need help?Risk Management Department You can also contact our Employee Benefit Consultants during business hours throughout the week. Their contact information is below: MGU of the West Insurance Services, Inc.
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Frequently Asked Questions: (Samples Only) Click on the question below to be taken to the answer.
Open enrollment takes place annually beginning the last week of September and the first 3 weeks of October, with changes effective November 1st. You may enroll at other times during the year provided it is a qualifying event (e.g. termination of other coverage, newly eligible based on hours worked, acquisition of new dependent, etc.) 2. What constitutes an eligible dependent? Eligible dependents are as follows:
3. How do I add new dependents? To add a newly eligible dependent you will need to complete the appropriate enrollment form and provide documentation of the dependent's eligibility (e.g. birth certificate, marriage certificate, divorce decree, adoption order, certificate of Domestic Partnership, etc.). Forms can be printed from the Web site, or secured at the District’s Risk Management Office. Completed forms along with supporting documentation must be submitted prior to coverage becoming effective. Newly eligible dependents must be added within 31 days of their initial eligibility. If not added within 31 days, the dependent will not be eligible until the next Open Enrollment period. 4. Can I cover my dependent while he/she is attending college? Yes, as long as the dependent is under age 19 to 25 and is enrolled as a fulltime student (12 units). 5. How do I add my Doctor to the provider network? You can ask your doctor to contact the respective insurance provider and request to be contracted. You may also send a nomination to the respective insurance provider asking that they contact the physician to discuss contracting. This process can be accomplished by using the customer service contact information contained on this Web Site. However, not all providers will be contracted with all insurance providers as each physician and insurance provider reserves the right to make contracting decisions. 6. As a Blue Cross member do I have to use a PPO provider? No. However, if you receive care from a non-preferred provider you could experience higher out of pocket costs in terms of copayments and/or applicable reimbursements. Additionally, non-preferred providers could “balance bill” you for extra expenses that become your responsibility and not that of Blue Cross or the District. 7. Can I self-refer to a specialist? It depends on which plan of benefits that you participate in. For example in the PPO plans you are free to self-refer to any specialist at any time. In the Kaiser plan you must be referred to the specialist by your Primary Provider. In most situations a specialist will not see or accept a new patient without a referral from a primary care physician regardless of the plan. Specialists have limited time to spend with each patient. Therefore, if a prospective patient self refers, the specialist has no data on symptoms, early diagnosis or preliminary treatment that may have already been provided or attempted. In all the plans, a female employee or dependent may have both a family practice doctor and OB/GYN as primary care providers. Children may elect either a family practice doctor or pediatrician. 8. Do our plans include mail order pharmacy benefits? If you have a Blue Cross plan call the customer service number and request a form or go to the Blue Cross website for more information. 9. As a Kaiser member, can I submit or drop off enrollment changes directly at the doctor’s office or hospital? No. The District requires that all enrollment changes be submitted through the Risk Management Office. This avoids eligibility and billing problems. If forms are not submitted through the Risk Management Office, the effective date of your coverage may be delayed. 10. What happens if my dependent college student terminates coverage mid-semester? Coverage would terminate at the end of the month in which their college enrollment terminates and the dependent would be offered COBRA continuation benefits.
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