| FAQ about Employee Benefits |
Q: Do co-pays go toward my deductible?
A: Unless otherwise stated, co-pays are separate from and in addition to deductibles, co-insurance and co-insurance limits.
|
Q: How do I find a Preferred Provider in my network?
A: The MBA website provides a link to all of the PPO Networks utilized by the plan. To search for a provider in your network click on the appropriate PPO Network web link. To verify the current participation of a provider, we strongly recommend you contact your network at the number on the back of your ID card prior to any appointment.
|
Q: How do I know when my deductible starts?
A: The Plan uses a "Calendar Year" deductible method for benefit determination purposes on individual and family deductibles.
|
Q: Is there a time limit on filing claims?
A: Yes. All claims for must be submitted within 12 months from the date of service to be considered for processing/payment unless you or your Employer Group has terminated the plan. For terminated members and/or terminated Employer Groups, all claims must be submitted within 90 days of the termination date in order to be considered for processing/payment.
|
Q: What is a "Hospital Deductible"?
A: A "Hospital Deductible" is a separate deductible that applies to each hospital admission or out patient services/procedures in addition to individual/family calendar year deductibles, co-pays and co-insurance limits.
|
Q: What is a co-insurance limit?
A: A co-insurance limit is the maximum co-insurance responsibility in a calendar year for which a covered member or family must pay before the Plan assumes 100% payment for eligible charges.
|
Q: What is a co-pay?
A: A Co-pay is a pre-determined charge that a member must pay each time they receive certain designated health services.
|
Q: What is a deductible?
A: A deductible is the "up-front" amount a covered memeber or family must pay for eligible charges each calendar year before the Coinsurance Rate applies for eligible charges.
|
Q: What is a PPO?
A: A Preferred Provider Organization is a network of providers (hospitals and/or physicians) where discount arrangements of billed charges have been made.
|
Q: What is considered a routine physical examination?
A: A routine physical examination is an examination performed as preventative medicine in the absence of complaints.
|
Q: Who is my PPO Network?
A: Refer to the back of your ID card to identify the PPO Network for your Plan.
|
