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Frequently Asked Questions
This information is provided as a general guideline only. Your company may have its own unique processes and procedures that are different than those shown below. Contact your company's Human Resources or Employee Relations department for specific instructions.
Help with Claim Inquiries
Help Understanding Your Benefits
Find a Provider or PPO?
Help Using the Benesight Web Site
Help Understanding Healthcare-Related
Law
Help With Claim Inquiries
How do I file a
claim?
When should I file a claim?
Why is Additional Information Sometimes
Requested?
How will additional Claim Information be
Requested?
What Are the Most Common Reasons for Requesting
Information?
Why Was my Claim Denied for Services that
my Doctor Suggested I Should Receive?
My claim was denied. How do I appeal this
decision?
Why are claims that have been submitted
several times still not in the system?
Why did you pay my claim as non-PPO?
What does over Usual and Customary Mean?
What is a PPO Discount?
My claim was submitted, but I cannot find
it in the system. What should I do?
I am responsible for handling my mother's
(father's) affairs and need to see if some claims were paid by the insurance,
can you help me?
What is an EOB?
What is the status of my claim?
I think my claim was processed incorrectly.
How can I find out if it is correct?
I did not receive a check for reimbursement
of my claim. Why not?
Help Understanding
Your Benefits
Medical Management
What is Utilization Review?
How does pre-certification work?
What is Case Management?
Benefit Plan Limitations
What's the difference between a deductible,
a copayment and out-of-pocket expenses?
I've met my deductible. Why aren't my
claims paid at 100 percent?
I've met my deductible for the year. Why
did you take another deductible from my spouse?
I paid my deductible to my doctor, but
I noticed you applied my deductible against the hospital bill. How will
this be resolved?
What is a Deductible Carry-Over Credit?
How does the Coordination of Benefits
work?
I am covered by two group health plans.
My other plan has better benefits; can I select which plan is primary?
If I have two group health programs, why
are my claims not paid in full?
What is a pre-existing condition?
How long does the pre-existing condition
limitation apply?
My deductible was already taken from
my paycheck. Why was another deductible applied on this claim?
My deductible has already been met. Why
did you apply a co-payment to my doctor's office visit?
What is an exclusion?
What is a maximum?
What does Usual & Customary (U&C),
Reasonable & Customary, or Usual & Reasonable mean?
Can a Pre-existing condition limitation
be offset? If so, how?
Pharmacy and Other Benefit Coverages
How do I obtain a new/replacement ID card
for medical benefits? For Pharmacy benefits?
I just heard about a new medical treatment
on the news. Is it covered under my plan?
The FDA has just approved a new drug for
treatment of a condition that I have. How do I find out if it is covered
under my plan?
What is an Employee Assistance program?
Do I have one? How do I access it? What does it cover?
Do I have coverage if I am traveling out
of the country and become sick or injured? If so, how do I file that claim
for reimbursement?
The pharmacy was not able to process my
prescription when I presented my ID card. What should I do?
I am trying to order a prescription from
my pharmacy vendor and they are telling me I am not eligible. What should
I do?
I am currently on COBRA and the pharmacy
was not able to process my prescription. What should I do?
Could you explain the orthodontic benefits
on my plan?
I want to find out if something is covered
under my plan, but I do not find it listed in my Plan document. How do
I find out?
What is the correct billing address: the
PPO or Benesight?
Eligibility, Enrollment and COBRA Continuation
What is a waiting period?
What is enrollment?
When do my benefits go into effect?
My spouse, who was the enrollee on this
plan, is recently deceased. Can I still keep the coverage?
Can I add my mother, who is dependent upon
me for support, be added to my plan?
My son/daughter is over the covered age
for dependents, but is totally disabled. Can he/she still be considered
a covered dependent under my plan?
I am on a COBRA plan which ends soon and
am interested in a conversion policy. Would you please let me know if
this is possible?
I've just lost my job (or, my company is
closing, or, my company is closing the plant that I work at). Will I lose
my benefits? If so, when? Can I keep my benefits?
I just got married. Can I add my new spouse
to my plan? How?
I just had a newborn child. Can I add
my new child to my plan? How?
I'm about to adopt (or have just adopted)
a child. Can this child be added to my plan? How?
Have you received my COBRA premium payment?
How do I complete the COBRA Election Notice?
Where do I send the COBRA Election Notice
I received a letter from the COBRA Department
and I have questions about its contents.
I need to add a dependent to my COBRA
benefits or extend my benefits because of a disability.
I am on a COBRA plan, which ends on September
20, 2000 and am interested in a conversion policy. Would you please let
me know if this is possible? Please let me know the particulars.
Making Changes in Benefits
Can I change my benefits to obtain a smaller
deductible? If so, how and when?
Can I change my benefits so that I can
participate in a different Preferred Provider Organization? Is so, how
and when?
Can I drop my dental coverage, but keep
the medical coverage?
Can I change my benefits so that I have
a lower payroll deduction from my paycheck?
My neighbor, who does not have coverage,
likes my coverage. Can they buy it from you?
Does Benesight sell a Medicare Supplemental
plan?
How do I get a HIPAA Certification Letter?
My name is spelled wrong. My birth date
is incorrect.
What does "in-network" mean?
What does "out-of-network" mean?
What does "family out-of-pocket" mean?
Find
a Provider or PPO
Can I use any provider I want to?
What is a Preferred Provider Organization?
