a small fee for monthly gas or liquid contents, where applicable, and a limited service fee to check the equipment every six months.
After an item has been purchased for you, you will be responsible for calling your supplier anytime that item needs to be serviced or repaired.
When necessary, Medicare will pay for a portion of repairs, labor, replacement parts, and for temporary loaner equipment to use during the time your product is in for servicing. What is competitive bidding? If you are located in a city where the program is in effect, you will need to obtain some or all of the following items from a contracted supplier: Oxygen, oxygen equipment, and supplies Standard power wheelchairs, scooters, and related accessories Enteral nutrition, equipment, and supplies Continuous Positive Airway Pressure CPAP devices and Respiratory Assist Devices RADs , and related supplies and accessories Hospital beds and related accessories Walkers and related accessories Support surfaces Group 1 and Group 2 mattresses and overlays Manual Wheelchairs and accessories Mail-order and local home delivery of diabetic supplies Nebulizers Home infusion therapy including insulin pumps and supplies TENS Units and supplies Patient Lifts Commodes Seat Lift Chairs Negative Pressure Wound Therapy Devices and related supplies and accessories Competitive Bidding areas are designated based on the zip code of your permanent residence on file with Social Security.
Medicare Supplier Standards Below is a summary of the standards Medicare requires of home medical equipment suppliers. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
An authorized individual one whose signature is binding must sign the application for billing privileges. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.
A supplier must maintain a physical facility on an appropriate site. This standard requires that the location is accessible to the public and staffed during posted hours of business. The location must be at least square feet and contain space for storing records.
The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.
If the supplier manufactures its own items, this insurance must also cover product liability and completed operations. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed.
A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
A supplier must accept returns of substandard less than full quality for the particular item or unsuitable items inappropriate for the beneficiary at the time it was fitted and rented or sold from beneficiaries. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier. A supplier must not convey or reassign a supplier number; i.
A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility. Complaint records must include: A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services except for certain exempt pharmaceuticals.
All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation. Must meet the surety bond requirements specified in 42 C. Implementation date- May 4, A supplier must obtain oxygen from a state- licensed oxygen supplier. A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.
Go Back Read Next: A respiratory assist device is covered if you have a clinical disorder characterized as I restrictive thoracic disorders i. Various tests may need to be performed to establish one of the above clinical disorders.
Three months after starting your therapy you must return to your doctor or healthcare provider for a follow-up to confirm the machine is benefitting you and that you are regularly using the device. Your physician or healthcare provider will be required to respond in writing to questions regarding your continued use along with how well the machine is treating your condition.
If you are not using your machine for an average of four hours per night per 24 hour period at the time you meet with your doctor or healthcare provider, then you may be held responsible via an Advance Beneficiary Notice to pay for the rental until you meet this requirement. BiLevel Devices are considered to be capped rental items, and that means they cannot be purchased outright.
You will own the equipment after Medicare makes 13 payments toward the purchase of the equipment. Depending on which product is ordered, your supplier may not be able to deliver this equipment to you without a compliant written order or certificate of medical necessity from your doctor or healthcare provider.
If the equipment is subject to these special rules, your supplier cannot get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier when a compliant order is not secured before delivery.
Breast Prostheses Breast Prostheses are covered after a radical mastectomy. One silicone prosthesis every two years or a mastectomy form every six months.
As an alternative, Medicare can cover a nipple prosthesis every three months. Mastectomy bras are covered as needed. There is no coverage for replacement prostheses due to wear and tear before the specified time frames. However, Medicare will cover replacement of these items due to: Loss Irreparable damage, or Change in medical condition e.
A mastectomy bra is covered if the pocket of the bra is used to hold a covered prosthesis or mastectomy form. Cervical Traction Cervical traction devices are covered only if both of the criteria below are met: You have a musculoskeletal or neurologic impairment requiring traction equipment. The appropriate use of a home cervical traction device has been demonstrated to you and you are able to tolerate the selected device.
You are confined to a single room, or You are confined to one level of the home environment and there is no toilet on that level, or You are confined to the home and there are no toilet facilities in the home. Heavy-duty commodes are covered if you weigh over pounds. Commodes with detachable arms are covered if your body configuration requires extra width, or if the arms are needed to transfer in and out of the chair.
