Frequently Asked Questions

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?

For small groups,( generally less than 100 employees), 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. Due to Health Care reform, dependents under age 19 are not subject to pre-existing.

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 lower copay than a secondary or specialist provider. Copay amounts may also be used for prescription drug transactions. It is important to remember that the amount of your copay does not apply to the accumulation of the 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 refer to your benefit booklet or 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 CFA. 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. New legislation (HCR) requires preventive care to be covered at 100% for all plans implemented or changed after 9-23-10. However, if your plan is a “grandfathered plan” then you may be required to pay for preventive coverage.

9) What are the procedures I need to follow if I go to the emergency room?

If it is a true emergency, dial 911 and 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, services may be denied. It is best to seek care at a local Urgent Care center if at all possible.

10) What doctors and hospitals can I go to with my plan?

During educational and/or enrollment meetings, you will receive instructions on how to access the network directory. If you did not, please see your employee benefits coordinator. With most insurance companies you can obtain an up-to-date listing of participating providers through their website.

11) I just got married. I have a newborn. How do I add dependents 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. If you have access to online changes then log in to your employer site and input the new data.

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 an accumulation of the charges that you pay and not the portion or percentage paid by the insurance company. 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 at that point.

13) I was covered on my employer’s 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?

You can either contact your 401K Administrator or call CFA for direction.

15) How can my HRA funds be used?

HRA funds may be used for out-of-pocket medical expenses – deductibles, coinsurance. Your employer may limit what expenses are eligible.

16) What can flex dollars be used for?

Flex dollars can be used for eligible medical expenses incurred by the member during the plan year, as allowed by current law. Prescription drugs, for example, are an eligible expense. Copays for doctor visits are legitimate expenses, as are non-cosmetic dental procedures, vision exams and prescription lenses.

17) How do I order another ID card?

Please call your Customer Relations Agent at CFA and they can order a new ID card for you or you can create a user name and password at the carrier’s site and order the card online.

18) What is the difference between COBRA and State Continuation?

COBRA refers to the Federal legislation (Consolidated Omnibus Budget Reconciliation Act) whereby a terminated employee may remain on the group health plan for a certain period of time by paying the monthly premium. State Continuation is similar in nature, for companies with fewer employees, and was established by State legislation rather than Federal legislation.

19) If I leave employment, which coverage can I take with me?

Coverage continuation of benefits depends of the size of your employer, benefits offered and if the benefits are voluntary or employer paid. Contact CFA for further instruction.

20) Explain pre-tax versus post tax deductions?

A pre-tax deduction for medical premium is when the deduction is taken before income is taxed. This allows less tax to be taken (on a smaller amount of income), and can often result in a slightly larger portion of take-home pay.

A post-tax deduction is when monies are deducted from an employee’s paycheck after income tax has been deducted.