Page 14 - 2018 MDT Benefits & Notices

Member Driven Technologies (MDT) 2018

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement (HRA) is an IRS-approved program which allows MDT to share in
the cost of specific expenses within designated health plans.

The PPO plan is an HRA plan. If you choose this plan, MDT will assist you in paying part of the
deductible should you or a covered family member require a service(s) subject to the deductible.

Here is how it works:

HRA PPO 15/0

IN NETWORK Deductible: $5,000 Single / $10,000 Family

Employee pays the first $700 of single IN NETWORK deductible /
$1,400 of family IN NETWORK deductible

MDT pays up to $4,300 of each single IN NETWORK deductible /
$8,600 of each Family IN NETWORK deductible

Maximum deductible exposure for Employee:
$ 700 Exposure on single IN NETWORK deductible
$1,400 Exposure on family IN NETWORK deductible
(Employee responsible for all/any OUT OF NETWORK
costs)

Process to Receive MDT Paid Portion of the IN NETWORK Deductible

(1) Provider bills services to BCBSM
(2) Employee receives EOB (Explanation of Benefits) from BCBSM for services
(3) Employee sends EOB(s) along with HRA Claim form to EBC for processing
(4) EBC electronically deposits CU portion in employee’s designated Checking or Savings account
(5) Employee pays billed deductible with funds received from EBC

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