How does it affect my benefits?
How do I find out if a provider is part
of my Preferred Provider Organization?
Can you help me find a provider, or, why
can't you help me find a provider?
My provider is not listed in my provider
directory. What do I do to get them added?
Help Using the Benesight Web Site
I forgot my password.
What do I do?
I'm having trouble downloading Adobe
Acrobat Reader. What do I do?
How can I save the file I open in Acrobat
Reader to my hard-drive?
I just downloaded a form. Can I complete
it online and email it back?
When I send a question via email, how
long will it take to receive a response?
I enter Benesight through an AOL connection.
Why am I having trouble?
What's the optimal screen resolution
for this site?
How should I set the font size on my
screen for best viewing?
Why do I get an alert about the site
certificate when I log in to Benesight?
Why do I get these "server/page not
found" errors in Internet Explorer 5?
Why do I receive JavaScript errors from
my browser while using this site?
Why do some photographs and other graphics
display poorly?
Why is the page cut off at the bottom?
I can't scroll to move it up.
Is it safe to view my private health
information over the Internet?
Help Understanding Healthcare-Related Law
What is HIPAA?
What is COBRA?
Help With A Claim
How do I file a claim?
To file a medical or dental claim, please download
and print a Benesight
claim form. Follow these important tips to ensure your claim is processed
accurately and efficiently:
Complete all applicable items on the EZ Claim Form
Include your
original itemized bill(s). Your health care provider should give you an
itemized bill(s) that contains the following information:
Employee's Name
Patient Name
Provider Name and Address
Dollar amount of charge(s) for services rendered
Type of service (CPT-4 codes)
Date(s) of service
Type of treatment or diagnosis (ICD-9 codes)
Time spent (for registered nurse services)
Anesthesia time (if anesthesia was used)
Type of work done (for X-ray & laboratory services)
If Benesight is
the secondary carrier, we will also need the
primary carrier's explanation of benefits (EOB)
.
Make a photocopy of the
claim form and all itemized bills and receipts for your personal records.
Receipts cannot be returned to you.
Mail this form with any itemized bills to Benesight at the
appropriate address.
To ensure prompt service:
Submit a separate claim
form for each covered family member each time you have a claim. For example,
do not include your child's receipts or bills with a claim form for yourself.
Use a new claim
form for each illness or injury.
If you receive additional
bills in connection with this claim after you have mailed this form, do
not complete another form. Simply identify the bills or invoices by noting
the following information on the bill and send to address on the back
of your ID Card:
Employer's Name
Employee Name
Employee Social Security Number
Patient Name
Generally, health care providers will complete and file Benesight
claims for members. Members do not need a claim form if your physician
is filing the claim for you. However, in instances when the provider does
not file the claim, members should submit the claim
to Benesight at the appropriate address.
When Should I File a Claim?
When your doctor or the provider will not bill
Benesight or the PPO directly and you are
being asked to pay the claim.
Claims should be filed with Benesight within 3 months of the date service
was incurred. Benefits are based on the Plan's provisions at the time
that the charges were incurred. Claims filed later than that date might
be declined unless it was not reasonably possible to submit the claim
within that timeframe.
Why is Additional Information
Sometimes Requested?
Benesight processes claims according to the requirements
outlined in your summary plan description. To determine whether or not
a claim meets those requirements, we sometimes need more information than
what appears on the bill.
How will Additional Claim Information
be Requested?
The claims analyst sends a letter requesting the
necessary information for a specific claim. The letter is usually sent
to the employee for a response, although occasionally the doctor or provider
will be asked for additional information. Two attempts will be made to
obtain the requested information. If a response is not received within
a 30-day period, a third and final letter will be sent indicating no further
action will be taken until the requested information is received.
What Are the Most Common Reasons
for Requesting Information?
The following are the most common reasons a request
for additional information is made:
1. To determine if the patient has other health coverage. If a patient is covered under two health plans, Benesight must determine which plan is the primary payer. This information is usually requested only once or twice a year.
2. To obtain accident information. Some plans provide higher benefits for accident claims, and some injuries (such as workers' compensation claims) may not be covered under the health plan. To determine the benefits available, we need to know when and how the accident occurred.
3. To determine Student Status. Most plans cover unmarried, full-time college students. Benesight must have documentation showing that a child is a full-time student during each college quarter or semester for which a claim is incurred.
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Why
Was my Claim Denied for Services that my Doctor Suggested I Should Receive?
Some services are excluded from your Plan. For
specific items, please refer to the exclusions listed in your summary
plan description. Covered services under the plan are subject to a medical
necessity review to determine if they are medically appropriate and necessary
based on national medical practice guidelines. Some services require specific
diagnosis or criteria to be considered as medically necessary and, therefore,
covered by the Plan. Most plans exclude services that are either experimental
or investigational. When in doubt, please contact your customer service
representative.
You have the right to have the provider submit a Prior Authorization Request
(AKA Pre-determination) before services are rendered. The Prior Authorization
Request is then reviewed for medical necessity criteria to determine if
the service is an eligible expense under the Plan. If it is not an eligible
plan expense, you will be notified so you can decide if you would still
like to have the services. This Prior Authorization of Service is not
a guarantee of coverage and DOES NOT meet your requirements for Pre-certification
with the Utilization Management company. You must contact the Utilization
Management company prior to receiving services if required by your Plan.
