| Q: |
Must we use an Anthem network medical provider?
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| A: |
No, you can use a provider not in the Anthem medicalnetwork.
If you use a non-network provider:
- You will pay a higher coinsurance amount (40% of reasonable & customary).
- You will have a separate and higher deductible.
- You will have a separate and higher maximum out-of-pocket.
- You will be responsible for any amount your provider charges above reasonable
& customary.
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| Q: |
Must we use an Delta Dental network dental provider?
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| A: |
No, you can use a provider not in the Delta Dental dental network.
If you use a non-network provider you will not have a higher coinsurance, separate deductibles,
or maximum out-of pocket. However, you may pay a higher rate for services, and you will be
responsible for any amount your provider charges above reasonable & customary.
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| Q: |
How do I know if a provider is in the Anthem network?
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| A: |
You can check the Anthem website at www.anthem.com, or you can call Anthem
Customer Service or Anthem Blue Card Customer Service if you are away from your home area.
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| Q: |
What is “Precertification” and must I do it?
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| A: |
Precertification (precert) is when providers must notify Anthem before performing certain tests or procedures.
Consult you plan booklet or call Anthem when in doubt. Since detailed medical questions are asked, your provider
should perform the precert. However, it is ultimately your responsibility to make sure it has been done.
Failure to precert may result in a reduced insurance payment or no payment at all.
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| Q: |
How do I get another medical card?
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| A: |
You can request a new card through the Anthem website.
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| Q: |
How do I add my spouse or child to my insurance coverage?
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| A: |
Contact the P&L Human Resource Department within 31 days of a marriage or birth of a child in order to complete
a new healthcare application. After 31 days, your new spouse or child cannot be added to the health plan until open
enrollment in November/December.
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| Q: |
Since I am getting divorced, how do I drop my spouse or step-child from my insurance coverage?
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| A: |
You cannot remove either until the divorce is final. At that time you must notify the P&L Human Resource Department
within 60 days of the final divorce decree in order to complete a new healthcare application. Failure to notify the
P&L Human Resource Department may result in action being taken to recover any claims paid on behalf of someone
not entitled to coverage.
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| Q: |
When does my dependent child lose coverage?
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| A: |
Children are covered until age 26.
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