Documentation Requirements for Reimbursement

This article applies to you if you have a Via Benefits reimbursement account (sometimes known as a Health Reimbursement Arrangement)*.

Via Benefits is required to confirm eligibility of a submitted expense based on the rules governed by your former employer or benefits provider. To confirm eligibility, the following supporting documentation is required:

Premiums

When submitting supporting documentation for premium expenses, use monthly premium bills or statements, insurance coverage confirmation letters, or annual notice of premium amount that confirms you've been accepted into the plan and have paid your initial premium. You may need to submit more than one document to provide all the required information.

The documentation needs to include the following information:

• Premium coverage period (e.g., 01/01/2024 – 12/31/2024)

• Premium type (e.g., Medical, Medicare Part B)

• Carrier (e.g., Humana, N/A for Medicare Part B)

• Individual serviced (e.g., John Doe)

• Monthly amount (e.g., $200.00)

Note: Proof of payment is required for future expenses. Supporting documentation needs to include proof the provider processed payment, such as a provider receipt or cancelled check.

Social Security Benefit Verification Letter

If you aren't eligible for Automatic Premium Reimbursement for Medicare Part B, you must submit your annual Social Security Benefit Verification Letter as documentation. This letter is usually sent in October or November and specifies the amount of your Social Security benefit for the coming year and deductible amounts. If you don't have your Social Security Benefit Verification Letter, call the Social Security Administration at 1-800-772-1213 and follow the prompts to request another copy. You may also be able to retrieve this document online at ssa.gov. Learn about Medicare Part B Premium Reimbursement. 

Out-of-Pocket Costs

Reimbursement for premium expenses often exhausts your account balance. Submit reimbursement for out-of-pocket expenses if you have a remaining balance. When submitting supporting documentation for out-of-pocket expenses, you can usually use the following documents:

• Explanation of Benefits (EOB) from your insurance carrier, provider receipt, or pharmacy receipt.

Documentation needs to include this information:

• Date of service (e.g., 01/01/2024)

• Expense type (e.g., Copay)

• Provider (e.g., Dr. Smith, CVS)

• Individual serviced (e.g., John Doe)

• Amount (e.g., $100.00)

Uploading Documentation

Reimbursement documentation can be uploaded on the mobile app or website. 

• Images can be any of the following file types: PDF, GIF, JPG, TIF or BMP up to 5 MB in size.

• An unlimited number of files can be uploaded.

• You can use your mobile camera or desktop scanner to create documents to attach to your reimbursement request.

*Via Benefits reimbursement accounts are administered by Extend Health, LLC.