My Claim was denied. How do
I appeal this decision?
Appeal a denial of benefits within 60 days from
the date of the notification of denial. You must:
1. Request that Benesight (as the Plan Administrator) review the claim for benefits. Your request must include the name of the employee, his or her social security number, the name of the patient and the group identification number.
2. File the request for review in writing, stating in clear and concise terms the reason or reasons for this disagreement with the handling of the claim.
The Plan Administrator will respond in writing typically within 60 days. Please reference your summary plan description for more information.
Why are claims that have been
submitted several times still not in the system?
To allow adequate time for the provider to complete their billing process
and submit your claim to Benesight, please allow at least 20 business
days from the date of service for Benesight to receive your claim.
If it has been more than 20 business days from the date of service, please
contact your provider. Please be aware that if your plan uses a preferred
provider organization (PPO), your claim may have been sent to the PPO
first for negotiated fee discount processing. This may cause a slight
delay in Benesight receiving your claim. Check back periodically to verify
receipt and/or processing of your claim(s).
Why did you pay my claim as
non-PPO?
This might happen due to a variety of reasons.
We will need additional information to assist you. Please contact our
customer service center or use our online secure mail service. In order
to research your claim and respond appropriately, please have the following
information available.
Employee SSN
Employer's name or Group number
Patient Name
Date of Service
Provider's Last Name
Type of charges in question or at issue
Your relationship to the Employee
What does over Usual and Customary
Mean?
Charges for the services received exceed the Usual
and Customary guidelines which appear in your Plan Documents.
What is a PPO Discount?
The contracted fee the provider has agreed to
charge for its services in return for being part of a PPO.
My claim was submitted, but
I cannot find it in the system. What should I do?
Please contact our customer service center or
use our online secure mail service. In order to research your claim and
respond appropriately, please have the following information available:
Employee SSN
Employer's name or Group number
Patient Name
Date of Service
Provider's Last Name
Type of charges in question or issue
Your relationship to the Employee
I am responsible for handling
my mother's (father's) affairs and need to see if some claims were paid
by the group medical plan, can you help me?
In order to assist you, we will need:
The Power of Attorney paperwork
Employee SSN
Employer's name or Group number
Patient Name
Date of Service
Provider's Last Name
Type of charges in question or the issue If you do not have a Power of
Attorney, we will be unable to release the information to you due to the
confidentiality of medical records. Your mother (father) will have to
contact us to receive the information.
What is an EOB?
An Explanation of Benefits is simply the statement
explaining your health care benefits activity. You will receive an EOB
anytime you or a family member receives services. The EOB will include
information about the services provided, the amount billed and the amounts
paid, if any. how to read an EOB.
What is the status of my claim?
The status of claims that have been submitted
to Benesight can be verified quickly and easily through the Claim Status
feature of Benesight.
To allow adequate time for the provider to complete their billing process
and submit your claim to Benesight, please allow at least 20 business
days from the date of service for Benesight to receive your claim.
If it has been more than 20 business days from the date of service, please
contact your provider. Please be aware that if your plan uses a preferred
provider organization (PPO), your claim may have been sent to the PPO
first for negotiated fee discount processing. This may cause a slight
delay in Benesight receiving your claim. Check back periodically to verify
receipt and/or processing of your claim(s).
I think my claim was processed
incorrectly. How can I find out if it is correct?
If you believe your claim was processed incorrectly,
please contact our customer service center or use our online secure mail
service. In order to research your claim and respond appropriately, please
have the following information available:
Employee SSN
Employer's name or Group number
Patient Name
Date of Service
Provider's Last Name
Type of charges at issue
Your relationship to the Employee
I did not receive a check for
reimbursement of my claim. Why not?
Check your EOB or our online Claim Status feature
to verify if there was an amount owed to you. This will determine if a
check was actually issued. If a check was issued, please verify the name
and address on the check to ensure we have the correct information on
file. To make changes in your address or other information, please go
to the Plan Enrollment section.
If your claim did not result in a check, it is possible that there was
a deductible that was owed before the plan would make payment. Contact
Us if you still have questions about your claim.
Help Understanding Benefits
What is the Utilization Review?
Utilization review is a program designed to help
ensure that al plan participants receive necessary and appropriate health
care while avoiding unnecessary expenses. The program typically consists
of pre-certification of certain services (as defined in your plan), retrospective
review of emergency services, concurrent review of inpatient services
and planning for discharge from a medical facility. Pre-certification
is not a guarantee of benefit payment by the plan.
How does pre-certification
work?
Before a plan participant enters a hospital or
other medical facility on a non-emergency basis or receives other listed
services (as defined in your plan), the patient, member or provider must
contact the utilization review company by calling the number on the front
of your Benesight medical plan ID card.
The utilization review company will pre-certify that the inpatient service
is medically necessary according to accepted medical practices.
Pre-certification is not a guarantee of benefit payment by the plan.
What is Case Management?
The process of identifying patients with specific
health care needs and working with them and their physicians to determine
and coordinate a treatment plan that promotes the best health outcomes
with efficient use of health care resources.
What's the difference between
a deductible, a copayment and out-of-pocket expenses?
Deductible. The amount the plan participant
is responsible for paying each year before the plan will make payment
for eligible benefits.
Copayment. The plan participant pays a specified amount for a specified
service, such as $20 for an office visit. Usually the plan participant
is responsible for payments at the time services are rendered.