Raised toilet seats that are used to position hand bars over a regular toilet are not covered by Medicare. Compression Stockings Gradient compression stockings worn below the knee are covered only when used for the treatment of open venous stasis ulcers. They are not reimbursed by Medicare for the prevention of ulcers, prevention of the reoccurrence of ulcers, treatment of lymphedema or swelling without ulcers. Medicare requires that you first meet with your physician or healthcare provider to discuss your symptoms and risk factors for Obstructive Sleep Apnea.
After meeting with your doctor or healthcare provider, you must then have an overnight sleep study performed in a sleep laboratory or through a special, in-home sleep test to establish a qualifying diagnosis of Obstructive Sleep Apnea.
Your doctor or healthcare provider may then prescribe a CPAP to treat your obstructive sleep apnea. Medicare will initially cover a three month trial of this equipment. Medicare will also pay for replacement masks, tubing and other necessary supplies as prescribed by your doctor or healthcare provider. If during your sleep study or during your trial period the CPAP device is not working for you, or if you cannot tolerate the CPAP machine, your doctor or healthcare provider may prescribe a different device called a Bi-Level or a Respiratory Assist Device, and Medicare can consider this for coverage as well.
After the first three months of use, you will be required to verify if you are benefiting from using the device and how many hours a day you are using the machine. Per Medicare, a follow-up face-to-face visit with your physician or healthcare provider is required to document an improvement of your symptoms no sooner than 31 days and no later than 91 days from the set-up date. Talk with your supplier if you are having problems adjusting to the therapy or using the equipment every night.
There are a lot of variations that can make the therapy more comfortable for you. CPAPs and Bi-Levels are considered capped rental items, and that means they cannot be purchased outright. Newly established requirements of the Affordable Care Act require a specific office visit with your physician or healthcare practitioner to assess and document your need for this equipment take place and must then issue a compliant written order. Depending on which product is ordered, your supplier may not be able to deliver this equipment to you without a written order or certificate of medical necessity from your doctor or healthcare provider.
When at home, you may receive up to a 3-month supply at one time. You must have nearly depleted the supplies on hand to be eligible for additional products. If you have a problem with mail delivery, or if you ever lose a card, you can print out a Monthly Pass Temporary Card from the WeightWatchers. Please contact Customer Service at monthlypass weightwatchers.
Members can cancel their Monthly Pass through their WeightWatchers. Note that we cannot process cancellation requests at meeting locations.
Except in special refund circumstances, there are no refunds for the current subscription month. If a special refund circumstance exists, the member will be refunded for the entire month, as refunds are based on subscription months and are not prorated. A full set of rules surrounding Monthly Pass cancellations and refunds can be found on the Weight Watchers website. No, all University of Rochester employee Monthly Pass members, regardless of how they purchased their Monthly Pass are welcome to attend the At-Work meeting.
However, if you want to obtain the special University of Rochester pricing and reimbursement, you must cancel your current subscription and sign up for a new subscription with the special University of Rochester discount code. If you wish to do this, you can contact Weight Watchers directly and have them transfer your existing account history to your new account so you will not lose previously recorded data.
Your Monthly Pass automatically renews each month at the special University of Rochester price until you cancel. Your credit card will be charged up to 15 days prior to the end of your first month, and then each month on that date thereafter, to ensure you receive your new Monthly Pass on time.
At Weight Watchers, weight management is a partnership that combines our knowledge and experience with your efforts. We teach you about good nutrition, activity, and healthy behavior. Upon joining, you are weighed and choose an initial weight goal and ultimate goal. If your ultimate goal is within the Weight Watchers healthy weight ranges chart which is based on Body Mass Index or has been prescribed by your doctor, you will be eligible for Lifetime Membership when you achieve it and complete the maintenance phase of the Program.
The Weight Watchers two food plans The Flex Plan and the Core Plan are explained, and you choose the one that suits you best initially. Members are taught the 8 Good Health Guidelines and the four pillars of the Weight Watchers program, which include eating healthy, being active, optimizing healthy behaviors, and the importance of a supportive environment.
Please visit the Weight Watchers site to find local meeting locations. Once you have registered for and purchased a Weight Watchers Online subscription, you may access it via WeightWatchers.
