Frequently Asked Questions:

1. While at the pharmacy the pharmacist tells me my prescription won't go through. What do I do?
   - Call the customer service number on your health insurance card and explain the problem. They will be able to help you. If it's after hours and they are not available, see if the pharmacist can give you a two day supply.
   - You can also pay for the prescription and if the prescription is a covered prescription, the pharmacy can reimburse you directly.
2. While at the pharmacy the pharmacist tells me that my health plan will not cover my prescription. What do I do?
   Some prescriptions have to be pre-certified by your physician. On your health plan's web site there is a list of all formulary prescription drugs and how they are covered. Also, you can talk to your physician about the insurance you have when they are prescribing a medication; there could be a substitute or generic equivalent.
3. I lost my Medical Identification Card. Where can I get a new one?
   On most web sites you can sign in and print a temporary card, as well as ordering a new card. You can access our company web site for carrier contact numbers.
4. I had a new baby. When do I need to add him or her?
   The baby needs to be added within 31 days of the birth; otherwise, your child will not be covered.
5. When can I drop a dependent?
   You can drop a dependent at any time.
6. When can I add a dependent?
   A dependent can be added during open enrollment or within 31 days of a qualifying event. (Qualifying event -- loss of other coverage, marriage, or birth/adoption of a child.)
7. What forms do I need to add an employee to our medical benefits?
   Typically a family health statement and an enrollment application are needed to add an employee.
8. How do I find out if my doctor is a provider?
   You can verify a physician's participation a number of ways. First, go online with the applicable carrier and search their provider list. Second, call the carrier directly and speak with a customer service representative. Third, contact the physician's office directly and ask the staff.
9. How many hours does someone need to work in order to qualify for group benefits?
   Most health plans require 30 hours or more. This applies to groups of 50 or less employees. However, groups of 51 or more employees may be allowed to lower that requirement.
10. If I have not received an ID card, does that mean I'm not covered?
    Not necessarily. ID cards are generated approximately 7-10 days after you have been entered into the system. All cards are mailed to your home address. Speak to your employer if a card is not received.
11. Will my insurance company cover my college student out of state?
    Typically they will be covered for emergencies only. Those who have point-of-service plans with out-of-network benefits can apply the non-emergency services to their deductible and co-insurance.

Contact us or call toll free: 877-250-7880
© 2005 The Benefits Group all rights reserved
EMPLOYEE BENEFITS CAN BE YOUR COMPANY'S
2nd LARGEST FIXED EXPENSE AFTER PAYROLL!