Appealing Your Funding Eligibility, Qualification, or Contribution Amount
This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement)*.
Setting Up Your Reimbursement Account
A reimbursement account is provided according to the terms specified in your benefit plan document.
Your former employer or benefits provider:
Establishes the contribution amount and frequency for each eligible participant.
Determines any qualification requirements necessary to access the funds designated for you. For example, they may require enrollment in a specific plan type to initially qualify for funding.
Requesting an Exception or Appeal
If you believe your qualification status is in error or disagree with the contribution amount, you can contact Via Benefits for a review of your account. Many issues can be addressed quickly with the assistance of one of our representatives, who can fix errors or help you request an exception. You also have the right to file a formal appeal.
Exceptions
An exception may be granted due to extenuating circumstances per the plan rules (outlined below). Exception requests can be made by contacting customer service by phone or in writing.
Appeal Requests
You may submit a written appeal to ask for additional review or for an exception. Send your written appeal to the address or fax number provided on your Reimbursement Request Form or other communication explaining a change in your status. An appeal can't be accepted over the phone. You have 180 days from the date you received the notice of the reimbursement denial or loss of funding to file the appeal.
A written appeal needs to be as complete as possible and contain the following information to improve processing.
Account holder name**
Account holder Social Security number or last 4 digits of SSN and ZIP Code
Expense number**
Expense amount**
Dates of service (start and end dates)**
Covered person’s name (if different from account holder)
Expense description**
Employer name**
Date of the denial or change in status**
Reason for denial or change in status
A statement that explains the reason for the appeal
The statement needs to indicate why you feel the expense should be covered, or why funding should be provided, reinstated, or the amount reviewed.
Include any information that would help substantiate or determine if the appeal can be approved.
Supporting documents that may include additional expense details, such as a Letter of Medical Necessity, proof of extenuating circumstance, or a request for an exception to the plan rules.
**Including the Explanation of Unpaid Expenses or other communication with the appeal is helpful in identifying the person and issue in question.
You will receive written communication of the appeal decision within 30 days of receipt. If your appeal is denied, the communication will provide information on next steps.
Possible Extenuating Circumstances
You feel you were provided misinformation regarding eligibility, qualification or enrollment requirements.
You are no longer enrolled or eligible to be enrolled and lost qualification as of a specific date because of changes in qualification or eligibility.
You indicate you weren't notified about initial or ongoing enrollment requirements.
A circumstance prevented you from enrolling in the required time frame.
Examples
Physical or mental incapacity during the enrollment window.
The address, email and phone number on file were outdated and you didn't receive communication regarding the change.
A policy was issued after the enrollment period due to timing with the insurance carrier’s application process.
You retired after the enrollment deadline.
You were still on group coverage after the enrollment deadline.
*Via Benefits reimbursement accounts are administered by Extend Health, LLC.