All frequently asked questions related to health care and insurance benefits are included on this page to encourage word searches to find the answer(s) you seek. Here are topics included:
Health Reimbursement Account (HRA)
The only on-going use of Health Reimbursement Accounts (HRAs) by the South Dakota State Employee Benefits Plan is limited to the Our Healthy Baby program and Opt-Outs. HRAs were utilized in FY16 for the one-time credit.
Q1. What is an HRA?
A Health Reimbursement Account (HRA) is an employer-funded account that reimburses employees for certain medical, pharmacy, dental and vision expenses incurred by employees, spouses and eligible dependent children.
Q2. Can unused amounts in the HRA be carried over to the next year?
Yes. Any remaining HRA dollars can be used in future plan years as long as you are employed with the State.
Q3. Can I make contributions to my HRA?
No. This is an employer–funded account.
Q4. How do I use the HRA?
If you already have a debit card from Discovery Benefits, you will be able to use the same debit card to access your HRA funds. If you don’t already have a debit card from Discovery Benefits, you will receive one. If you are not interested in using a debit card for expenses, claims for out-of-pocket expenses can be filed online. You can download the HRA claim form here.
Or they can be mailed into Discovery Benefits, PO Box 2926, Fargo ND 58108 or faxed to 1-866-451-3245.
Q5. Are there different types of HRA accounts?
Yes, there are also Limited HRA accounts and Wellness HRA accounts.
- If you elected the High Deductible Health Plan with an HSA plan during the recent annual enrollment or were previously covered on the High Deductible Health Plan, you have a Combination HRA. A Combination HRA can only be used for dental, vision, or expenses that remain after your medical deductible is satisfied.
- Your Wellness HRA can be used to reimburse wellness expenses, such as park passes, gym membership, and hunting/fishing licenses.
Q6. What types of medical services can be used to reimburse myself?
Eligible medical services reimbursable by your HRA are those that are not reimbursable by insurance (or another source) and are medically necessary. This includes deductibles, copays and any co-insurance amounts you may incur. Dental and vision expenses also qualify for reimbursement.
Q7. Can I take my HRA balance with me when I leave employment with the State?
No. HRAs are only available to employees.
For a more complete list of qualified medical expenses, visit www.discoverybenefits.com/employees/eligible-expenses
Note that if you have already been reimbursed for an expense through your flexible spending account, you cannot be reimbursed for the same expense through the HRA account.
- HSA Employee Guide
- HSA FAQ - Participants
- HSA Employee Handout
- HSA Terms & Conditions FAQ — Employees
- HSA Payroll Deduction Form
Q1. How do I set up an HSA?
If you enrolled in the High Deductible Health Plan for FY18, you will receive information from the South Dakota State Employee Benefits Program and Discovery Benefits on how to set up an account.
Things we want you to know:
- You will not have maintenance fees with the Discovery Benefit account.
- The State only will make employer contributions and pretax payroll contributions to Discovery Benefit accounts.
Q2. What is a Health Savings Account (HSA)?
HSAs are individual savings accounts designed to pay for qualified medical expenses of a participant (plus spouse and dependents) in a High Deductible Health Plan. An HSA plan has two components:
- A qualified high-deductible health insurance plan
- An individual tax-exempt trust (savings/investments)
The savings account is designed to pay for routine medical expenses/and or provide savings for the future. Money put into the account can be used either during the year or accumulated in the account.
Allowable medical expenses are defined by the IRS and are much broader than most insurance carriers (i.e., includes dental, vision). For additional information refer to the IRS Publication 502 for specific details.
- High deductible health plans, like the $1800 Deductible Health Plan, have lower premiums than other plans with copayments.
- By allowing individuals to keep any unused money in the HSA, there are incentives for consumers to check bills, compare costs, and evaluate urgency/frequency of appointments.
Q3. Who is eligible for a Health Savings Account?
Members enrolled in the High Deductible Health Plan may set up an HSA. You are not eligible if you are:
- covered by a health plan that is not a qualified high-deductible health plan (dual coverage).
