FAQs

Has your employer recently instituted a Medical Expense Reimbursement Plan (MERP)?  Are you confused about how the plan works?  ClaimLinx helps members understand how MERPs are administered through our system. 

Q

Why do I need insurance?

A

Without insurance, you and your family could literally be wiped out financially by just one trip to the emergency room or one surgical procedure.  In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. (source: www.kff.org)

Q

Is ClaimLinx an insurance company?

A

No. We are a third party administrator for employer sponsored plans.  We service “you” the client, not the insurance company.  Part of our expertise is in making sure that each individual claim has been reviewed for the maximum pay-out allowed.  In addition, we act as an educational resource for employees and their families in order to better educate themselves on the health care system.

Q

If I have regular health coverage, do I need any other insurance?

A

Having regular health coverage is nice, but when examining your overall personal profile, it is best to cover all the bases.  ClaimLinx partners with consultants/brokers in the area that also offer products designed to enhance your existing health coverage.  Such products include supplemental products, long-term care, life insurance, tax consulting and financial planning.

Q

What is a MERP?

A

Medical Expense Reimbursement Plans (MERPs) have been around for many years.  The MERP utilizes tax code that is over 50 years old called a Section 105.  The code allows business owners to deduct any portion of a medical expense for its employees.  This could include a business size of one or more. Therefore, if you are a sole proprietor, you could take advantage of this tax code. Click here to see how others have saved on health insurance. 

Q

Why did my employer purchase a MERP?

A

Your employer was shown the MERP because they are looking out for your best interest.  They are examining ways to cut costs while providing you with the same benefits.  Some employers have told us they would not have been able to even provide any health benefits without instituting a MERP.  

Q

What is a Section 105 Plan?   

A

Section 105 is a part of the tax code that allows employers to reimburse premiums and/or any health insurance costs tax free to the employee.  The tax code has been around for over 50 years and has been implemented by many large employers, but is also available to smaller employers.  For more information contact the IRS or click on Section 105 information.

Q

What is a deductible?

A

A deductible is a specific dollar amount that an individual must pay before reimbursement for expenses begins.  The higher the deductible, the lower the cost of the health insurance plan.

Q

For insured employees with dependent coverage, does the deductible for each person have to be satisfied before the reimbursement begins? 

A

Each person covered under the group health plan must meet a deductible before expenses will be covered.  However, plans usually include some type of family deductible in order to limit a family’s exposure for health care expenses.

The family deductible is usually some multiple of the individual deductible, generally two or three.  For the family deductible to be satisfied, the combined expenses of covered family members are accumulated.  Some plans require, however, that at least one family member satisfy the full individual deductible before the family deductible can be met.

Q

Is my information privacy protected?

A

Yes.  Our employees strictly adhere to all HIPAA privacy regulations.  Upon enrollment into the MERP plan, employees are asked to sign a HIPAA release form that ensures ClaimLinx follows all protected health information guidelines related to self-insured plans.  In addition, your employer will not be released any proprietary information, unless you know about it.  ClaimLinx maintains all personal information onsite, and performs strict electronic security measures.  Specific HIPAA regulations can also be found in the MERP document that is kept onsite through your plan administrator.