Page 10 - Jones and Frank Benefits Enrollments Guide

Health Reimbursement Account

Jones & Frank subsidizes a portion of the deductible when an employee or dependent incurs
applicable charges toward his/her deductible. The Deductible Maximum is per individual, up to 2
per family unit.

UHC Deductible: $5,000 /$10,000 for Core Plan
Deductible Responsibility: Employee Pays: Employer Pays:
First $3,500 $3,500 $0
Next $1,500 $0 $1,500
Total Liability $3,500 $1,500

UHC Deductible: $3,500 /$7,000 for Buy-Up Plan
Deductible Responsibility: Employee Pays: Employer Pays:
First $2,000 $2,000 $0
Next $1,500 $0 $1,500
Total Liability $2,000 $1,500

What are applicable charges? All charges applied toward the deductible.

How do I access the subsidy ? UHC will issue an Explanation of Benefits alerting you to the

amount applied toward your deductible. You will send the Explanation of Benefits to Flores &
Associates along with a Deductible Reimbursement Claim Form. This form can be found at
www.flores247.com or by contacting them at 800-532-3327. Claim forms can be faxed to Flores &
Associates at 800-726-9982.

How does it work?

1. The employee or dependent encounters an eligible expense.
2. The Provider files the claim with UHC at which time the claim is properly adjudicated. UHC
mails the Participant an Explanation of Benefits (EOB).
3. The Provider receives payment from UHC (if applicable) and bills the Participant for their
deductible portion.
4. The Participant submits the Explanation of Benefits (EOB) to Flores & Associates along
with the Deductible Reimbursement Claim Form.

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