- a dependent on someone else’s tax return.
- entitled to Medicare benefits (age 65 or older)
- have a spouse who is contributing to a medical savings/flexible savings account that is not limited
HSA rules are determined at the federal level. Individuals may be eligible under state guidelines for qualified health insurance coverage, but not eligible to open the savings account portion of the plan.
Q4. Does the State contribute to my HSA?
Yes. If you are an active employee enrolled in the High Deductible Health Plan for FY18 and have an HSA with Discovery Benefits, the State will contribute to your Discovery Benefits account.
Q5. How much can I contribute to my HSA?
Contribution amounts are indexed annually at the Federal level. Maximum contribution amounts from all sources are:
- $3,400 (single coverage)
- $6,750 (family coverage)
Q6. Am I able to make "catch-up" contributions to my HSA?
Yes. For individuals age 55 or older, additional "catch-up" contributions of $1,000 are allowed. Contributions must stop once an individual is enrolled in any type of Medicare.
Q7. For what types of medical services can I be reimbursed?
An HSA lets you set aside money for medical, dental, and vision expenses on a pretax basis. IRS Publication 502 has a checklist of expenses that can be itemized. Most of these expenses qualify for tax-free withdrawal from an HSA, unless the expenses were reimbursed by your health care coverage.
You may use your HSA to help fund your deductible. Using your HSA dollars toward your deductible is optional. You can choose to pay your deductible out-of-pocket and save your HSA money for future medical needs.
One expense that cannot be reimbursed from an HSA is the premium for most health care plans.
To order IRS Publication 502, call 1-800-TAX-FORM or you may view the list by visiting http://www.irs.gov/pub/irs-pdf/p502.pdf.
Q8. Can unused amounts in the Health Savings Account be carried over to the next year?
Yes. You may use your Health Savings Account for future eligible medical expenses if you do not deplete your HSA during the plan year.
Q9. Are there tax advantages for using a Health Savings Account?
Yes. You get triple tax benefits with tax-free growth, tax-free withdrawals, and tax credits to pay for out-of-pocket health care expenses.
Q10. Can I take my Health Savings Account balance with me when I leave employment with the State?
Yes. You can take your account balance with you if you leave employment with the State.
Flexible Spending Accounts
Eligible Employees may choose to participate in the following flexible spending accounts:
- Medical Expense Spending Account
- Provides pre-tax reimbursement for eligible expenses
- Dependent Care/Day Care Spending Account
- Provides pre-tax reimbursement for eligible expenses
Flexible Spending Accounts (FSA) Documents:
- Flexible Spending Account (FSA) Employee Guide
- Guide to the Benefits Debit Card
- Guide to Filing Claims
- Guide to Substantiating Debit Card Transactions
- Mobile App Instructions
Q1. Can I still use my Flexible Spending Account (FSA) funds from FY17?
Per IRS regulation, unused amounts remaining in your account will be forfeited in accordance with the use-or-lose rule. You have until September 14, 2017 to incur eligible expenses for you or your family members for reimbursement. Claims must be submitted to DAKOTACARE Administrative Services by October 27, 2017 to be eligible for reimbursement.
Q2. How do I submit a claim?
- Web Page – www.dakotacareflexonline.com
- Log-in using the first four letters of your last name and the last four of your social security number.
- Navigate to “Submit a Claim” in the blue header, fill in your information and upload an itemized statement from your provider.
- Submit claims via mail, fax or email. You will need to fill out a claim form and attach an itemized statement from your provider.
Q1. What do I need to know about the dental plans this year?
- Both the Base Plan and the Enhanced Plan pay for services based on a covered percentage of allowable charges.
- The deductible under the Base Plan is $25 per plan year per member. There is no deductible on the Enhanced Plan.
- On the Enhanced Plan, problem focused exams, periapical x-rays, full mouth x-rays, dental sealants and space maintainers will be covered at 100% rather than 80%.
