Chrysler Benefits Express and YSA - NCRO

1 Chrysler Benefits Express and YSAM arket/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)1BE and YSA -Partnership Your HRA/RHCA claim submissions are administered by Your Spending Account (YSA) which is managed by Benefit Express Benefit Express maintains the actual eligibility and enrollment information This info is sent to YSA to fund the HRA which allows for claims processingMarket/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)2 Top 5 HRA is an eligible expense? do I file a claim? do I update my information? do I sign up for auto-reimbursement and/or direct deposit?

2 Is my available balance?Market/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)3 Chrysler Retiree Accounts with YSAHRA and RHCAE ligible Expenses Premiums for Medicare Parts A and B, Medicare Advantage plans and Medigapplans Premiums for other health care coverage such as Dental, Vision or Hearing Deductibles, coinsurance, copayments and supplies Note: Expenses incurred solely for cosmetic reasons such as liposuction, hair transplants, and face lifts are not 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)4 HRA and RHCAP rescription Drugs/OTCsRHCAHRARxYesNoOTC medsYeswith doctor s prescriptionNoOTC suppliesYesYesMarket/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)5 Claim Submission-How to Submit a ClaimMust submit a claim form with proper documentation Claim forms are available online or by calling YSA.

3 Complete allsections of the form Attach or Upload copiesof your receipts or proof of expense (keep the originals) Be sure to sign and date where indicated Fax or mail your completed form and documentation to Your Spending AccountNOTE: Upload does not need to be printed and fax or mail doesMarket/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional) | Date (Optional)6 Benefit Express -Always a Resource Log on to the Your Benefits Resources Website at with your user name and password Or call1-888-409-3300 Representatives are available from 8 to 4 , Eastern Time, Monday through FridayoHRA QuestionsoUpdate your home addressoUpdate your personal email address oDirect Deposit Banking InformationoBeneficiary informationDirect DepositContact UsSecure Messaging MailboxMarket/Division/Tier 3 (Optional)| Practice Group/Tier 4 (Optional)Proprietary & Confidential (Optional)

4 | Date (Optional)10 Top 5 Claim supporting submitted outside of coverage period or after funds missing patient name, date, amount, or form not signed or expensesInvalid vs Valid Receipts RHCA Funds IMPORTANT INFORMATION RHCA Funds housed at Merrill Lynch YSA requests RHCA funds from ML to cover claim payments Be sure there are sufficient funds in your Institutional Money Market Fund to pay the claim. If there is not enough in the Institutional Money Market Fund, the needed amount will be pulled from all of your mutual fund holdings on a prorated basis by Merrill Lynch. To choose specific mutual funds to be used for claims, you may liquidate those funds and move them to the Institutional Money Market Fund (must be done at them same time as you send in the claim).

5 If you see a claim denial notice due to not enough funds available, it may be that the funds are not in the Institutional Money Market Fund. Contact ML assistance. Note: It could take several days to Enhancements YSA Communications Claim email rewrites Reviewing and enhancing claim processed emails with additional details Adding a table with claim details (plan name, date of service, amount, status) to avoid situations in which an employee would need to access the website Timeframe: Q1 2013 Questions