Out-of-pocket expenses. The portion of health service payments
required to be paid by the plan participant which may include deductibles,
copayments and coinsurance, before the plan will pay at a higher benefit
level.
I've met my deductible. Why
aren't my claims paid at 100 percent?
Once the deductible is met, payments will be made
at the rate shown under Percentage Payable in the Schedule of Benefits.
A higher benefit level may apply when the Out-of-Pocket maximum is met
for the plan year.
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I've
met my deductible for the year. Why did you take another deductible from
my spouse? Does the deductible apply to me or does my whole family have
to meet it?
Typically, there is one deductible amount per
covered person for every Plan Year and also a family deductible maximum.
Once an individual has met their Plan Year deductible, the plan will make
payments for eligible benefits for that individual. Expenses applied toward
an individual deductible by any covered family member can satisfy a family
deductible. The individual deductibles of all members of that family unit
will be considered satisfied once the family deductible is met. See your
Schedule of Benefits for deductible amounts and family unit maximums.
I paid my deductible to my
doctor, but I noticed you applied my deductible against the hospital bill.
How will this be resolved?
Benesight processes claims in the order in which
they are received. Therefore, we applied your deductible to the first
bill we considered. We had no way of knowing that you had paid anything
to another provider until we received the claim from the provider showing
you had made a payment. In this situation, the doctor would be paid the
balance due (if it did not exceed the normal benefit), and the member
would be issued any remaining benefit.
What is a Deductible Carry-Over
Credit?
If specified in your Plan, charges applied to the deductible for services
performed during the last three months of a plan year may be used to satisfy
the following year's deductible during the first three months of the new
plan year. After the first three months of the new plan year, the deductible
would be reset at zero.
How does the Coordination
of Benefits work?
When a person is covered under more than one group
medical program, payment of benefits may be coordinated to eliminate over-insurance
or duplication of benefits. The Primary Coverage is the plan that considers
and pays first any eligible expenses without consideration of any other
coverage. The plan that has the responsibility for payment of a portion
of all or any remaining eligible charges not covered by the primary benefit
plan is considered the Secondary Carrier.
I am covered by two group
health plans. My other plan has better benefits; can I select which plan
is primary?
No, each employer group specifies the order of
benefits determination. Generally, as the covered employee, your group
plan is primary for yourself. For covered dependents, the rules may vary
based on either the birth date rule or the gender rule. Please refer to
your summary plan description for more information.
If I have two group health
programs, why are my claims not paid in full?
It depends on the type of coordination of benefits
(COB) provision the second plan has adopted. Each employer group selects
one of the three COB types for its entire group. Here are examples of
how claims would be handled if Benesight's Plan were secondary:
1. Carve-out COB. With this option, Benesight computes the normal benefit under the plan. Then the primary plan payment is subtracted from this figure. The benefit to be issued is the remainder. If the primary plan paid up to our more than our normal benefit, then there is no additional payment.
2. Exclusion COB. Benesight takes the submitted charges and subtracts the primary plan's payment and write-off amount. Then we compute our normal plan benefit on the remainder.
3. Standard COB. Here we compute what our normal benefit is and we will issue the balance remaining after the primary carrier payment as long as it does not exceed our normal benefit.
What is a pre-existing condition?
A condition for which medical advice, diagnosis,
care or treatment was recommended or received prior to a member's effective
date of coverage. Pre-existing conditions may not be covered for a specified
period of time as defined in your Summary Plan Description (usually six
to 12 months).
As a result of HIPAA, an individual can only be required to satisfy a
pre-existing waiting period once. As long as members maintain continuous
group health coverage with one or more carriers, they can request a Certificate
of Credible Coverage (CCC) or a HIPAA Certificate from their prior employer
to waive the pre-existing condition exclusion.
How long does the pre-existing
condition limitation apply?
This is plan-specific. Your summary plan description
includes information about your pre-existing condition limitation.
My deductible was already
taken from my paycheck. Why was another deductible applied on this claim?
A Deductible is the amount the plan participant
is responsible for paying each year before the plan will make payment
for eligible benefits.
The amount deducted from your paycheck was for your Plan Contribution,
which is the amount you pay to your employer toward the cost of coverage
to provide medical benefits for yourself and/or your dependents.
Please see your Human Resource Department for more information about your
Plan Contribution.
My deductible has already
been met, but you applied a co-payment to my doctor's office visit. Why?
Some plans require the plan participant to first
meet a Deductible each year before the plan will make payments for eligible
benefits. In addition the plan may also require a Co-payment at the time
services are rendered. Please refer to the "Schedule of Benefits" section
in your Plan Document for further information.
What is an exclusion?
Benefits, conditions, or expenses which are not
covered by the Plan. Exclusions are listed in the Plan Document.
What is a maximum?
A dollar or frequency limit established for a
benefit. Any expense that exceeds this limit is not covered by the Plan.
What does Usual & Customary
(U&C), Reasonable & Customary, or Usual & Reasonable mean?
The amount charged by a percentile of physicians
in a specified zip code area where a service is performed. The percentile
of physicians on which the usual and customary charge is based will vary
depending on the plan: the plan may select any percentile over 50 percent.
Another term for this is Reasonable and Customary or Usual and Reasonable.
Can a Pre-existing condition
limitation be offset? If so, how?