- Both the Base and Enhanced Plans include Smile Smart for Your Health, a program which provides additional preventive dental care services for members who have certain medical or dental conditions.
Q2. What is the deductible?
The deductible is the dollar amount members pay for covered services in a plan year before benefits are available. Only the Base has a $25 per plan year per member deductible.
Q3. What is the annual maximum benefit?
The annual maximum benefit is the amount each member is eligible to receive for non-orthodontic covered services in a plan year. The annual maximum benefit is $1,000 on the Base Plan and $2,000 on the Enhanced Plan.
Q4. How do the Base and Enhanced Plans cover services?
Both the Base and Enhanced Plans pay for services based on a percentage of allowable charges. The Enhanced Plan covers a higher percentage of allowable charges than the Base Plan. Refer to your FY17 Decision Guide for plan specific percentages.
Q5. What are the differences between the Base and Enhanced Plans?
- The Enhanced Plan covers a higher percentage of allowable charges than the Base Plan.
- The annual maximum benefit for non-orthodontic services is $1,000 per member on the Base Plan and $1,500 per member on the Enhanced Plan.
- The Enhanced Plan allows qualified members to carry over $250 per plan year of unused annual maximum benefits in a Maximum Bonus Account (MBA) if they file at least one claim during the plan year and benefits paid are less than $750 for the plan year.
- The Base Plan provides a $1,000 lifetime orthodontic benefit for children only and the Enhanced Plan provides a $1,500 lifetime orthodontic benefit for children and adults.
Q6. Is there a waiting period for services in FY17?
No, there is not a waiting periods for FY17. If you do not enroll in either dental plan during FY17, there will be one year waiting periods for major and orthodontic services.
Q7. What happens if I enroll in one plan and want to switch plans next year during annual enrollment?
Both plans allow enrolled members to switch between plans during annual enrollment without waiting periods.
Q8. How many routine exams and cleanings are covered?
Both the Base and Enhanced Plans allow for two routine exams and cleanings per plan year. These exams and cleanings do not have to be six months apart. You may be eligible for additional cleanings through the Smile Smart for Your Health program.
Q9. Are there frequency limitations on dental services?
Yes, some services have a time frequency on how often they will be covered by your plan. Many of the frequencies are outlined in the dental plan summary plan description. You may also contact Delta Dental at 605.224.7345 or 877.841.1478 with frequency limitation questions.
Q10. What is a participating/network dentist?
A participating/network dentist signed an agreement with Delta Dental and agrees to abide by certain guidelines, such as not charging Delta Dental subscribers more than the pre-approved fees. Participating/ network dentists submit claims directly to Delta Dental for their patients.
Q11. How do I find a participating/network dentist?
To find a participating/network dentist, visit www.deltadentalsd.com and click on “Find a Dentist”.
Q12. Do I have to go to a participating/network dentist?
No, you can go to any dentist you choose but you may pay less out-of-pocket when you go to a participating/network dentist. Roughly, 98% of South Dakota dentists participate in the Delta Dental network.
Q13. Can I visit an out-of-state dentist?
Yes, you can visit dentists out-of-state and receive the same coverage as long as they are a Delta Dental participating/network dentist.
Q14. Do I need a referral to have a procedure done by a specialist?
No, you do not need a referral to receive care from a specialist. However, we strongly encourage you to use a participating specialist to maximize your benefit coverage. Visit www.deltadentalsd.com and click on “Find a Dentist” to locate a participating/network dentist.
Q15. Will I receive additional orthodontic benefit under Delta Dental if I already received my maximum orthodontic benefit?
No. Delta Dental has agreed to continue paying the lifetime orthodontic benefit for eligible members with plans in progress who have not met their full benefit by 6/30/2015. If you already received your full maximum orthodontic benefit under the previous plan, you will not receive an additional orthodontic benefit under the Delta Dental plans.
Q16. Can I move to the Enhanced Plan to receive an additional $500 in orthodontic benefits if I am currently enrolled in the Base Plan?
