Call
or
Group and Pension Administrators at 1-800-827-7223
A
specified dollar amount of covered expenses which must be incurred during a
calendar year before any other covered expenses can be considered for payment
according to the applicable benefit percentage. “Deductible” also means that
dollar amount of the expense of a particular procedure or covered expense for
which it is indicated in the schedule of benefits that a special deductible
will apply. The plan administrator reserves the right to allocate and apportion
the deductible and benefits to any covered persons and assignees.
The
portion of covered expenses that is shared by the plan and the covered person
in a specific ratio (i.e. 70%/30%) after the calendar year deductible has been
satisfied. The amount of co-insurance paid by or on behalf o f the covered
person is applied towards the covered person’s or family’s annual out-of-pocket
maximum.
The
maximum dollar amount a covered person will pay for covered medical expenses,
in addition to the calendar year deductible, other deductibles, copayments, and
any covered charges already paid at 100% in any one calendar year period,
unless otherwise specified in the schedule of benefits.
You
can verify if your doctor is in network by going online and visiting HealthSmart.com or call 1-800-687-0500
No
No
IF YOU STILL HAVE QUESTIONS CALL
Yes
– January to December
You
will receive an explanation for benefits from GPA
No
– Your dependent will be covered up to the day before their 25th
birthday
No
– only if there is a change of status
No
– only at open enrollment
The
first of the following month of date of hire
A
spouse and child(ren)
Yes
– you have a separate out of network deductible and your co-insurance
percentage will change
No
Up
to $250 per office visit – included examination, treatment, lab, x-ray, tests
and supplies provided by and billed by Physician at the time of the office
visit, except surgery, chemotherapy/radiation therapy, infusion therapy,
physical therapy, occupational therapy and speech therapy
A
statement sent from the health insurance company to a member listing services
that were billed by a healthcare provider, how those charges were processed,
and the total amount of patient responsibility for the claim.
IF YOU STILL HAVE QUESTIONS CALL
You
do not have and in and out of network for dental. You can see a provider of
your choice.
It
depends on what plan you are on. You will have a $10 copay for generic drug,
$25 copay for brand name drug, $50 copay for a non-preferred drug, or your
prescriptions will apply towards your deductible.
GPA
will apply your prescriptions towards your deductible as soon as they receive a
monthly report from Pharmacare. You will then be sent an EOB.
Yes,
dental services incurred in
a. treatment is necessary and recognized as usual
treatment for that condition;
b. dental expenses are considered Usual and Customary
according to the HIAA, based on the nearest
c. procedures are approved by the
d. all usual Plan provisions and limitations apply;
e. expenses must be filed in U.S. dollar amounts and
must be translated into English; and
f. benefits may not be assigned to the Provider
Policy
# = Social Security Number
Group
# = H870428
PHI
– Individually identifiable health information that is created or received by a
Covered Entity (the Plan) and relates to: (a) a person’s past, present or
future physical or mental health or condition; (b) provision of health care to
that person; or (c) past, present, or future payment for that person’s health
care. This term shall be constructed in accordance with the Privacy Regulation.
IF YOU STILL HAVE QUESTIONS CALL
Should
you need a designated person on your policy, a written authorization must be
submitted to our office. The document
must include the date, the name and relationship of designee and your
signature.
HIPAA
– With regards to health care plans, it should be noted that this Act
implemented the portability of health insurance set standards for Pre-existing
Condition exclusion periods and change health status eligibility provisions for
employee health plans.
Any
physical or mental illness or injury for which the covered person received
medical care, advice, diagnosis or treatment, or for which a physician was
consulted or for which medical expenses were incurred or for which a covered
person has taken prescribed drugs or medicines during the six months
immediately prior to the covered person’s enrollment date in the Plan.
IF YOU STILL HAVE QUESTIONS CALL