Frequently Asked Questions

How do we enroll a new employee onto our group plan?

Have the new employee complete an enrollment form within 30 days of his or her date of eligibility, and mail or fax the form to Business Benefits, Inc. If the ee waives coverage, keep a signed copy of the waiver in your company’s file. The insurance carrier does not need a copy of the waiver.

If I have not received my id card yet, can I still receive medical attention?

Yes. Most providers will treat you if you have the following information: copy of your enrollment application, group number, social security number, and the claims address of the insurance carrier. If you are not in the system yet, pharmacies may require you to pay for your prescription first and get reimbursed later. If the provider cannot verify your eligibility with your carrier, they may require you to pay for services prior to receiving them. Typically, you may then be reimbursed for covered expenses after you receive your id card.

How do I get a new card if my id card is incorrect or I lose it?

Call your customer service representative at Business Benefits, Inc., or the insurance company to get it replaced.

How can I change my primary care physician (PCP)?

Select your new PCP from your directory book or the carrier’s directory on their website. Write down your PCP’s provider number, then call your customer service representative at Business Benefits, Inc., or the insurance company to make the change. Keep in mind, your plan may not require you to name a PCP.

May I choose a different PCP for each member of my family?

Yes. Most health plans allow each family member to select his or her own PCP from the network of participating physicians.

What happens if I go to non-participating provider with my PPO or POS plan?

If you go outside the network, your provider’s office may require payment at the time of service or bill you directly, as in a traditional insurance plan. In either case, you’ll need to submit a claim form for reimbursement. Your reimbursement may be subject to deductible, coinsurance and or copays. You may also be responsible for costs that excede the carrier’s contracted rate. Be aware that some treatment may not be covered outside the provider directory even under PPO and POS plans.

If I am out of the area, what kind of health insurance coverage do I have?

Typically you have coverage, 24 hours a day, 7 days a week, anywhere in the world for EMERGENCY and LIFE THREATENING situations. If you have a true medical emergency, you should seek immediate care at the nearest medical facility. You may not have coverage for other situations. You may consider: 1) Calling your PCP to ask for guidance; perhaps a prescription can be called in to the local national pharmacy chain. 2) Looking for an Urgent Care Center. These are sometimes covered with a lower copayment. 3) Call the customer service number on your ID card and asking for assistance.

If you are enrolled in an HMO, emergency care is typically the only kind of coverage you have outside of your service area. Any care that does not require immedite attention, will only be covered within your service area.

My managed care plan requires referrals for specialists. Are there some specialists who do not require referrals?

Many carriers do not require referrals for annual visits to obgyn’s, or routine eye exams if they are a covered expense.

What happens if I require a scheduled hospitalization?

If you are under the care of a participating provider that provider will pre-certify your admission with your carrier. If your plan has out-of-network benefits and you are under the care of a non-participating provider, it is your responsibility to precertify your admission with your carrier.

When can I add dependents to my insurance coverage?

Open enrollment is the time to make voluntary changes to your coverage, including which family members are covered under your plan. However, if there has been an IRS defined qualifying event, dependants may be added to the plan immediately. These events include, but are not limited to, death, divorce, and termination of employment.

How long do I have after a qualifying event to add my dependent to my policy?

You have 30 days from the qualifying event to add dependents to your policy. You also have 30 days from the date of your wedding to add your spouse or from the date of birth or date of adoption to add your child.

My dependent child just started college. What should I do?

As long as your child is a full-time student and meets the age requirements for the insurance carrier, he or she can be covered under your insurance plan. Generally, you just need to show proof of full-time student status at the university. Often this can be something as simple as their class schedule.