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MEDICAL BENEFITS QUESTIONSDo I need to pre-certify for outpatient procedures? What is the medical deductible? What
are maximum out-of-pocket expenses? For emergency room care, am I responsible for a co-pay?Are
routine medical exams covered? What
else is covered under the Wellness Benefit? Why do I get letters when I file a claim? What do I need to provide when there is a change of Family Status? How long are my dependents covered? Will I have one card to present for prescription and medical benefits? Can I order additional cards for family members? What is the dental deductible? Are braces/orthodontics covered under the dental plan? Can I get a pre-estimate on extensive dental work from the Fund? Are routine vision benefits covered? How do I get a refund if I use an out-of-network vision provider? Are VSP in-network providers also contracted for Medical Vision Benefits? MEDICAL Do
I need to pre-certify for outpatient procedures? No,
the only time you need to pre certify is if you are being admitted
inpatient into the hospital or other inpatient healthcare facility.
HealthLink
pre-certifies patients, the Fund is responsible for benefits allowed and
paid. What
is the medical deductible? The
medical deductible for Schedule of Benefits I is $500 per individual and
$1500 per family. What
are maximum out-of-pocket expenses? For Schedule of Benefits I, maximum out-of-pocket (in network) is $5,000/person or $7,500/person (out of network). There is a cap limit of $10,000 aggregate per family in network and $15,000 aggregate per family out of network. For emergency room care, am I responsible for a co-pay?Yes, each time you or a family member go to the emergency room, you have a $100 co-pay. This $100 co-pay is not applied toward deductible. The $100 co-pay is waived only if you are admitted to the hospital from the emergency room. Are
routine medical exams covered? Yes,
100% per eligible member and eligible dependent per calendar
year. What
else is covered under the Wellness Benefit? Well-baby immunizations, school physicals, routine lab work, HPV vaccine, etc.
For
a newborn child, provide the Fund office a copy of the baby’s birth
certificate and fully complete a new enrollment/beneficiary form. For marriage, provide a copy of the marriage certificate and fully complete a new enrollment/beneficiary form. For divorce, provide a copy of your divorce decree (showing who is responsible for dependent(s) health insurance) and complete a new enrollment/beneficiary form. INSURANCE CARDSWill I have one card to present for prescription and medical benefits? Present your Healthlink ID Card to Medical/Dental providers and a RX prescription card from MEDCO for pharmacy. Can I order additional cards for family members? Yes, call the Fund Office to request a Healthlink or MEDCO ID Card. You can download a temporary RX card from the Medco website at www.medco.com. Dental FAQ: http://www.cichealth.org/Health_Welfare/Welfare_FAQs.html#DENTAL%20QUESTIONS. DENTAL
What
is the dental deductible? The dental deductible is $100/person ($300 family limit). Preventative exams, cleanings and bitewings are covered at 100% Effective January 1, 2012 and not subject to this deductible and are covered twice a year per person. Are
braces/orthodontics covered under the dental plan? No, this benefit was removed September 2002. Can
I get a pre-estimate on extensive dental work from the Fund? Yes, request your dental provider to submit charges to the Fund office for processing a pre-treatment-estimate. VISION
Are
routine vision benefits covered? Routine vision benefits are covered directly through Vision Service Plan (VSP). How do I get a refund if I use an out-of-network vision provider? You can submit your claim directly to VSP for a refund. A VSP Out-of-Network Reimbursement Form can be downloaded from www.vsp.com or requested from the Fund office. |
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