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centurylink health and life reimbursement account

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HRA PREMIUM CLAIM FORM CenturyLink (08041) P.O. Box 785040 Orlando, FL 32878-5040 Fax: 1-888-211-9900 Customer Service: 1-800-729-7526 www.centurylinkhealthandlife.com ACCOUNT HOLDER FIRST NAME ACCOUNT
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PAYMENT STATUS (PREMIUM EXCEEDED/PAID) POLICY HOLDER NAME $ * This should be the address to which your Premium Payment is being sent. ITEM 3 FEE PAYMENT SENT (EXCEEDED/PAID) POLICY HOLDER NAME $ * This should be the telephone number to which your FEE Payment is being sent. ITEM 4 FEE PAYMENT DENIED (EXCEEDED/PAID) POLICY HOLDER NAME $ * This should be the address to which your FEE Payment is being sent. It is not necessary for you to provide this information. ITEM 5 FEE PAYMENT RECEIVED (NOT RECEIVED) POLICY HOLDER NAME $ CHARGE PAYMENT SENT BY NONCOMPLIANT CHARGE TYPE (EXCEEDED/PAID) POLICY HOLDER NAME $ * This should be the address to which your charge is being sent. ITEM 6 CHARGE DENIED (NOT RECEIVED) POLICY HOLDER N/A CHARGE EXCEEDED/PAID POLICY HOLDER NAME $ * This should be the billing address of the account being billed. FEE WAIVER OPTIONAL FEE POLICY HOLDER NAME $ (OPTIONAL) POLICY HOLDER NAME * * This should be your Name and Title on your premium payment receipt and your name on your insurance policy. The statement you provide must indicate the amount of your premium, the date you paid your premium, and how you obtained the Premium Payment. The statement you fill out must contain: Your name, Your telephone number, Your address, and The full name of the charge recipient's insurance company. Please Note: We are prohibited by applicable federal and state laws from requiring the submission of more than one premium payment for the same charge. You may submit one or two premium payments for the same charge or for different periods, and may submit one or two premium payments per form. ITEM 7 PAYMENT RECEIVED (NOT RECEIVED) POLICY HOLDER NAME $ (OPTIONAL) POLICY HOLDER NAME * * Please provide your full name. It is important to use your correct name on your account and to complete it clearly. Your mailing address should be a true mailing address. ITEM 8 PREMIUM PURCHASE ACCOUNT POLICY HOLDER N/A FEE WAIVER OPTIONAL * * This

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Hi my name is Omar Reid, and I'm the senior vice president of HR for hairs Health System I'm here today to talk a little about the changes that are coming for our retiree benefits program post employment health benefits program we recognize that a promise has been made in the past to retirees, and certainly we want to make sure we keep with that promise or promise made is a promise kept so on June 1st the first thing that is changing is that new employees will no longer be eligible for retiree health cares and then on January 1st 2020 we will introduce what is known as a health reimbursement account to retirees it absolutely has no effect on pinch in the pension and 401k and 457 will remain intact and there is no impact to pensions whatsoever an HRA is a health reimbursement account an HRA is an account that can be used to pay for medical expenses out-of-pocket expenses, and it can also be used to pay for health care services and our HRA is going to be a fully funded HRA in every month hairs health will deposit money into retirees accounts, and you will be able to take that money and go out and purchase services in the marketplace to be eligible for the HRA you have to be a retiree of Harris health system who is eligible for a retiree benefits which means you have to have reached the rule of 80 not necessarily do you have to be over 65 we will have people who are under 65 right now who are current retirees who are eligible for the HRA, so there are really three main benefits to an HRA one is that it is fully funded by the employer second benefit is going to be that it is an account that we fund to you tax-free, so you'll receive the money tax-free and the third benefit is it that it gives you more choice it gives you an option to really go out and look for the benefits that are important to you, so HR BS are certainly a common form of health insurance that is in the marketplace right now many of the institutions in not only the Texas Medical Center but across the city of Houston fund Has not only for their active employees but also for their retirees, so an HRA is a very common form of health reimbursement that we see in the marketplace right now if you have questions certainly you can call our benefits department and well be happy to answer those questions, and you can send us emails also and were happy to answer those questions via email Music

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