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Your First Year on The Plan

How To Effectively Use The Plan

Suggestions To Make The Plan Work Effectively
Prepared By
The Employee Benefit Service Center

1     Enroll Yourself And Your Dependents For Coverage On-Time
It is extremely important that you enroll on-time to assure that there are no restriction on your coverage. When you become eligible, you have 31 days to enroll your self and any eligible dependents. If you or the dependents are not enrolled within the 31 day period, there may be some limits that you should understand. These are explained on this Web Site in the section titled, Your First Year On The Plan.
When you get married or have a new family member, it is also important to enroll the new spouse or new dependent within 31 days of the event.

2     Carry Your Identification Card
Carry your current identification card with you at all times and show it when you receive covered services. If you have an older card, return it to your supervisor. Insist that the provider of care uses the proper claims filing address when they file the claim. The card has phone numbers for pre-certification, preferred provider networks and claims administration. Understand the difference between these phone numbers as follows:

  • Pre-Certification: Call (you or your physician or the hospital) when you have a scheduled service that needs to be pre-certified or as soon as possible after an emergency admission.
  • Preferred Provider Network: Call to verify the participation status of a medical care provider, before having a service or to complain about a provider billing over the Network payment level.
  • Claims Administrator: Call when you have a question about your or any or your dependents eligibility, want to know what is covered, want to know the status of a claim, or question a payment. 

3     Understand Your Drug Card And Your Medical Card 
If you have a drug card, understand the difference between the drug card and the medical identification card. Use the drug card only when obtaining prescriptions and the medical card only when obtaining medical services.

4     Confirm Provider Network Participation Before Any Service
Always confirm that a medical care provider you will see is in the network. Look up the status on the network Web Site (links are within this Web Site) or call the phone number on the ID card and ask the staff at the network for participation status. While the booklets are helpful, they may be out-of-date concerning the status of a provider's participation.
 

5     Use Network Providers
Use network providers to maximize your coverage under the Plan.
 



 [ Part 2 ]

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