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ExplainingBenemax toyour ProvidersGlossary ofTermsFinancialAcademyClaimsConnectionContact UsByte-SizedBenefitsPodcastAdditionalResourcesFromYour MedicalPlan andBenemaxFlexibleSpendingAccountsBenemax CardCommuterMedicare
Who pays for what and when?You or a member of your family visits your provider(doctor/hospital) and shows both their medical carrier ID cardand their Benemax Card. 1.Your provider will bill your medical carrier. 2.Your medical carrier will process your claim, notify yourprovider, and send a Claims Summary to you and yourprovider. 3.In most cases, Benemax receives a report of your claims fromyour medical carrier. Benemax reviews your claim and (ifapplicable) makes additional payments on behalf of youremployer. 4.Benemax posts a Benemax Explanation of Benefits (EOB) onyour Claims Connection portal. You are responsible to pay theamount due to your provider as shown.5.Understanding Your Explanation of Benefits (EOB)When you receive your Benemax Explanation of Benefits (EOB),pay very close attention to it. Your Benemax EOB not only containsall the important information about your claim(s), it also serves asyour bill. Any other documentation or invoice you may receive isinformational only. When it comes to what you should pay, your Benemax EOB is yourguide. If you have questions or need help understanding your BenemaxEOB, please contact a Benemax I Member Advocate either byphone (800-528-1530) or via emailbenemax.service@onedigital.com.Do not make a payment to your provider until you havereviewed your claim responsibility amount on your BenemaxClaims Connection portal.Reading and Understanding your EOBBenemax Claims Connection PortalUnderstanding the Benemax CardAccessing your Benemax EOBYour Medical Plan and BenemaxBack
Plan members can track their claims history and spending throughthis secure portal. The individualized claims site also offersinformational videos, the ability to access your EOB online, and theoption to use electronic upload for claims.Medical Claims SubmissionIn most cases there is a weekly automatic claims feed from yourmedical carrier to Benemax. Members and providers may alsosubmit claims using any method below.Email: benemax.claims@onedigital.comFax: 508-242-6198Mail: Benemax , POBox 950, Medfield, MA, 02052You should include an EOB or Claims Summary and a copy of theProvider Bill. You can also submit claims electronically (Some of our plans arenon-reporting with the insurance carrier and employees mustsubmit claims manually). Submit a copy of your invoice and EOB tobenemax.claims@onedigital.com for processing. Please indicatewhether your claim is for medical coverage, dental, or FSA/DCA.Logging InIf you are a first time user. please use your SSN as your usernameand password in the following format (you must include the dashesin your SSN):Username: XXX-XX-XXXX00 (add two zeros at the end of yourSSN)Password: XXX-XX-XXXX (no additional zeros needed)You will then be directed to change both your username and yourpassword to complete your registration.FormsBenemax Claims Connection PortalClaims ConnectionHIPAA Designation of Personal RepresentativeHIPAA Release FormFSA and DCA Claim Details and SubmissionCommuter Claim Details and SubmissionBack
Explaining Benemax to your ProvidersSample Provider LetterIf your provider needs help understanding how both layers of coveragework together, you can share with them this letter.Back
Member ServicesFor questions about your benefits or yourclaims, always call Benemax first - yourIndependent Member Advocate (IMA) canhelp! You’ll get one-on-one access to a local,licensed Benemax team member who willhelp answer questions you may haveregarding your benefits. This is not a callcenter, but an extension of your employer’slocal service team dedicated to helping you.We can help you to:Learn how your claims are paidUnderstand your covered benefitsUnderstand pre-tax accountsUnderstand and lower costsNavigate escalated claim issuesBenemax.service@onedigital.com800-528-1530, prompt 3Available Monday - Friday, 8:30am - 5pm ESTBe sure to provide your name, employername, and your question or issue. EnrollmentEnrollment Coordinators can assist with allenrollment questions.We can help you with:ID CardsEligibility VerificationEnrollment and Demographic Changes*COBRA Support*Enrollment Changes must be coordinated through your HRDepartment. They will submit the information to Benemax.benemax.enrollment@onedigital.com800-528-1530, prompt 4Online ServicesWe offer online support, educational videos,and the ability to ask a question online.Claims Connection allows members to tracktheir own claims and individual spending.Online services include:Online VideosOnline Claims AccessHelpful LinksBenemax Claims Connection PortalFSA and DCA Claim Details and SubmissionContact UsMedical Claims Connection DetailsCommuter Benefit Claim Details and SubmissionBack
