Do I need to inform you that I am changing my PCP (Primary Care Physician)?
No, the Plan does not track your PCP.
Do I need a referral to see a specialist?
No, the Plan does not require referrals to see specialists.
Can I use a BCBS Provider for my routine vision exam?
No. Coverage for routine vision exams is covered by EyeMed. In order to maximize your benefits, you should use an EyeMed provider. Please do not use your Independence Blue Cross Blue Shield identification card at your vision appointment. You must advise the vision provider that your vision coverage is through EyeMed.
How do I add my spouse to the policy?
Please submit a copy of your marriage certificate and your spouse’s social security card to the Fund Office.
What do I need to do to add my baby to the policy?
Please submit a copy of the baby’s birth certificate and a copy of the baby’s social security card to the Fund Office within 30 days of the dependents birth date.
Do we have any dental coverage under our Health Plan?
Certain procedures that are not covered under the Delta Dental Plan may be eligible for coverage under the Health Plan.
My spouse has a health plan under his/her employer, under which both our dependent children and myself are also covered. Being that our family has two health plan policies, which plan would be the primary carrier for my spouse, our dependent children and myself?
The Plan has rules that determine which plan is primary. Refer to the section called Coordination of Benefits in your Summary Plan Description for details.
Does my Health Plan cover acupuncture?
Yes.
Does my Health Plan cover weight loss programs or the cost of a fitness club membership?
No, your plan does not cover weight loss programs or the cost of a fitness membership.
Is emergency room care covered at 100%?
No, you are responsible for a $100 copayment, unless admitted. “Admitted” means: Inpatient; patient kept for observation; Emergency Surgery including OR & Recovery.
I RECENTLY GOT LEGALLY SEPARATED / DIVORCED. WILL MY SPOUSE/ EX-SPOUSE BE REMOVED FROM MY HEALTH INSURANCE?
Yes, if you become legally separated or divorced your ex-spouse is not eligible for benefits under the Health Plan. You must provide the Fund Office with a copy of your legal separation or divorce decree and all documents filed with the decree. The Plan will not provide coverage once the legal separation or divorce decree is filed with the court. If you fail to notify the Health Fund of your legal separation or divorce and any claims are paid, or reimbursements are made, on behalf of your former spouse you are responsible to repay the Health Fund.