No, only when your orthodontist starts a completely new treatment plan will additional benefits be considered. Delta Dental will pay $1,000 for orthodontics in the first year on either plan. In order to receive the additional $500 payment in the second year on the Enhanced Plan, the enrollee must still be enrolled in the Enhanced Plan. Orthodontic benefits paid by your current plan will count toward your lifetime orthodontic benefit.
Q17. How will I know when my claim has processed?
You will receive an Explanation of Benefits (EOB) that describes the services your dentist submitted and the benefits that your plan provided. You may also visit the website www.deltadentalsd.com and log on to the
Q18. Can I find out what my treatment will cost before I have it?
Yes, your dentist is encouraged to submit a Predetermination of Benefits of your proposed treatment plan to Delta Dental. Delta Dental will process it and send your dentist an Explanation of Benefits that shows what would be covered and how much you would have to pay. Your dentist will send you this information.
Please keep in mind that although a pre-treatment estimate may state Delta Dental will pay a certain amount for a procedure, it is not a guarantee of payment, as circumstances may change (e.g. your annual maximum could be met before the proposed treatment date). For services that your dental plan does not cover at 100%, having a pre-treatment estimate lets you know what your out-of-pocket costs will be.
Q19. What is a Maximum Bonus Account (MBA)?
The Maximum Bonus Account is a savings account available to members enrolled in the Enhanced Plan. Enhanced Plan members are eligible to receive $250 per year in Maximum Bonus Account (MBA) benefits if they file at least one claim during the plan year and benefits paid are less than $750 for the plan year. The MBA maximum is $1,500 per member and cannot be used on orthodontic claims.
Q20. What is the Smile Smart for your Health program?
Delta Dental’s Smile Smart for your Health program allows for additional benefits (extra cleanings and/or fluoride treatments) for enrollees that have any of the following health conditions: periodontal disease, diabetes, pregnancy, high-risk cardiac conditions, kidney failure or undergoing dialysis, undergoing cancer-related chemotherapy and/or radiation, suppressed immune systems, and a brush biopsy test for those at risk for oral cancer.
Q21. What happens if I am covered by two dental plans?
Having two dental plans (called "dual coverage") does not "double" your coverage. However, it may mean that you will pay less out-of-pocket. One plan will be considered primary (the one that covers you as an employee), and the other will be secondary (the one that covers you as a dependent). If you have children covered, the primary is usually the plan that covers the parent whose birthday falls first in the calendar year (month and day, not year). For example, if your spouse's birthday is March 13 and your birthday is June 27, your spouse's plan is the primary plan for the children.
When a member has coverage through two carriers, benefits are coordinated by the two carriers so the member gets the maximum benefit from both plans, but not to exceed 100% of the total charge. Claims should first be submitted to the primary plan for payment. If the charges are not paid in full by the primary plan, the claim should then be submitted to the secondary plan for possible additional payment on the charges. Some dental plans may have a non-duplication of benefits rule. This means the secondary plan would pay only if the primary plan paid less than the secondary plan would have paid had it been the primary plan. In this case, the total benefit would be limited to the payment made by the primary plan. You are responsible for paying the remainder.
If both members are employed by the State of South Dakota, you cannot have dual coverage.
Q22. Whose insurance covers the children first if my former spouse and I both have dental coverage?
It usually depends on who has financial responsibility for the children. If the parents have joint custody, then the parent with the birthday earliest in the calendar year has primary coverage.
Q23. Can my former spouse's insurance still cover our children if I am divorced and have physical custody?
If your former spouse has dental coverage that includes dependents, the children have coverage regardless of whether or not they reside with you or your spouse.
Q24. How do I replace lost ID cards?
You can print new ID cards by going to Delta Dental’s website at www.deltadentalsd.com and clicking on the Subscribers section. Under “Your Delta Dental Benefits at a Glance” click ID card. You will be asked to sign on to the secure site to get your ID Card. You can also call 605.224.7345 or 877.841.1478 and ask for a replacement card.
