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Tips for Using a Premium Only Plan

A Premium Only Plan (POP) is a tax-advantaged arrangement for people who purchase their own non-medical insurance coverage. POP allows you to deposit pretax dollars into a special account to pay for eligible insurance premiums. This can ultimately decrease your taxable income and put more money in your pocket. Here’s what you need to know about how your POP works and how to submit claims.

What’s covered

If you are an active employee, you can use your POP to pay for insurance premiums for stand alone policies like dental, vision, or other benefit policies not under guidance by the Affordable Care Act with pretax dollars.

What’s not covered

You cannot use your POP to pay for major medical health plan insurance, long-term care insurance or expenses, or policies with a return-of-premium feature, such as a cancer policy.

Medicare pretax premium reimbursement

Pretax premium reimbursement for Medicare premiums through a cafeteria plan such as POP is NOT allowed for active employees or their spouses or dependents because it may violate the Medicare Secondary Payer (MSP) rules. Simply stated, Medicare insurance premiums (including Medicare Part B and Part D premiums, Medicare Advantage (Part C) and Medicare Supplement) are not reimbursable pretax through your POP.

Submitting claims

To ensure that your claims are processed promptly and accurately, please upload the proper documentation with your claim. Documentation must include:

  • Your name;
  • The amount of the claim or expense;
  • The time period that the amount covers;
  • The type of insurance or expense, and the name of the insurance company.

Submit your claim to Further no sooner than 30 days before the last date of coverage for a specific time period.
(For instance, submit claims for May no sooner than May 1.)

Documentation options (choose one):

  • A billing statement from your insurance company; or
  • A letter from your insurance carrier; or
  • A bank statement or a printout of an online bank statement that shows the withdrawal amount as the same amount that’s being requested for reimbursement.

When using a bank statement, the dates of service will be the one-month period in which the withdrawal was made or the actual dates of coverage shown on your policy.

  • If you use electronic funds transfer (EFT) to pay your monthly insurance premium, you will need to submit a copy of the verification or confirmation letter you received from your insurance plan when you initially signed up for EFT. This EFT confirmation states the amount that would be withdrawn from your account each month. You must submit a copy of the same letter with every claim. You will need an updated or amended EFT letter from your insurance plan each year, and any time the amount being withdrawn changes during the year.

Further cannot accept the following items as documentation for your claim:

  • Canceled checks
  • Handwritten statements from you detailing expenses
  • Copies of online bank statements that do not show your name and address
  • A copy of your application for coverage