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MEDICAL
Q:
What
type of medical plan is provided by my employer?
A:
Lincoln Hospital
provides
a Premera Blue Cross PPO medical plan
for the employees and their eligible dependents. A "PPO"
plan utilizes a network of "Preferred Providers".
Generally, services received from Preferred Providers will be
covered at a higher benefit level than services of a
non-Preferred Provider.
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Q:
Who is eligible?
A:
Generally, all employees who will regularly work
24 hours or more per week for one calendar month are eligible
for coverage.
Q:
When does coverage take effect?
A:
Coverage is
effective the 1st
of the month following 90 days.
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Q:
Are pre-existing conditions covered?
A:
As long
as you had 12
months of continuous, creditable medical insurance prior to
enrolling in the Lincoln Hospital/Premera Blue Cross 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, not counting your 90 day
probationary period, immediately prior to your enrollment in
the Lincoln Hospital/Premera Blue Cross plan.
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Q:
How do you receive care?
A:
You will maximize your benefits by utilizing
"Preferred" Providers.
Simply present your I.D. card, and these
"Preferred" providers will
submit the claims for you. A listing of these
"Preferred" providers is
available online.
Q:
What
happens if a provider will not accept my card?
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 may need to obtain from the provider and
submit an itemized bill yourself to Premera Blue Cross, with an accompanying
claim
form.
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Q: Is
pre-approval required under our plan?
A:
Prior
authorization is generally required for all inpatient hospital
admissions. In emergency situations,
you or your representative must notify Premera Blue Cross by
the end of the next working day following admission.
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Q: Do
I need a "referral" to see a specialist?
A:
No, you do not need referrals for either in- or
out-of-network benefits.
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Q:
Are
naturopaths or acupuncturists covered?
A: In-Network
Acupuncturists and Naturopaths are covered providers
will be covered to the same extent and subject to the same
limitations as services provided by any other participating
provider. Non-Preferred
acupuncturists and naturopaths are not covered.
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Q: Is routine preventive
care covered?
A:
Routine preventive care
exams are covered on your PPO plan, and are subject to the office
visit co-pay. No benefits are provided for
out-of-network preventive care.
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Q:
How are prescription drugs covered?
A:
Retail Generic
drugs are covered subject to a $15 co-pay, Preferred Brand
Name drugs are subject to a $35 co-pay, and Non-Preferred Brand
Name drugs are subject to a $35 co-pay. Each prescription
shall not exceed a 30-day supply.
Mail
order Generic prescriptions are covered subject to a $30
co-pay, Preferred Brand Name drugs are subject to a $70
co-pay, and Non-Preferred Brand Name drugs are subject to a
$70 co-pay. Each prescription shall not exceed a 90-day supply.
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Q:
Are
oral contraceptives covered?
A: Yes,
contraceptives are covered under the prescription drug plan.
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Q: What
is not covered under my medical plan?
A:
Please refer to the "Exclusions" section of your Benefit Booklet for details.
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Q:
How
do I confirm that a certain procedure is covered?
A:
If the answer is not clear after reviewing your Benefit
Booklet, please contact the appropriate
Customer
Service Department to confirm coverage.
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Q:
Who
can answer questions?
A:
If
you have a claims question, please contact the appropriate
Customer
Service Department. If you do not get an adequate
answer, please contact
LoRee Pauls,
in the
HR Department, or
Sharon Bjork
with
Moloney, O'Neill, Corkery & Jones (our agent)
at (509) 325-3024.
Q: In what situations are claim forms required?
A:
Claim forms will
be required when you must submit the bills yourself, usually with
non-participating providers.
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Q:
Do I have coverage out of the area?
A:
Your
Premera Blue Cross 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
has networks across the
country. Outside this area, the Blue Cross Network system
is called "BlueCard". If you do not utilize
this network, you still have coverage, but it would more than likely
be with lesser benefits.
Outside
the United States, if you have Blue Cross coverage, 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 contracting 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.
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DENTAL
Q:
Is
pre-determination necessary for dental coverage?
A:
A
treatment plan should be submitted by your dentist to MetLife prior to extensive procedures being performed.
This will allow you to know in advance what procedures are
covered, the amount MetLife will pay toward the treatment, and your
financial responsibility.
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Q:
Is
orthodontia
covered?
A:
No. Please see your Benefit Booklet for a listing of
covered dental services, exclusions and limitations.
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Q:
Are there
waiting periods under our dental plan?
A:
There are no
waiting periods for Dental Services, as long as you enroll in
the plan within 30 days of your initial eligibility date.
BASIC LIFE and AD&D INSURANCE
Q:
What amount of life insurance is provided by my employer?
A:
As
an active full-time employee, your
group term life insurance benefit is $15,000.
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Q:
Do I have Accidental Death and Dismemberment coverage?
A:
Yes, as an
active full-time employee you are entitled to certain additional
benefits. 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.
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