Q25. Can I continue my dental coverage after I leave my job?
You may be eligible for COBRA continuation coverage through your employer. If you have questions about COBRA, please contact the South Dakota State Employee Benefits Program at 605.773.3148.
Q26. Does Delta Dental offer a toll-free number if I have a question?
Delta Dental's local (Pierre) number is 605.224.7345 and the toll free number is 877.841.1478.
beneFIT Wellness Program
Q1. Am I required to complete the three wellness qualifications?
The beneFIT well-being program is offered as a benefit to employees. Incentives are provided to those who choose to complete all three wellness qualifications:
- Health screening
- On-line health assessment
- Earn 100 wellness points
Q2. What are the incentives for completing the three wellness qualifications?
If you complete the three wellness qualifications prior to March 31, 2018, you earn:
- Eligibility to sign up for the Low Deductible Health Plan
- The maximum contribution by the state to your Health Savings Account (HSA) on the High Deductible Health Plan for FY19.
Q3. If I do not complete all three wellness qualifications by March 31, 2018, can I still select the lowest deductible plan for FY18?
No. To be eligible for the Low Deductible Health Plan, you must complete all three wellness qualifications prior to March 31, 2018.
Q4. If my spouse is also covered by my health plan, do they need to complete the wellness qualifications too?
Yes. Covered spouses must also complete the three wellness qualifications in order for you to be eligible for either incentive: 1.) the Low Deductible Health Plan, or 2.) maximum contribution by the state to your Health Savings Account (HSA).
Q5.I have completed the three wellness qualifications. When do I receive my Health Savings Account (HSA) money?
If you select the High Deductible Health Plan for FY19, you will earn the maximum contribution by the state to your Health Savings Account (HSA), if you complete the three wellness qualifications prior to March 31, 2018. These funds will be transferred to your health savings account in July 2018.
Q6. I do not have access to a computer, how can I complete the three wellness qualifications?
If you do not have access to a computer, tablet or smartphone, you can call the StayWell HelpLine at 800-721-2749 and they will provide alternate methods for documenting the wellness qualifications.
Q7.I do not have access to the internet. Can someone help me schedule a health screening?
Yes. Call the StayWell HelpLine at 800-721-2749, and they can assist you.
Q8. I missed the on-site health screening event in my area. Is there any other way to complete this qualification?
You can complete your health screening qualification by scheduling an annual wellness exam with your physician. Log in at benefitstaywell.com to print out the health care provider form. Once logged into your account, scroll down to the beneFIT News section. Click the Let’s go! button under Screenings. Scroll down and select the hyperlink for the Health Care Provider Form. The form includes instructions on submitting the form prior to March 31, 2018.
Q9. If I visit my health care provider to complete the health screening as a part of my annual wellness exam, will the cost be covered by insurance?
Yes. Each member is eligible for one annual wellness exam covered at 100 percent as preventive care once per plan year. If you have not visited your physician for preventative care since April 1, 2017, it will be covered. If you have had screening tests conducted earlier in the year, you can print the Health Care Provider Form and have the clinic fill in the results from your last appointment.
Q10. How do I change my health screening appointment?
Log into benefit.staywell.com. Select the Programs Tab, click on screenings, and select “schedule a screening” to log into the Summit Health portal where you made your appointment. In the upper left corner of the screen, select Appointment >>Manage Appointment. You can cancel or edit your scheduled appointment from this screen. Call the StayWell HelpLine at 1-800-721-2749, if assistance is needed.
Q11. How do I get a copy of last year’s health screening results?
Log into your account at benefit.staywell.com and select the My Health Assessment tab.
Scroll down and select View Results
Q12. I am visually impaired. Is there someone that can help me do the online health assessment?
Yes. Call the StayWell HelpLine at 800-721-2749. They will schedule an appointment for you at a later date with a trained staff member to assist you in completing the health assessment.