Help is available in the upper right-hand corner of every page on WeightWatchers. The typical response time is within 24 hours. The Become a Runner program starts out with a mix of walking and running and very slowly progresses to all running. By the end of the program you will run 3. At the beginning, expect to walk 1 minute, run 1 minute or as much as you can for 20 minutes total.
Register through the YMCA website- http: You will find additional enrollment information on the Well-U, Become a Runner page. You must attend 7 of the 9 in-person training sessions to receive the refund. Enter your employee ID number correctly and you will receive your refund loaded into your paycheck within 2 pay periods of program completion. This is your chance to meet the coach, look over the training plan, and ask any and all questions you have before committing to the program.
Refunds for participants dropping from the program will not be issued. Running in the rain is fun! Unless weather conditions are extreme, we will be running outside. Parking costs are based on the program location for each session. Listed below are the parking options for each location:. Parking is available in the visitor lot at Saunders Research Building for a fee. Well-U will not cover the cost of parking. This is about a minute walk to Saunders Research Building. Champions are responsible for promoting wellness programs and events to their coworkers and communicating the needs and wants of their department back to Well-U.
At the beginning of each year we require Champions to reenroll in order to affirm their commitment to being a Champion and allow new people to sign up if the previous Champion is no longer interested in being a Champion. Along with the title, Well-U also holds quarterly events, exclusively for our Champions, to thank you all for your dedication to health and wellness in our UR community. The majority of classes are held once a week for 8-week sessions, and you must sign up again after the 8-week session is over if you would like to continue attending.
Session begin and end dates are listed on the Well-U fitness class page. Certain classes are held on a monthly basis. Participants enrolled in classes that are held monthly must still re-sign up at the end of every session. If someone is no longer able to attend, we immediately notify the next person on the waitlist.
As a waitlist member, you may be notified to join the class early on, or you may never get into the class. We encourage all employees to pay attention to the registration opening date and enroll as early as you can.
Sign up for the Weekly Wellness newsletter to receive information about fitness class registration dates. As per the Enrollment Policy, employees may only enroll in 1 class per session. However, if a class still has open spaces in it after the first class, you may sign up for a second class.
If you cannot make it to a class, please notify your instructor at least 24 hours in advance when possible so that we can notify the next person on the waitlist. Log on to Securian Life's website, www. Pays the policy benefit and any accumulated cash value if the insured person dies during the term of coverage. Allows you to set aside money that can be used during your lifetime for longer term financial needs such as paying for college, buying a new home or building retirement funds.
Often used to cover a specific need such as covering medical bills and burial or paying off a home mortgage. You may continue all of your GUL coverage until age if you terminate, retire from the University of Rochester or become ineligible for the plan.
You may continue your GOTL coverage, within limits, until age 70 if you terminate, retire from the University of Rochester or become ineligible for the plan.
Service completed at any higher educational institution, teaching hospital, not-for-profit research foundation, or not-for-profit support organization for higher educational institutions, as well as service at a member of the controlled group of the University, will count towards the two-year service requirement.
To receive this service credit, you must complete a Retirement Service Credit Form. Complete the form within 90 days of your appointment date to receive University Contributions retroactively. Thompson Health System, Inc. All employees are eligible to make Voluntary Contributions; except you are not allowed to participate if you are a student whose employment is incidental to your education at the University.
In addition, eligible employees will be automatically enrolled explained below to make Voluntary Contributions. Effective July 1, , newly hired or rehired eligible faculty and staff will be automatically enrolled to make their own contributions, unless you affirmatively elect a different percentage or affirmatively decline to make contributions within 60 days of becoming eligible to participate in the Plan. If you opt out within 60 days of becoming eligible, no contributions will be withheld from your paycheck.
Once automatic Voluntary Contributions start, you may elect to change or stop Voluntary Contributions at any time. You may elect to make Voluntary Contributions as soon as you are hired, and you may increase, decrease or begin making Voluntary Contributions any time during the year.
Complete your election online at TIAA. For the Plan Year during which you satisfy the eligibility requirements, Direct Contributions will be made on base salary paid for full payroll periods after you satisfy the eligibility requirements i.