Yes, as a result of HIPAA, an individual can only
be required to satisfy a pre-existing waiting period once. As long as
they maintain continuous group health coverage with one or more carriers,
the employee can request a Certificate of Credible Coverage (CCC) or a
HIPAA Certificate from their prior employer to waive the pre-existing
condition exclusion.
PHARMACY AND OTHER BENEFIT COVERAGES
How do I obtain a new/replacement ID card for medical
benefits? For Pharmacy benefits?
After you have completed your initial enrollment
process with your employer, you will receive ID cards within a couple
of weeks.
I just heard about a new medical
treatment on the news. Is it covered under my plan?
To determine the amount the plan will reimburse
for a service, a covered employee may choose to submit a claim before
they actually receive the service. Such claims are called pre-determination.
Your provider can submit the predetermination to Benesight for review.
Generally, Experimental and or Investigational services are not covered.
Please see your Plan Document under "Exclusions" for more information.
The FDA has just approved a
new drug for treatment of a condition that I have. How do I find out if
it is covered under my plan?
To determine the amount the plan will reimburse
for a service, a covered employee may choose to submit a claim before
they actually receive the service. Such claims are called pre-determination.
Your provider can submit the predetermination to Benesight for review.
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What is an Employee Assistance
program? Do I have one? How do I access it? What does it cover?
An EAP (Employee Assistance Program) is a benefit
that may be offered by your employer. It provides assistance with personal
issues that may affect your health or productivity. Please contact your
Human Resource Department for further information.
Do I have coverage if I am
traveling out of the country and become sick or injured? If so, how do
I file that claim for reimbursement?
As each Benefit Plan covers this issue differently,
please refer to your Schedule of Benefits in your Plan Document under
Non-PPO or Out-of-Network benefits. If your Plan does cover these services,
please refer to "How do I file a claim" for further information.
The pharmacy was not able to
process my prescription when I presented my ID card. What should I do?
Your ID card should have a customer service phone
number for the prescription drug program. Please call the number to see
why they have denied your claim. If the prescription drug carrier states
that the medication needs a medical necessity override/ authorization,
contact your provider to obtain a letter of medical necessity and forward
this letter to the prescription drug program for review.
I am trying to order a prescription
from my pharmacy vendor and they are telling me I am not eligible. What
should I do?
This might happen due to a variety of reasons.
We will need additional information to assist you. Please contact our
customer service center or use our online secure mail service. In order
to research your claim and respond appropriately, please have the following
information available:
Employee SSN
Employer's name or Group number
Patient Name
Date you submitted the prescription
Name of drug you are trying to get filled
Your relationship to the Employee
I am currently on COBRA and
the pharmacy was not able to process my prescription. What should I do?
It's possible that we have not received your most
recent COBRA premium. COBRA questions should be directed to our toll-free
number: 1-888-224-3704.
Could you explain the orthodontic
benefits on my plan?
Check your Summary Plan Description to verify
if your Plan covers orthodontic benefits.
If your plan covers this benefit, upon your first visit to the orthodontist,
the doctor will provide you with a total case fee for the services. This
will be broken down into an initial placement fee (down payment) and a
monthly payment plan that would coincide with the number of months required
to obtain proper teeth alignment.
Instruct the orthodontist to send this information to Benesight for a
predetermination of dental benefits. At this time, Benesight will send
both the orthodontist and the covered employee a determination of benefits
in relation to this specific treatment request. It will state how much
will be applied to the deductible, the coinsurance reimbursement rate
and the lifetime maximum allowed by the Plan for the orthodontic services.
The orthodontist then returns the predetermination to Benesight with the
date that the treatment is started. Then we will reimburse for the initial
placement fee. The provider will need to send monthly bills for the monthly
adjustments until either the lifetime maximum has been exhausted or the
total case fee has been considered.
I want to find out if something
is covered under my plan, but I do not find it listed in my Plan document.
How do I find out?
Check under the "Exclusions" section, listed in
your Plan Document, to see if the diagnosis/procedure is listed. If you
still do not see the diagnosis/procedure you can have your provider submit
a claim before you actually receive the service. Such claims are called
pre-determination because no benefits will be paid, but it will determine
the amount the plan will reimburse for a service if it is a covered benefit.
What is the correct billing
address: the PPO or Benesight?
This will depend on your Plan. Please refer to
the Plan Contacts section or your ID card for further information. Generally,
if you see a PPO Provider, the claim should be sent to the PPO. If you
see a non-PPO provider, then the claim would be sent to Benesight.
Eligibility, Enrollment and COBRA Continuation
What is a waiting period?
The time between the first day of employment and
the first day of coverage under the plan. The Waiting Period is counted
in the Pre-existing condition exclusion time.
What is enrollment?
A process in which the employee can enroll for
various benefits through their employer to cover themselves and/or their
family members.
When do my benefits go into
effect?
Please refer to your Plan Document under the section
"Eligibility" as each plan has different requirements.
My spouse, who was the enrollee
on this plan, is recently deceased. Can I still keep the coverage?
