Here you will find a list of the most frequently asked questions
followed by a brief explanation of each.
1) I have ordered new insurance cards. How
long will it take me to receive the cards?
It will take approximately 7 to 14 business
days for you to receive your new identification cards. If you have
not received them by this time, please contact your customer service
representative.
2) I have just enrolled on my employer's group insurance.
Will I be subject to a waiting period for pre-existing conditions?
If you had prior coverage within the past 63 days, then the amount
of time you were covered under the prior carrier will count toward
the pre-existing condition time limit for this plan. If you did
not have prior coverage, then you will be subject to pre-existing
limitations. The pre-existing limitations vary, so please contact
your customer service representative for the details of your plan.
3) What is my deductible?
A deductible is a specified dollar amount of covered services that
must be incurred by you before your plan will provide benefits for
all or part of the remaining covered services. Deductibles vary
by plan; please refer to your benefit booklet or call your customer
service representative to determine the dollar amount of your deductible.
4)
What is copay?
A copay is encountered once a service is rendered by a network provider. Typically,
a primary provider requires a lower copay than a secondary or specialist provider.
Copay may also be used for prescription drug transactions. It is important to
remember that the amount you copay does not count towards your deductible. Consult
your insurance booklet or call CFA if you have further questions regarding copay.
5) Do I need a referral to go to a doctor other than
my primary care doctor?
This varies according to your plan. Please contact CFA before you
seek care, for the details of your plan.
6) What do I do if I need a prescription filled before I receive
my identification card?
You will need to pay the full price for the prescription and send
the receipt from the pharmacy to us. We will file the prescription
for you with your insurance carrier and you will be reimbursed all
but the member responsibility.
7) I went to the pharmacy to get a prescription and I
had to pay more than my copay, why?
This could be for a variety of reasons. Please contact your customer
service representative and we can contact the pharmacy and insurance
company to assist you in finding out why you paid more than your
copay.
8) Do I have coverage for routine physical exams?
Most plan designs include an allowance for routine physical exams.
Typically, primary care copays apply to this situation.
9) What are the procedures I need to follow if I go to
the emergency room?
If it is after hours or on the weekend, then
you must contact your primary care physician as soon as possible,
usually within 24 hours, or on the next business day. Please remember
that if this is not an emergency medical condition, all services
will be denied.
10) What doctors and hospitals can I go to with my plan?
When you enrolled on the plan, you should have received a provider
directory. If you did not or it is more than 6 months old, please
see your employee benefits coordinator for a new directory. With
most insurance companies you can obtain an up-to-date listing of
participating providers through their website. Please see our links
page to find your insurance carrier.
11) I just got married. I have a newborn. How do I add
them to my plan?
You need to see your employee benefits coordinator for an enrollment
change form. You must complete this form within 30 days of the event
for the effective date of coverage to be the date of the event.
If you do not, then your new dependents may not be able to enroll
until your group's open enrollment and may be subject to pre-existing
condition limitations.
12) What is the difference between my deductible and my
out-of-pocket?
Your deductible is a specified dollar amount that must be incurred
by you before your plan begins paying benefits. Your out-of-pocket
is a specified dollar amount that you must pay after your deductible
has been met. The out-of-pocket limit is met on charges that you
pay a portion and the insurance company pays a portion, in other
words, you share the cost of the charge with the insurance company.
Once the out-of-pocket limit is reached, your share of the cost
will decrease to an amount specified by your plan - usually with
there being no member responsibility and the insurance company paying
the entire cost of the covered charges.
13) I was covered on my employers group insurance plan.
I left employment and continued the coverage on COBRA. How long
can I stay on COBRA?
COBRA is a federal law. Depending upon the reason you left employment,
the length of time you can continue COBRA will vary. Please contact
CFA to help you determine the length of time you may continue.
14) I left employment and had money in my 401K plan. How
do I get my money and what can I do with the money?
CONTACT US! We will send you the appropriate
forms to complete. Not only can we help, we can explain the taxes
and penalties that may apply if you get your money. We can also
help you with options to rollover your money so you will avoid
taxes
and penalties. As always, CALL US or e-mail us if you have any
questions or we can be of any assistance in any way.
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