MOST OFTEN ASKED QUESTIONS IN THE RISK MANAGEMENT DEPARTMENT

HELP!!!!

 

1.   When  and how can I change my insurance?

There is an annual enrollment during the month of August for coverage changes effective September 1st.    For 2008-2009, the enrollment will be August 11th through August 21st.  Enrollments and changes during this period are made on-line or manually on forms in the Risk Management Department or from your school or department secretary.  

If you have a qualifying event such as the birth of a baby, or marriage, job changes, etc., you have 30 days to complete paperwork for this change.

 

2.   What is the name of my medical insurance?  What is my group #?

 The district offers two self-funded plans:

                Aetna HMO (group #212180)

                Aetna CPOSII (group #100085)

 

3.   How do I contact my medical insurance company?

Aetna HMO Customer Service                          1-888-287-4296

Aetna CPOSII Customer Service                       1-866-381-8933

 

4.   Where do I get claim forms?  Is there a separate claim form for dental?

All claim forms are available at your building or in the Risk Management Department.

Each of the following have separate claim forms and individual mailing addresses:

                Aetna HMO                                                                          Aetna CPOSII

                P O Box 981107                                                                     P O Box 14586

                El Paso, TX  79990-1107                                                      Lexington, KY  40512-4586

                Attn:       Claims Processing                                                Attn:       Claims Processing

                Prescription Drug                                                              CompBenefits

                Aetna                                                                                     P.O. Box 806274

                Pharmacy Management                                                      Chicago, IL  60680-3296

                Attn: Claim Processing

                P O Box 398106

                Minneapolis, MN  55439

               

5.   Do I have to have a Primary Care Physician (PCP)?

All Aetna HMO participants must select a Primary Care Doctor from the Aetna HMO Directory.   Currently, within the HMO network there are 2 networks: Kelsey-Seybold  & Independent.  When you choose a Primary Care Doctor from one of these networks, you can go to an OB/GYN within that network without a referral.    Kelsey-Seybold offers self referral when using its network.  If you choose a Primary Care Doctor from the Independent listing, except for OB/GYNs in the Independent system, you will need to get a referral from your PCP to see specialists within the Independent system.  If you wish to see an OB/GYN or a specialist in the Kelsey network, you will first need to change your PCP to the Kelsey Network.   For Mental Health services, contact Aetna at 1-800-424-5707.

Participants in the CPOSII do not need to select a Primary Care Physician.  In most cases, referrals are not necessary to see a specialist.

 

6.   Where do I get my prescriptions filled?

Aetna has a very extensive network of pharmacies.  Ask at the pharmacy of your choice if they accept the Aetna HMO or the Aetna CPOSII.  If they do not, check with another one, or go the Aetna Website, http://www.aetna.com/, to search for a participating pharmacy.  Maintenance medication is also available through mail order allowing a 90 day supply for the cost of 2 co-pays instead of 3.  Forms are available at your campus or in the Risk Management Department. 

 

7.   Do I get a card?

Aetna mails I D cards:  HMO & CPOSII cards are also the cards used for prescriptions

                CompDent mails I D cards for all dental plans

Ameritas mails ID cards for all vision plans

 

8.   How much do I pay for prescriptions?

Mandatory Generic—If the member or the physician requests brand-name when a generic is available, the member pays the applicable Copay plus the difference between the generic price and the brand-name price, or full brand price, whichever is less.

There is a Three Tiered Copay:

                In-Network (required on HMO)                                          Out-of-Network (CPOSII only)

                Generic                                   $10                                          Generic                   50% after $10

                Formulary Brand                  $30                                          Form. Brand          50% after $30

                Non-Formulary                     $50                                          Non-formulary      50% after $50

 

                Problems with Prescriptions:

                Have your pharmacist call Aetna Pharmacy Management at 1-800-238-6279.

 

                Mail-order Benefit

                Both the HMO & CPOSII plans have the same mail order benefit through Aetna RX Home Delivery.  Maintenance medications can be ordered for a 90-day supply at a cost of up to 2 times the single co-pay of the one month retail price.  As an example, a 90-day supply of a generic prescription would be $20.  Contact your campus secretary or the Risk Management Department for the mail order forms.  If you need your medication now, have your doctor write a prescription for a 30-day supply to be filled at the pharmacy and then another prescription for the 90-day supply.

                To have your prescriptions filled with the generic, please ask your doctor to write the prescription so that generic substitution is permitted.

 

9.   How do I know which of the tiers my prescription is on?

You can go to the Aetna Website to check, or contact Risk Management for a booklet of prescriptions.

 

10.  If I have the CompBenefits DHMO, must I use one of their dentists and what do I pay?

Yes, you must select a dental facility within their network.  You can change your selection during the year.  You do have free access to their specialists without referral.  Please note that in order to get the co-pay schedule with specialists, they must accept Prestige 55 or you will receive a 25% discount rather than the co-pay schedule.  A co-pay schedule is available in your booklet and/or on the Risk Management website in the Explanation of Benefits.  You can also call CompBenefits Customer Service at 1-800-342-5209.

 

11.  I have the vision plan and I need glasses.  Where do I go and what do I do?

The new vision plan beginning September 1, 2008 will be with Ameritas Group Vision.  We have two vision plans with Ameritas, ViewPointe and Vision Perfect.  Please see the online Explanation of Benefits to see how these plans work.  You can find providers at www.ameritasgroup.com and view plan benefit information at www.eyemedvisioncare.com.

 

12.  How do I get information on my Disability Plan?

For claims filed before December 31,2007, call American Fidelity Assurance Co at 1-800-662-1113.  For claims filed after January 1, 2008, please go online to www.BenefitSolver.com to the reference section, or call UnumProvident at 1-800-527-4572. 

 

13.  How do I get information on one of my supplemental plans?

Go online to www.BenefitSolver.com to the reference section to look up information, or call the applicable company:

American Heritage (Cancer Insurance)….1-800-521-3535

IA Pacific (Term Life Insurance)….281-286-3570

JEM Resources (Flex Account)….1-800-943-9179

NexStep (Gap Plan)….1-800-767-6811

Paragon Benefits….281-286-3590

UTA (Heart Plans)….1-800-880-8824

 

14.  How do I get information on a 403(b) or a 457?

Call Leslie Natale in Risk Mgt at ext 3000 for a list of companies or

For 403(b) retirement plans, call JEM at 1-800-943-9179

For 457 retirement plans, go to the Retirement Manager web site at https://www.aigretco.com/retireman/

 

15.  Where do I get a claim form for a Flexible Spending Account?

Go to www.benefitsolver.com to download a form, or call Leslie Natale in Risk Mgt at ext 3000

 

16.   How do I change my beneficiary?

Call or come to Risk Management to request a form.  You may also request the form from your school or department secretary.

 

17.   How do I change my name and/or my address?

Contact the Human Resources Personnel Department.  You must present a Social Security Card or receipt from the Social Security Office indicating the name you are changing to.

 

 

Always contact Risk Management for any questions or assistance you need regarding your insurance/benefits.  Telephone numbers are 281-498-8110, X 3001 or 281-988-3001.  Names and numbers are available on the Alief ISD Website.

 

                                                                                                                                                Revised 10/29/2008