Yes, you have just described a Qualifying Event,
which is a condition that requires an employer to provide continued coverage
to their employees as part of COBRA. The length of time employers must
offer continued coverage is determined by the qualifying event. Qualifying
events and the length of time coverage can be continued for, for each
reason are listed below:
- Death of covered employee (coverage for dependents) 36 months
- Termination of employment 18 months
- Termination of employment or reduction in working hours: 29 months
- Reduction in working hours 18 months
- Divorce or legal separation from covered employee 36 months
- Employee becomes eligible for Medicare (coverage for dependents) 36 months
- Dependent no longer meets eligibility requirements 36 months
- Employer files for Chapter 11 bankruptcy petition* *Note: Continued coverage must be offered to all retirees and beneficiaries whose coverage is substantially reduced within a year before or after the employer files for bankruptcy. Retirees and widows or widowers of retirees who die before the bankruptcy filing are entitled to lifetime continuation coverage. Surviving spouses and dependent children of retirees who die after the bankruptcy filing my elect up to 36 months of continuation coverage.
Can I add my mother, who is
dependent upon me for support, be added to my plan?
No. A dependent is defined as a covered employee's
spouse and unmarried children from birth to the limiting age of 18 or
19 years.
My son/daughter is over the
covered age for dependents, but is totally disabled. Can he/she still
be considered a covered dependent under my plan?
Yes, if the Dependent child who is Totally Disabled
meets the definition of being incapable of self-sustaining employment
by reason of mental retardation or physical handicap, is primarily dependent
upon the covered Employee for support and maintenance, is unmarried and
covered under the Plan when reaching the limiting age.
Please see your Plan Document under "Eligibility, Eligible Classes of
Dependents" for more details.
I am on a COBRA plan which
ends soon and am interested in a conversion policy. Would you please let
me know if this is possible? Please let me know the particulars.
Because Benesight administers health benefits
for self insured employer groups (employers who pay for their employees'
medical expenses out of their own funds) we do not offer conversion policies.
We would recommend that you contact a local insurance agent to assist
in finding you a cost-effective medical benefits plan to participate in
when your COBRA expires.
I've just lost my job (or,
my company is closing, or, my company is closing the plant that I work
at). Will I lose my benefits? If so, when? Can I keep my benefits?
You have just described a Qualifying Event which
is a condition that requires an employer to provide continued coverage
to their employees as part of COBRA. The length of time employers must
offer continued coverage is determined by the qualifying event. Qualifying
events and the length of time coverage can be continued for, for each
reason are listed below:
- Death of covered employee (coverage for dependents) 36 months
- Termination of employment 18 months
- Termination of employment or reduction in working hours 29 months
- Reduction in working hours 18 months
- Divorce or legal separation from covered employee 36 months
- Employee becomes eligible for Medicare (coverage for dependents) 36 months
- Dependent no longer meets eligibility requirements 36 months
- Employer files for Chapter 11 bankruptcy petition* *Note: Continued coverage must be offered to all retirees and beneficiaries whose coverage is substantially reduced within a year before or after the employer files for bankruptcy. Retirees and widows or widowers of retirees who die before the bankruptcy filing are entitled to lifetime continuation coverage. Surviving spouses and dependent children of retirees who die after the bankruptcy filing my elect up to 36 months of continuation coverage.
I just got married. Can I add
my new spouse to my plan? How?
Yes, please contact your Employer's Human Resource
or benefits representative within 30 days for the necessary forms and/or
procedures.
I just had a newborn child.
Can I add my new child to my plan? How?
Yes, please contact your Employer's Human Resource
or benefits representative within 30 days for the necessary forms and/or
procedures.
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I'm about to adopt (or have
just adopted) a child. Can this child be added to my plan? How?
Yes, please contact your Employer's Human Resource
or benefits representative within 30 days for the necessary forms and/or
procedures.
Have you received my COBRA
premium payment?
Please contact the COBRA department at 888-224-3704
to verify receipt of your premium payment.
How do I complete the COBRA
Election Notice?
Check or elect the coverage you wish to continue
on the form. Then sign and date the bottom and mail it to:
Your Employer: If you received the form
from your Employer, please return it to your Human Resources Department.
Benesight :
If Benesight is handling COBRA for your group, the form can be returned
to: Benesight, P.O. Box 9305, Minneapolis, MN 55440.
If you have further questions regarding this form, please contact the
COBRA department at 888-224-3704.
Where do I send the COBRA
Election Notice?
If you received the form from your Employer, please
return it to your Human Resources Department.
If Benesight is handling COBRA for your group, the form can be returned
to: Benesight, P.O. Box 9305, Minneapolis, MN 55440.
If you are unsure as to who is handling the Election Notice form, please
call our COBRA Department at 888-224-3704 for clarification.
I received a letter from the
COBRA Department and I have questions about its contents.
Please contact the COBRA department at 888-224-3704.
I need to add a dependent
to my COBRA benefits or extend my benefits because of a disability.
Please send all changes in writing to:
Your Employer: If you received COBRA information
from your Employer or normally send all correspondence in regards to your
COBRA premium is sent to your Employer, please send it to your Human Resources
Department.
Benesight: If Benesight is handling COBRA
for your group: Benesight, P.O. Box 9305, Minneapolis, MN 55440.
If you are unsure as to who is handling the COBRA for your group, please
call our COBRA Department at 888-224-3704 for clarification.
I am on a COBRA plan, which
ends on September 20, 2000 and am interested in a conversion policy. Would
you please let me know if this is possible? Please let me know the particulars.
Benesight administers health benefits for self-insured
employer groups, and does not offer conversion policies. We would recommend
that you contact a local insurance agent to assist in finding you a cost-effective
medical benefits plan to participate in when your COBRA benefits expire.
