When an employee switches policies mid-year, they can request to transfer what they've paid towards their deductible in the current calendar year over to their new policy. This can potentially alleviate the employee from having to pay extra towards a deductible on their new plan.
Who can apply for a credit?
Employees moving to an Aetna or UnitedHealthcare plan are eligible to apply for a deductible credit. Those employees moving to a Kaiser Permanente plan cannot receive a credit.
How much of a credit will be applied?
Ultimately the amount of the credit is up to the carrier to determine.
When should employees submit a request?
Deductible credit requests can only be submitted after the effective date of the plan. There is no deadline to submit a deductible credit or credit request during a calendar year, but the sooner it is submitted the more beneficial it is because fewer claims will be affected.
Employees should explicitly request a deductible credit and not a deductible transfer, or a deductible carryover as they are different.
How to apply for a credit on Aetna
There are two kinds of deductible credits that can occur:
Aetna to Aetna
Another carrier to Aetna
Aetna to Aetna Deductible Credit
Using their Aetna portal online:
The employee should log in to their Aetna account under Justworks
Click on 'Contact Us' then 'Send Message'
Select 'Other' topic
Select 'Other' topic again
The following info is required:
Indicate "Requesting Deductible Credit" (not a transfer or carryover as they are different and not allowed under our policies)
The employee's name
Old employers name
All dependents on the previous plan with DOBs
New group number (found on the new ID card)
Amount each person paid toward the previous plans' deductible
This can be obtained by going to your old Aetna account, see coverage and costs, click on medical balances & limits (you can provide a screenshot of this)
Another Carrier to Aetna Deductible Credit
The employee will need to provide their Explanation of Benefits (EOB) from their prior carrier to Aetna. If they had dependents they will also need to also provide a letter breaking down the deductible amounts for each member on the policy.
The employee will then fax the EOB (and letter) to Aetna and on a cover page include your new Aetna Member ID # and indicate "Requesting Deductible Credit" and fax to (859)455-8650. If they do not have access to a fax, you can mail the EOB to the address on the back of their Aetna ID Card.
COBRA transfers are eligible to apply for deductible credits and can follow the steps above.
How long does this process take?
Both kinds of deductible credit requests take 1-2 weeks for Aetna to review and process if approved.
Deductible credit visibility in Aetna Navigator
Log in to Aetna Navigator
See Coverage and Costs
Look for the “financial adjustment” under transaction type
Please note that deductibles and out of pocket maximums will reset at the end of the calendar year.
Aetna Dental & Prescription
Aetna would only provide a deductible credit for dental if the acquisition is mid-year. The employee or provider would need to submit the Explanation of Benefits (EOB) from the prior carrier as proof the deductible had been met. Similarly, prescription deductibles may also be considered when applying for a deductible credit. The employee would need to request an EOB showing these amounts in order to apply for these specific credits. Please note it is up to Aetna's discretion to approve these requests on a case by case basis.
For UnitedHealthcare deductible credits the employee must have continuous coverage. They will not complete a deductible rollover if an employee has a gap in coverage.
How to apply for a credit on UnitedHealthcare
There are three kinds of deductible credits that can occur:
- UnitedHealthcare to UnitedHealthcare (Company-wide)
- UnitedHealthcare to UnitedHealthcare (Individual)
- Another carrier to UnitedHealthcare (Individual)
UnitedHealthcare to UnitedHealthcare (Company-wide)
When an entire company previously on UnitedHealthcare moves onto Justworks' UnitedHealthcare plan we will work with the carrier to move the employee's credits from their prior policy to their new policy deductible automatically.
UnitedHealthcare to UnitedHealthcare (Individual)
When an individual is coming from a previous UnitedHealthcare policy to a current Justworks UnitedHealthcare policy, the individual can work with the carrier directly to have deductible credits processed.
The employee can send an email stating the prior policy/member ID information and the current policy/member ID information to email@example.com. The employee will not receive a response indicating that the email was received or that the request was completed. Once the information is emailed to firstname.lastname@example.org, the member should allow 7-10 business days for the information to be listed under the member’s myuhc.com profile, under the accumulators amounts.
UntedHealthcare's customer service can provide updates for deductible credits if needed.
Another carrier to UnitedHealthcare (Individual)
The employee must provide UnitedHealthcare with an Explanation of Benefits (EOB) that includes a summary of the accumulations met for the current plan year for each individual member in the family. This includes in-network and out of network deductibles and out of pocket maximums. This will ensure a smooth transition for credits to be applied from the member's prior non-UHC carrier to their new UHC policy.
- Employees should fax their EOBs to (877)420-1579. If they do not have access to fax, they may email their EOBs to email@example.com.
- Once the EOB is received, an agent will submit the request to UnitedHealthcare's conversion department and note the employee's account.
- Pro-Tip: UnitedHealthcare will not reach out proactively to give employees confirmation of receipt. The employee will need to contact UnitedHealthcare's customer service team directly and put in a request that they reach out once the process is completed. Similarly, UnitedHealthcare will also not reach out to the employee if any information is missing/unclear in the documentation provided. Instead, a note will be made in UnitedHealthcare’s customer service system and the employee will need to contact them directly to find out why the documentation was not sufficient.
How long does this process take?