Flexible Spending AccountsNot available or offered to all Benemax customers. Referenceyour benefit enrollment information to determine your eligibilityand benefit specific details, as well as vendor specific resources.Flexible Spending Account(s) allow employees to elect a specificdollar amount from payroll that you wish to direct to a specificaccount as show below. These funds are taken pre-tax and followthe same laws as other types of pre-tax benefits (like medical anddental). Once elected, you must have a qualifying life event to stopor change your deduction amount. If you do not elect wheneligible/available, you cannot newly enroll without a qualifying lifeevent. Allowed Expense TypeFull Purpose FSA (FSA): Medical, Dental, and VisionLimited Purpose FSA (LPFSA): Dental and Vision OnlyDependent Care Account: Child(ren) under the age of 13 orDisabled Dependent2024 FSA IRS Maximum Allowed Contributions*Full Purpose FSA (FSA): $3,200 annuallyLimited Purpose FSA (LPFSA): $3,200 annuallyDependent Care Account: $5,000 annually*Check your benefits information for your exact plan maximums.Claims Instructions and FormsMembers must complete an FSA/DCA Claim Form, attach a bill orpaid receipt, and submit to benemax.claims@onedigital.com. Linksto claim form and our claims email should be included.FSA Eligible ExpensesFSA and DCA Claim FormLetter of Medical NecessityThe FSA StoreUsing the Benemax Debit Card and FAQsCommuter Benefit InformationElectronic Submission: Claims ConnectionBack
Benemax ID CardCards are automatically issued in a set of 2 and come in thesubscriber's name. If you have covered family members, they mayuse the card with “dep” printed on the front.Present your provider with both your medical carrier card AND yourBenemax card. Be sure your provider's office takes copies of BOTHcards. Ensure your provider knows Benemax is your secondarypayer.Benemax Debit CardNot available with all plans.You may receive a debit card (vendor: master card) to pay forpharmacy expenses at the time of purchase (please call and activateyour card upon receipt). Depending on when Benemax coveragebegins in your plan, you may receive a card when your plan beginsor after you satisfy a portion of your out of pocket responsibility.You should ONLY use the card for expenses covered by your plan.The card will allow other expenses, but you will be required torepay any non-qualified expenses you charge.Your Benemax Debit Card expires after 5 years, and you willautomatically be reissued a new one at that time.Benemax FSA Debit CardFor FSA participants only.You may also receive a debit card if you enrolled in a FlexibleSpending Account or Dependent Care Account. This card may beused to pay for eligible expenses.XXXXXYour NameBenemax ID CardFSA and DCA Claim Details and SubmissionUsing the Benemax Debit Card and FAQsBenemax CardBack
CommuterNot available or offered to all Benemax customers. Referenceyour benefit enrollment information to determine your eligibilityand benefit specific details, as well as vendor specific resources.Commuter Accounts include Transportation and Parking. TheseQualified Transportation Accounts (QTA) allow employees to setaside pre-tax funds used to commute and/or park at work. QTAsare governed by IRC Section 132. Unused funds roll forward month to month.Commuter accounts do not require a qualifying event to makea change. You can start and stop contributions at any time (if you wish tostop contributing, change your contrition to $0, do notterminate. Terminating coverage will forfeit any remainingbalance on your account.)You can have both a transit and parking commuter account.Allowed Expense TypeCommuter, Transit: Public transportationCommuter, Parking: Workplace parking2024 FSA IRS Maximum Allowed Contributions*Commuter, Transit: $315 per monthCommuter, Parking: $315 per month*Check your benefits information for your exact plan maximums.Claims Instructions and FormsMembers must complete a Claim Form, attach a bill or paidreceipt, and submit to benemax.claims@onedigital.com. Links toclaim form and our claims email should be included.Commuter Claim FormUsing the Benemax Debit Card and FAQsElectronic Submission: Claims ConnectionFSA and DCA Benefit InformationBack