Can I change my benefits to
obtain a smaller deductible? If so, how and when?
Because Benesight administers health benefits for self-insured
employer groups we do not control your benefit level. Please contact your
Human Resource Department for further information.
Can I change my benefits so
that I can participate in a different Preferred Provider Organization?
Is so, how and when?
Generally you do not have an option in which PPO
to use. Please contact your Human Resource Department for further information.
Can I drop my dental coverage,
but keep the medical coverage?
As each Benefit Plan covers this issue differently,
please contact your Human Resource Department for further information.
Can I change my benefits so
that I have a lower payroll deduction from my paycheck?
Because Benesight administers health benefits
for self-insured employer groups we do not control your benefit level.
Please contact your Human Resource Department for further information.
My neighbor, who does not have
coverage, likes my coverage. Can they buy it from you?
Benesight administers health benefits for self-insured
employer groups and does not offer Individual policies. Your neighbor
should contact a local insurance agent for assistance in finding a cost-effective
medical benefits plan.
Does Benesight sell a Medicare
Supplemental plan?
Benesight administers health benefits for self-insured
employer groups and does not offer other types of policies. Contact a
local insurance agent for assistance in finding a cost-effective medical
benefits plan.
How do I get a HIPAA Certification
Letter?
Please contact your Human Resource Department
for assistance.
My name is spelled wrong. My
birth date is incorrect.
Please contact your Human Resource Department
to correct your information.
What does "in-network" mean?
In-network refers to a health care provider that
participates with the preferred provider organization (PPO) network that
your employer selected for your health plan.
What does "out-of-network"
mean?
Out-of-network refers to a health care provider
that does not participate with the preferred provider organization (PPO)
network that your employer selected for your health plan.
What does "family out-of-pocket"
mean?
The maximum amount a family, as a unit, is expected
to pay in a plan year. Please refer to the "Schedule of Benefits" section
in your Plan Document for further information.
Can I use any provider I want
to?
Yes, but to get the highest benefit possible from
your Benefit plan, you must use the Preferred Provider Organization network
designated by your plan. You can choose to see any provider you wish outside
of the network, but your benefits may be reduced or not covered depending
on your plan. Please refer to the Schedule of Benefits section of your
plan document for specifics.
What is a Preferred Provider
Organization? How does it affect my benefits?
A network of physicians and facilities with which
Benesight or one of its clients has contracted to offer medical care at
reduced rates.
If you use a provider within the PPO network, your benefits will be paid
at the highest level for your plan. If you choose to see a provider outside
of the network, your benefits may be reduced or not covered depending
on your plan. Please refer to the Schedule of Benefits section of your
plan document for specifics.
How do I find out if a provider
is part of my Preferred Provider Organization?
You can access your PPO provider listing via a
toll free number or an Internet site. Please refer to our "Find a Provider"
site for more information.
Can you help me find a provider,
or, why can't you help me find a provider?
You can access your PPO provider listing via a
toll free number or an Internet site. Please refer to our "Find a Provider"
site for more information.
My provider is not listed in
my provider directory. What do I do to get them added?
It is possible your provider recently contracted
with the PPO and is not yet listed in their provider directory. Call your
provider and ask them if they are a Participating Provider with your PPO.
If they are not, your provider will need to contact the PPO directly to
become a Participating Provider. That process can take up to one year
depending on the Provider and the PPO.
Help Using the Benesight Web Site
I forgot my password. What
do I do?
If you are an employee member, you can view the
password hint that you established when you first registered with Benesight.
If you are an Employer Client or Broker/Consultant, contact your Benesight
Customer Web Manager.
I'm having trouble downloading
Adobe Acrobat Reader. What do I do? How can I save the file I
open in Acrobat Reader to my hard-drive? When I send a question via
email, how long will it take to receive a response? I enter Benesight through
an AOL connection. Why am I having trouble? What's the optimal screen
resolution for this site? How should I set the font
size on my screen for best viewing? Why do I get an alert about
the site certificate when I log in to Benesight? Why do I get these "server/page
not found" errors in Internet Explorer 5? Why do some photographs
and other graphics display poorly? Why is the page cut off
at the bottom? Is it safe to view my private
health information over the Internet? Help Understanding
Healthcare-Related Laws What is COBRA?
Adobe® Acrobat® Reader™ is free, and
freely distributable, software that lets you view and print Adobe Portable
Document Format (PDF) files. With Acrobat Reader, you also can fill in and
submit PDF forms online, as well as download encrypted content from the
Web and unlock it with Web Buy.
If you are having difficulties, please visit their web site for additional
information.
From the toolbar within Acrobat Reader, select File
then Save. Enter the location where you want to save the file (Save in:)
and the name of the file (File Name) and press Save. Back
to top
I just downloaded a form.
Can I complete it online and email it back?
No, at this time it is not possible to send forms
to Benesight by email. Please mail the form to the appropriate address
on the back of your ID card.
Generally, we will respond to your inquiry within
24 hours or on the next business day.
Benesight tries to maintain a good balance between high
color, attractive graphics and fast, simple page design. Some Internet
Service Providers, such as AOL, will compress and cache graphics. Compression
reduces the size of graphics. Caching stores them on your hard drive.
This conserves your provider's server capacity and improves your Internet
session. The bad news is it can also reduce the number of colors in graphics
and make them look blotchy. Unfortunately, there is often no way to fix
this on your computer. One thing you can control is graphic compression.
