QPS Emergency Funding Report

Welcome ,

Need help? Please email any questions to healthplanhelpdesk@coalitionexchange.org

Please enter the information of the primary applicant/Employee below
Date of Birth(mm/dd/yyyy)
Last 4 digit of your SSN:

Click to view your available balance on your Summit MasterCard.
Click to request emergency cash funding. (Only use this if you have already paid your provider direct and have a reimbursement reported below)

EGYPTIAN TRUST ERA

In the months of January-October 2022 You Were Insured at the Egyptian Trust

This was the Benefit You Signed Up For

This was the Amount of Deductibles, Coinsurance and Copays Each Family Member Incurred- THIS IS THE AMOUNT BCBS SHOULD HAVE CARRIED OVER

Calendar Year	First Name	Last Name	Relationship	Deductible	Coinsurance	Copay	OOP Sum Ded Plus Coinsurance

BCBS ERA

In the months of November-December 2022, BCBS was to combine the claims of the Egyptian Trust Era with any claims incurred under the new BCBS Plan.

Below is the Benefit You Were Awarded at BCBS. This plan has less protection than you are used to. In order to recreate your original benefit,
Quincy Public Schools runs an HRA (Health Reimbursement Account) that reimburses any increased out of pocket attributable to deductible and coinsurance (some copays have gone up but the total OOP remains).

Second plan Not to worry, This benefit is when combined with an QUINCY PUBLIC SCHOOLS DEDUCTIBLE REIMBURSEMENT.

Calendar year	Plan Name	Individual			Family
		Max Deductible	Max Coinsurance	Max OOP	Max Deductible	Max Coinsurance	Max OOP

Below is the New QPS BCBS PLAN (Nov and Dec) Amount of Deductibles, Coinsurance and Copays Each Family Member

Plan year	Name	Total BCBS Billed	Total BCBS Allowed	Total BCBS Paid	Total Due Provider	Total BCBS Deductible	Total BCBS Coinsurance	Total BCBS Copay	Total BCBS OOP
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Below is the FULL YEAR COMBINED Amount of Deductibles, Coinsurance and Copays Each Family Member (Egyptian Trust + New QPS BCBS PLAN in Nov and Dec).

Calendar Year	First Name	Last Name	Relationship	Deductible	Coinsurance	Copay	OOP Sum Ded Plus Coinsurance

Quincy Public Schools HRA

BCBS has acknowledged that they did not carry over Egyptian Trust credits. They are in the process of correcting claims.
We know that providers have begun to bill employees as they are unaware that the information they got from BCBS is incorrect.

The below report identifies the expected amount BCBS will be funding as well as the amount your HRA will reimburse to cap your out of pocket to the benefit you enrolled for in September.

The HRA amount depicted is the TOTAL that has been placed on your card since December.
Please click the SUMMIT MASTERCARD link above to view your current available balance and any prior transactions.

The below calculation takes into account only deductible expenses. If you are on an M series plan you have doctor visit and RX copays. You will receive a separate reconciliation this week.

If your report indicates an additional amount is due from BCBS, you will receive separate instructions as we will assist in getting your provider to stop billing until BCBS corrects your claims.

Plan year	first name	last Name	Relationship	YOUR BALLOTED PLAN	potential Funds Expected From BCBS	HRA budgeted TO YOUR MASTERCARD
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BCBS CLAIM TRACKER

Every 20th day of the month we receive the claims that BCBS processed in the month prior.

Any information you received last month on a BCBS explanation of benefits is summarized below.

Plan year	Name	Total BCBS Billed	Total BCBS Allowed	Total BCBS Paid	Total Due Provider	Total BCBS Deductible	Total BCBS Coinsurance	Total BCBS Copay	Total BCBS OOP
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Claim Type	Date Of Service	Place Of Service	Billed Amount	Allowed Amount	Carrier Paid	Your Responsibility	Primary Diagnosis	Procedure Description	Procedure Code	Deductible	Coinsurance	Copay	Penalty	Medication Name	Medication QTY	Medication Supply	LineId

Processed Date	Date of Service	Plan Year	Name	Claim Number	Provider	Claim Type	Total Billed	Penalty	Allowed Amount	BCBS Paid	Amount Due Provider	Total Deductible Reimbursements	Total Copay Reimbursements	Employee Real Responsibility
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