A: North Idaho College provides a Blue Cross of Idaho Managed Care plan and a Group Health Managed Care plan for its employees and their families.

Managed Care plans require that you select a Primary Care Physician.   You do not generally need referrals for specialists. 

Q: Who is eligible?

A:  Generally, all employees who will regularly work 20 hours or more per week are eligible for coverage. Once eligible, you may also enroll your spouse and/or your unmarried dependent children who are under the age of 23 and primarily dependent on you for financial support.

Q: When does coverage take effect?

A: Coverage is effective the 1^st of the month following date of hire.

Q: Are pre-existing conditions covered?

A:  As long as you had 12 months of continuous, creditable medical insurance prior to enrolling in the NIC plan, your pre-existing conditions will be covered according to plan provisions. Continuous coverage means that there was not a lapse of more than 63 days immediately prior to your enrollment in the NIC plan.      

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Q: How do you receive care?

A: You will maximize your benefits by utilizing "Participating" Providers.  Simply present your I.D. card, and these "Participating" providers will submit the claims for you.  A listing of these "Participating" providers is available online.

A: This usually means that the provider is non-participating with the plan you have selected and therefore your benefits may be less.  It also means that you will need to obtain from the provider and submit an itemized bill yourself to Blue Cross of Idaho or Group Health, with an accompanying claim form.

A: Pre-Admission Review is required for all inpatient hospital admissions except for covered services subject to Emergency Admission Review.   In emergency situations, you or your representative must notify Blue Cross of Idaho or Group Health by the end of the next working day.  If it is medically impossible for you to do so, once you are medically able, you must notify the appropriate carrier.  The Blue Cross Pre-Admission Review phone number is (800) 627-1187, and the Group Health Pre-Admission Review phone number is (800) 788-8987.

A:  Under the Blue Cross of Idaho plan, referrals are generally not required to seek care from specialists.  However, office visits to specialists are subject to the higher $35 copay.

A:  Group Health covers these services the same as any outpatient office visit.  Blue Cross of Idaho does not cover Acupuncturists and Naturopaths under the medical insurance plan.  However, Blue Cross of Idaho does have a special discount program for these types of services.  Click here for more information.  

A:  Under the Blue Cross plan, preventive care is covered subject to a $20 co-pay per visit if you see your Primary Care Physician.  Preventive care with a Non-Primary Care Physician visits are, but only if a Participating Provider is utilized (see contract for limitations).  Preventive care is not covered out-of-network.  Physicals for travel, employment, insurance, license, etc. are not covered. 

Group Health covers in-network preventive care the same as any outpatient office visit.  Out-of-network preventive care is covered at 70% after the deductible to a $300 maximum/individual and $600 maximum/family.

A: Please refer to the "Exclusions" section of your Benefit Booklet for details.

A: If the answer is not clear after reviewing your Benefit Booklet, please contact the appropriate Customer Service Department to confirm coverage.

A: If you have a claims question, please contact the appropriate customer service department.  If you do not get an adequate answer, please contact our agent, Scott Burkhardt.

A: Claim forms will be required when you must submit the bills yourself, usually with non-participating providers. 

A:  Yes, your coverage is worldwide.  If you are inside the United States, please keep in mind your benefits will be maximized if you use the appropriate Provider Networks.  Blue Cross of Idaho has networks across the country.  In Eastern Washington, the Provider Network is called "PHCO".  In all other areas of the country it is called "BlueCard".  If you do not utilize these networks, you still have coverage, but it would more than likely be with lesser benefits.

Outside the United States, Blue Cross does have a Worldwide Hospital Network that will allow you to maximize your benefits.  Even if you do not use one of these Hospitals, you still have coverage, but it would be considered out-of-network.  For most cases outside the United States, even with Participating Hospitals, you will more than likely need to pay the bill yourself at the time of service.  Then simply obtain an itemized bill from the provider, and submit that bill along with a claim form to the appropriate insurance company for reimbursement.

Group Health Options Out-of-Network care is subject to reduced benefits.  See benefits summaries for what is covered.  Group Health Options covers urgent and emergent care out of the service area subject to a $125 deductible.

A: A treatment plan should be submitted by your dentist to Delta Dental or Willamette Dental prior to your treatment for the following procedures:  Crowns, Full or Partial Dentures, Inlays, Periodontal Surgery (including curettage), Bridgework, Surgical Removal of Impacted Teeth, Laminate Veneers and Bonding Procedures.

If a claim for completed treatment is submitted that includes covered services for which benefits have not been pre-determined, the claim will be reviewed in the same manner as if it were being submitted for pre-determination.  Your carrier will consider whether alternate procedures would have produced a professionally satisfactory result.  If you and your dentist have chosen a more expensive method of treatment than is determined professionally satisfactory by Delta or Willamette, they will pay benefits for the less expensive treatment.  The excess amount will be your responsibility.

A:  Orthodontia is only covered under the Willamette Dental plan.  Please see your Benefit Booklet for a listing of covered dental services, exclusions and limitations.

Q: What amount of life insurance is provided by my employer?

A: As an active employee, your group term life insurance benefit is $40,000.  NIC pays 71% of the cost of this and all other benefits. 

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Q: Do I have Accidental Death and Dismemberment coverage?

A: Yes, as an active employee you are covered for an additional $40,000 if your death is the result of an accident, and you are also covered for varying amounts for certain other losses and/or dismemberments.  Please refer to your Benefit Booklet for more details on your coverage.

Q: Do I pay taxes on my Long Term Disability benefits received?

A: Yes, but proportionate to the amount your employer pays in premiums for this coverage.  Since NIC pays 71% of the cost, you would have to pay the appropriate taxes on 71% of the LTD Benefits received.

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Q: Does the long term disability plan provide coverage if I am injured on the job?

A:  Yes, your LTD plan provides 24 hour coverage.  However, income received from other sources, such as Worker's Compensation for being injured on the job will be integrated with your long term disability benefits.

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Q: Are health questions required to be answered to qualify for this plan?

A:  No, not if you enrolled when initially eligible for coverage.

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Q: Are there pre-existing condition waiting periods on LTD?

A: Yes, if you have a disability arise during the first 12 months you are insured due to a pre-existing condition, then that disability will not be covered by the plan.  A condition is considered pre-existing if during the 90 days immediately prior to your enrollment on the plan, you consulted a physician, received medical care or services, or took prescription drugs or medications.

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A:  Click here for detailed information on your Cafeteria Plan - Section 125.

A:  The Employee Assistance Program (EAP) provides short-term, confidential counseling for you and your family at no out-of-pocket expense to you.  APS, a care management company, provides the counseling services in collaboration with your employer or health insurer.

A: Yes, all discussions between you and the EAP therapist are confidential.  Personal information is never shared with anyone, including your employer, at any time without your direct knowledge and approval.

A:  The 24-hour crisis hotline number is (800) 833-3031.  For general information call (800) 390-9150.  For the EAP appointment line call (800) 444-2715.  The website is www.apshealthcare.com.

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