You can change your AOL preferences to set your graphic compression to
100% (no compression). This will allow the Internet graphics to display
as they were intended.
Another good practice is to download and install a full version of Microsoft
Internet Explorer or Netscape Communicator. (The version of Internet Explorer
that comes with AOL is a smaller, modified version. It's not the same
thing as the standard Internet Explorer.) You can then sign onto AOL as
usual and minimize the window. Launch Internet Explorer or Netscape Navigator
and surf the Internet using that browser. Another tip is to refresh your
screen. Because AOL often cache Web pages, you may not be looking at the
updated version of a Web site. Just refresh or reload your screen to make
sure you're seeing the most recent version.
We designed our site for the resolution and font
settings which fit the majority of computers that visit our site while
giving us a good amount of space to display information. Most computers
and monitors made within the last decade can be reset to these specifications.
Windows 95/98/NT
Click on Start, then Settings, then Control Panel, then Display, then
Settings. Or, click your right mouse button on any empty area on the desktop.
Select Properties, then Settings.
Slide the desktop area Screen Resolution indicator up until 800 x 600
or higher is displayed. Use the drop down menu under font size to select
small fonts. Click Ok and you're ready to go! If you can't select it,
or if you get an alert box explaining your system can't display that resolution,
then you won't be able to view our entire site.
Mac OS
From your lower left toolbar, click on the icon for Multiple Scan Display.
Choose the display settings closest to 800 by 600.
The Screen Resolution indicator should be set
at 800 x 600 or higher.
For your protection, Benesight relies on secure
sockets layer (SSL) encryption technology. The industry standard, SSL
encryption technology is among the safest software available today for
secure transactions. It encrypts all the personal information you send
and receive so someone else can't read it as it travels over the Internet.
If you have ever used your credit card on a Web site, chances are you've
used the same technology!
Any company that wants to encrypt information over the Internet applies
for a digital certificate. When your browser finds a certificate for the
first time, you will receive an alert message. You'll be able to see who
owns the certificate, and make sure that company is one you trust. If
it is, approve the certificate. Your browser will walk you through the
process. Your computer will then "remember" this site so you won't have
to approve the certificate again.
Areas of this site use new technology to generate
Web pages specific to your requests. If you let your browser cache history
pages for better performance, you may find that a page you viewed the
last time no longer exists on the system. Usually, the browser recognizes
content changes and would display the new page rather than the cached
copy in your history file. Under some circumstances, though, the change
goes unnoticed until you try to navigate to a connected page. If you wish
to avoid this, follow your browser's Help instructions to make sure you
automatically refresh pages each time you visit a site.
Benesight tries to maintain a good balance between
high color, attractive graphics and fast, simple page design. Some Internet
Service Providers, such as AOL, will compress and cache graphics. Compression
reduces the size of graphics. Caching stores them on your hard drive.
This conserves your provider's server capacity and improves your Internet
session. The bad news is it can also reduce the number of colors in graphics
and make them look blotchy. Unfortunately, there is often no way to fix
this on your computer.
One thing you can control is graphic compression. You can change your
AOL preferences to set your graphic compression to 100% (no compression).
This will allow the Internet graphics to display as they were intended.
I can't scroll to move it up. We designed our
site for the resolution and font settings which fit the majority of computers
that visit our site while giving us a good amount of space to display
information. Most computers and monitors made within the last decade can
be reset to these specifications.
Windows 95/98/NT
Click on Start, then Settings, then Control Panel, then Display, then
Settings. Or, click your right mouse button on any empty area on the desktop.
Select Properties, then Settings.
Slide the desktop area screen resolution indicator up until 800 x 600
or higher is displayed. Use the drop down menu under font size to select
small fonts. Click Ok and you're ready to go! If you can't select it,
or if you get an alert box explaining your system can't display that resolution,
then you won't be able to view our entire site.
Mac OS
From your lower left toolbar, click on the icon for Multiple Scan Display.
Choose the display settings closest to 800 by 600.
We take your privacy seriously. For your protection,
Benesight relies on secure sockets layer (SSL) encryption technology.
The industry standard, SSL encryption technology is among the safest software
available today for secure transactions. It encrypts all the personal
information you send and receive so someone else can't read it as it travels
over the Internet. If you have ever used your credit card on a Web site,
chances are you've used the same technology!
If your browser is set up to alert you, then you may get a warning message
when you enter Benesight. This message tells you that you are about to
enter a secure site. Even if you do not get this alert box, Benesight
is still secured.
To complete your protection, remember to guard your selected user name
and password. This is your personal lock on all your information. You
also need to be careful if you are using the Internet at a public place,
such as the library or your place of business. Just remember to log out
of Benesight by clicking on the logout button in the upper right corner
of the site. This will prevent someone else from looking at your data.
It's just like leaving your keys in the car ... be sure to take them with
you when you leave!
What is HIPAA?
Health Insurance Portability and Accountability
Act of 1996. This act sets federal requirements for group health plans
that let individuals carry over credit for coverage from one carrier to
another. This may reduce or eliminate the member's pre-existing condition
limitations under a new plan.
Consolidated Omnibus Budget Reconciliation Act. A federal law that allows
the continuation of health care benefits for employees whose employment
has been terminated. Employers are required to notify employees of these
benefit continuation options, or the employer will face penalties and
fines. The enrollee pays the premiums (cost of coverage).