The University Direct Contribution is calculated each pay period based on your eligible gross earnings, using your accumulated earnings throughout the plan year July 1, June 30, and follows the formula below:. No, the University of Rochester Retirement Program is not a matching plan. For the Plan Year during which you satisfy the eligibility requirements, Direct Contributions will be made for base salary paid for full payroll periods after you satisfy the eligibility requirement, regardless of your Voluntary Contributions.
To review your contributions, log into your TIAA account online tiaa. You are not required to take action to begin receiving University Direct Contributions; however, you can complete your enrollment, elect your investment allocations, and designate your beneficiaries online at tiaa.
You will receive your first contribution on earnings from the first full pay period in which you are eligible. If you become eligible in the middle of a pay period, you will receive your first contribution with the next pay period's earnings. Your combined pre-tax and Roth after-tax Voluntary Contributions to the Retirement Program may be made in any amount up to the limits imposed by the Internal Revenue Code.
Maximum annual Voluntary Contribution limits for Calendar Year You may be able to 'roll' a distribution from another unrelated employer's plan and certain IRAs to the Retirement Program, provided that the distributing plan or IRA was qualified and the following requirements are met:. If you have any questions about rollover contributions or would like to initiate a rollover into the Retirement Program, contact the record keeper, TIAA, at You may choose from wide range of mutual funds and annuity options from well-known financial providers.
View the Investment Menu for more information. Additional information on these funds, including performance, can be found at tiaa. TIAA can help you to understand, enroll, and manage your participation in the University of Rochester Retirement Program at no additional cost.
Call , or schedule an individual advice session, with a local TIAA financial consultant. To schedule a session, go to TIAA. When you sever from employment from the University and members of its controlled group, you have four options with your accounts:. The b Retirement Program allows eligible employees the opportunity to save for retirement on a tax-advantaged basis and provides a direct contribution toward retirement savings.
Detailed eligibility information can be found here. The Deferred Compensation b Plan allows eligible participants to accumulate tax-deferred savings for retirement or other financial needs beyond the limits of the University of Rochester b Retirement Program. The UR has established criteria in determining retirement eligibility. We use several key factors to determine eligibility and appropriate retirement grandparent level:.
There are additional factors that are detailed in our Retiree Benefits Summaries. We encourage employees to read through the summaries, attend a Retiree Session and meet with a Retiree HR Representative. A comprehensive list of retiree health benefits is located here.
These forms should only be completed once you have met with a Retiree HR Representative and have selected your retirement date. Your cost for retiree health plan benefits are determined by the UR health plan that you are enrolled in, your retirement grandparent level and the contribution from UR. Retiree health plan costs are located here. Covered spouses and domestic partners will be included on billing statements. The billing statement will include amount due, where to send payment and date payment is due by.
If you enrolled in a University of Rochester Medicare Advantage plan, coverage will begin first of the month following your retirement date. You retire January 20th, your coverage will start February 1st. Generally, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, home health services. Medicare Part D is prescription drug coverage. There are two ways to get prescription drug coverage — enroll in a Medicare Advantage plan that has Part D coverage or purchase drug coverage through Medicare Private Fee-for-Service plans and Medical Savings Account plans.
There are several ways to sign up for Medicare Part A and B. You may be eligible for active employee health benefits and will become ineligible for retiree health benefits. This, in turn, could help you reduce, or even eliminate, the need for diabetes medication.
Weight loss is heart protective — benefits may include reduced blood pressure and improved cholesterol levels. You can also reduce your risk of developing other lifestyle-related diseases.
The program has been proven to alleviate symptoms of knee and hip osteoarthritis, by reducing the load and stress on joints, improving range of motion and relieving pain.
If you register your interest via this website or by calling us on 13 13 34 , you will be requested to register through the Prima website to enrol in the program, which will collect some personal information including health and other sensitive information about you. The personal information that you provide to Prima is used and disclosed only for the purpose of delivering and evaluating the program. If you do not provide this information, Prima may not be able to provide you with the services which form the program.
As part of the enrolment process HCF will disclose to Prima your member number and customer number in order to confirm the validity of your membership with us. Prima will not disclose your personal information to HCF other than your name, address, date of participation with Healthy Weight for Life, member number and customer number in order to allow HCF to evaluate the service.
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