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Q.
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What is my claim status?
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A.
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You should contact your administrative office for the status of specific claims.
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Q.
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Are there limitations?
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A.
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Depending on your plan, there are plan maximums, exclusions and limitations based on types of service and calendar years. Please refer to your plan booklet for information regarding limitations and exclusions.
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Q.
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Do you require pre-authorization?
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A.
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There are certain services which require pre authorization. All inpatient surgeries must be pre-authorized by Beech Street. Any outpatient surgery which may fall into the realm of possible cosmetic services, should be pre-authorized to determine if services are medically necessary. If you are uncertain as to whether or not a specific service must be pre-authorized, please contact your administrative office.
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Q.
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Do you cover expenses incurred out of the country?
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A.
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Yes. Charges for services obtained outside of the U.S. are subject to the same limitations, exclusions and maximums of the indemnity plan.
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Q.
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What is the dollar maximum per year?
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A.
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While there are no annual dollar maximums for services under the indemnity medical plan, there are calendar year visit limitations for such services as home health care and non-surgical services of the spine. Please refer to you plan booklet for specific information regarding these services.
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Q.
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What is the lifetime max on my Medical Plan?
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A.
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$1,000,000.00 per person.
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Q.
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Does the Medical Plan cover dental implants?
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A.
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No. Dental implants fall under the medical benefit exclusion for treatment of the teeth and surrounding tissue. However, dental implants are considered an eligible expense under the Indemnity Dental plan. Please refer to your plan booklet for benefits under the Dental portion of the indemnity plan.
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Q.
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How much is the deductible?
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A.
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Under the Active and Casual plans, the annual deductibles apply to charges for services rendered by a non-preferred provider. Under the Active and Casual Indemnity Plans, a deductible of $100.00 per person per calendar year, or $300.00 per family per calendar year must be satisfied. Non-Medicare Retirees must satisfy a $300.00 per person per calendar year deductible for all services rendered. Medicare eligible Retirees must satisfy a $100.00 per person per calendar year deductible for all services rendered.
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Q.
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Has the medical plan deductible been met?
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A.
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You will need to contact your administrative office for specific information regarding the satisfaction of your calendar year deductible(s).
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Q.
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What is considered a calendar year?
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A.
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A calendar year is from January 1st through December 31st.
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Q.
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What is stop loss?
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A.
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This is the point at which the individual satisfies his/her individual or family out-of-pocket maximum. Once the out-of-pocket has been satisfied, benefits for most services are reimbursed at an increased percentage.
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Q.
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What is my out-of-pocket maximum?
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A.
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Under the Active and Casual Indemnity Plans, the out-of-pocket maximum for services rendered by a non-preferred provider is $1,000.00 per person or $3,000.00 per family per calendar year. This does not include deductibles, charges in excess of Usual, Customary & Reasonable Charges, co-insurance, or payments imposed due to non-compliance with inpatient hospital pre-authorizations. Participants and their eligible dependents covered under the Non-Medicare Retiree Plans must satisfy a $1,500.00 Preferred provider out of pocket or a $2,500 non-preferred provider out of pocket. Please note that preferred provider out of pocket expenses also apply towards the non-preferred provider maximum of $2,500.00. However, non-preferred provider out of pocket expenses do not apply toward the preferred provider out of pocket. The maximum out of pocket expense for each non-Medicare participant/dependent is $2,500.00.
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Q.
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Is the patient eligible?
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A.
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Eligibility under the indemnity plan is month to month based on hours/shifts worked by the participant. Please refer to the Eligibility section of your plan booklet for specific information.
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Q.
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Who is considered an eligible dependent?
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A.
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(1). Your legally married spouse (2). Your own children, natural or adopted under age 19 (3). Your stepchildren or foster children under age 19 (4). Children for whom you are required to provide medical coverage pursuant to a Qualified Medical Child Support Order. Please refer to you plan booklet for specific definitions of an eligible dependent. (5). Children who are age 19 or older and are unable to attend school on a full time basis due to a physical or mental handicap may be eligible for an extension of benefits. Please contact your administrative office for information regarding this provision.
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Q.
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How can I cover my child once they reach age 19?
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A.
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An eligible dependent child age 19 or older, but under age 26, may continue to be eligible for benefits while he or she is a full-time student in an accredited educational institution.
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Q.
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What constitutes full-time enrollment?
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A.
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Usually it is a minimum of 10 credit hours, but can go as high as 15 credit hours.
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Q.
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Does my plan have a routine benefit?
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A.
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The Active and Casual plan has a routine benefit for participants and their eligible dependents. There is a $500.00 annual maximum benefit for routine services rendered by a non-preferred provider. Routine services rendered by preferred providers are not subject to an annual maximum. There are no routine benefits available to participants and dependents covered under the Indemnity Retiree Plans.
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Q.
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Are hearing aids covered under my plan?
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A.
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A hearing aid benefit is available to Active and Casual Indemnity plan participants and their dependents. Benefits are limited to $1,000.00 ($500.00 per ear) with replacement once in a three year period. Participants and dependents covered under the Indemnity Retiree plans are not eligible for this benefit.
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Q.
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Are foot orthotics covered under my plan?
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A.
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Orthotics that have been determined to be medically necessary are considered eligible under the indemnity plan. However, it should be noted that they are not covered as a "first line" form of treatment. More conservative forms of treatment must be tried prior to obtaining the orthotics. You should contact your administrative office for additional information regarding this benefit.
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