Q13. I have completed several activities to receive my points. Why does the progress bar still show 0?
You can track your progress under the My Incentive tab. The progress bar across the top of the page will not activate until you have completed the health screening and the online health assessment. Once you have completed both of these gateway qualifications, your points will populate across the progress bar. Please note it takes 14 business days for health screening results to be loaded into the system and marked complete. Certain points may take up to 48 hours to be updated in the system. You can also track your progress by checking your points on the upper left side of the screen.
Q15. I have entered dates for all of my exams (annual wellness, dental and vision exams). Each is worth 25 points, but it is only giving me credit for 50 points?
The beneFIT well-being program is designed to encourage involvement in a variety of wellness activities. Therefore, maximum point limits have been designated within each category. For the Prevention Care Programs category, the maximum you can earn is 50 points.
Q16. How long does it take for points to appear on the website and on the tracker?
Please allow 48 hours for the website to refresh and reflect your points.
Q17. How long does it take for my screening results to appear?
Screening results can take up to 14 business days to be loaded onto the website and marked complete on your account.
Q18. If I had my mammogram or annual wellness exam in April, can I receive wellness points for that visit?
Yes. You can earn points for any preventive care exams between April 1, 2017 and March 31, 2018.
Q19. Can I connect my fitness tracker to my beneFIT wellness account?
Yes. There are 13 different types of fitness trackers that can be connected to the beneFIT well-being program website at benefit.staywell.com. Log into the website, select the Programs tab and scroll down to select Health Trackers. Fitness trackers can be used to set a goal and track your progress.
Q20. Can I earn points for syncing my fitness tracker to my beneFIT wellness tracker?
Witness points will not be automatically credited to your account when syncing. You can earn points by tracking your activity for 3 days per week for 3 consecutive weeks. When you have completed this activity tracking, report your completion by selecting the My Incentive tab, under well-being activities, select “Physical”. Click on ‘Self Report Now’ and enter the date and the type of activity completed to earn 25 points!
Q21. I have been participating in the Conditions Management Program and have a coach through Health Management Partners (HMP); do I need to switch to a StayWell coach?
No. Your current Condition Management Program coaching arrangement will continue. You are welcome to also participate in lifestyle coaching through StayWell if desired. Some choose to engage with a StayWell lifestyle coach to address issues other than the areas you receive coaching through your Conditions Management Program.
Q22. Can I earn all of my wellness points by participating in a condition management program with Health Management Partners?
No. 100 wellness points are needed to meet the qualification. You can earn 25 points per month for up to three months for a maximum of 75 points, by participating in a conditions management program through Health Management Partners. These points will automatically populate under the My Incentive tab, HMP Enrollment Programs category, for each month you actively participate.
Q23. How do I request a change in the email address used by StayWell to send me reminders?
The email addresses are taken from your profile with the Bureau of Human Resources. Board of Regents employees, should contact your human resources office for more information. State employees can update information by logging into employee space at https://bfm.sd.gov/hr/es.aspx.
Q24. Can you participate in the beneFIT well-being program if you opted out of the South Dakota State Employee Health Plan insurance?
Yes. Any benefit-eligible employee may participate. Call the Bureau of Human Resources at 605-773-3148 to get a nine-digit health plan ID number and register at benefit.staywell.com.
Q25. I am retired. Can I access the beneFIT well-being program and resources? If I do not complete the three wellness qualifications will it impact my health plan?
You are welcome to access all of the beneFIT well-being program services. The three wellness qualifications will not have any impact on your ability to choose the health plan you want. The FY18 incentives apply to active employees only.
Q26. How do I know I have completed all three qualifications?
Once you have completed your health assessment, health screening and achieved your 100 wellness points, the progress bar under the My Incentive Tab, will show 100% and change to full green. If you have a spouse on your health plan, you and your spouse’s individual progress bar in the middle of the page will need to turn green, before the progress bar at the top will turn green.
Monitor your progress and your covered spouse's progress.