Q: Why didn't the
insurance pay for my service?
- To get the most benefit from
your plan you must go to a participating provider and
present your ID card when you receive services.
- Most plans have a
deductible that you as an individual or a family must
meet before certain services are covered.
- Check your Evidence of
Coverage/Plan Summary Description booklet to see if the
service you received is covered under your plan.
- Sometimes the insurance
company needs more information from you or your doctor to
process the claim. See below.
Q: I have a claim
problem. What do I do?
- You should contact customer
service for the insurance company in question. Have
your Explanation of Benefits/Member Statement from
the insurance company, your ID card and the doctor's bill in
hand when you call.
- Ask why they denied payment
on your claim.
- Follow the instructions of
the customer service person to get the claim resolved.
Q: When can I add my
dependent?
- You can add a spouse,
domestic partner or child at Open Enrollment.
- Outside of Open Enrollment,
you can add dependents when you acquire them (marriage,
establishment of domestic partnership,
birth of a child, court ordered coverage).
- You can add dependents if they
experience a loss of health converge under another group
plan. Documentation is required. Call the insurance
office for more details.
- The Insurance Office must be
notified within 30 days of the event for your
dependent to be added outside of Open Enrollment.
Q: What happens if I
get separated or divorced?
- Your spouse may stay on your
plan if you become legally separated. In California
you are still married even if you are separated.
- If you file for divorce,
your spouse will no longer be eligible to continue on your
insurance plan as of the date of the final dissolution of
marriage.
- You MUST
inform the office within 30 days of your divorce becoming
final.
- Your former spouse will be
offered COBRA continuation.
Q: How long can I keep
my child on my insurance?
- Dependent children
(including step-children and adopted children) may stay on your plan until their
19th birthday.
- Between ages 19 and 25 the
child must be unmarried and a full-time student (12 units) at an
accredited school, college or university. Proof of
student status may be required.
- After age 25 your child is
not eligible unless he/she is disabled.
- Please
notify the insurance office if your child no longer meets
the student criteria so that COBRA continuation may be
offered.
Q: When is Open
Enrollment?
- Open Enrollment for SISC
Blue Cross (faculty medical) happens in August/September for the new plan year starting
on October 1.
- Open Enrollment for Blue
Shield, Delta Dental, MES Vision and AFLAC happens in
November/December for coverage beginning on January 1.
Q: How do I get a new
ID card?
- You may request a
replacement Blue Shield card by calling customer service or by
requesting one through the company's website. Phone
number and websites are listed on the Insurance
Benefits
Home Page.
- If you need a new SISC/Blue
Cross card contact the Insurance Benefits Office for
assistance.
- Dental ID cards are only
issued to new participants. An ID card is not required
to receive services. You simply need your group
number, 6736-0001 and the subscriber's (employee) Social
Security number.
- MES Vision does not print ID
cards. Similar to the dental plan, all you need is
your group number and SSN to access benefits. You can
create your own card for convenience. See the
Vision page.
Q: How do I know if my
doctor is a Participating Provider/Preferred Provider?
- Each of the medical, dental
and vision plan websites allow you to search for a provider
in their network. See the Benefits Home
Page for websites.
- Call Customer Service to see
if your doctor is a provider.
- Request a directory by
calling or emailing the Insurance Benefits Office.
Q: How do I change my
TSA (403b) or 457 contribution?
- 403(b) contributions can be
changed by filling out a new
Salary Reduction
Agreement.
- You must pick up or request
a CalPERS 457 change form from the office.
- If you have a SESLOC 457
plan, you must initiate the change with SESLOC and bring the
completed forms to the office.
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