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Retiree H&W -
Frequently Asked Questions
General Questions (for all retirees)
Preferred Provider Questions (for
retirees not eligible for Medicare)
How long
will it take to get my claim processed?
Most claims are processed within 14 days from
the day the Plan receives the claim in the Administrative Office.
Processing of claims that may be paid by other insurance and claims
for injuries caused by an accident with third party responsibility
tend to take a little longer.
An updated Annual Medical/Dental Claim Form for
the patient must be on file at the Administrative Office for any claims to be
processed. If the Annual Medical/Dental Claim Form is not current,
the participant will be requested to fill one out and the claim will
be not be paid until the form is completed. The most common
cause for a delay in processing a claim is that the patient does not
have a current Annual Medical/Dental Claim Form on file.
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How many times do I have to fill out one of those medical claim
forms?
The Plan requires that an Annual Medical/Dental
Claim Form be updated once every twelve months or whenever the
patient’s information changes. . If you cannot remember when each family member’s form
expires, and you anticipate using the Plan within the coming year, you may
download the form in January and fill one out for each covered
family member.
How long do I have to
file a claim?
The Plan accepts claims for medical services
for one year from the date of service.
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What is
pre-authorization and why does my procedure
need to be pre-authorized?
Pre-authorization is a medical review by an
independent group of physicians to determine whether a procedure or
treatment is medically necessary. The Plan will only cover
procedures and treatments that are medically necessary and has
contracted with HealthCare Strategies to perform medical reviews for retirees
that are not eligible for Medicare. Medicare determines
medical necessity for those who are eligible for Medicare.
For retirees not eligible for Medicare, the Plan
requires pre-authorization on all in-patient hospital stays and on
the following outpatient procedures:
-
Bariatric Surgery (surgery to
treat obesity)
-
Bletharoplasty
-
Botox Injection
-
Breast Surgery
-
CT Scan for Virtual Colonoscopy
-
Durable Medical Equipment over
$1,500
-
Home Health Care
-
Home Infusion Therapy
-
Lithrotripsy
-
Panniculectomy
-
Varicose Veins,
stripping, ligation and sclerotherapy
The Plan also requests that maternity stays be
pre-authorized as soon as practical. To pre-authorize your procedure,
have your physician or health care provider call HealthCare Strategies at
1-800-582-1535.
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Yes, effective January 1, 2003, all retirees are required to use the prescription drug plan in order to
take advantage of lower negotiated rates at the Caremark network of
pharmacies. Click here to
learn how to save money by using Caremark.
Do my
prescription co-pays apply to my medical deductible?
No, your prescriptions DO NOT apply to your
medical deductible.
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Mail order is a
cost-effective way to obtain medications you take on an on-going basis.
Mail order prescriptions are filled in 90 day increments (even if the
script is for a year). To fill a new prescription, you must submit a
Mail Order Form
and provide
an original doctor’s script which indicates whether a brand name drug
or a generic is appropriate.
When you need a refill, simply call
Caremark at 1-866-818-6911 or log on to their website,
www.caremark.com
to reorder. Your prescription will be
sent to you via the US Postal Service or through a delivery service if
special handling is required.
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Why should I use generic drugs instead of brand name drugs?
Once a drug patent has expired, other companies
may start to sell the same drug under another name. The generic
drugs are not normally advertised, helping to keep their costs to a
minimum. Generic drugs are
required by the federal Food & Drug Administration to have the same
quality, strength, purity, and stability as brand name drugs.
By using generic drugs when they are available, you can receive the
same quality of health care for less money - and these savings can be
used to offset other health care expenses to help keep premiums low.
Please ask your doctor and pharmacist if a generic is available for
your prescription.
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Are travel expenses covered?
Travel to the nearest facility will be reimbursed
by the Plan if treatment is unavailable locally and it is medically
necessary. If the member traveling is a minor, the Plan will
reimburse travel for one parent or guardian to accompany the minor.
The Plan will also reimburse travel for one companion to assist an
adult member if the member is incapacitated due to a medical condition
and will need assistance.
Please note that the Plan does not reimburse for
ground transportation or room and board. This means that car rentals,
motels/hotels, parking, and cab fares are not covered expenses.
For reimbursement for travel expenses, you must
submit a letter of medical necessity from your current physician, a
copy of the ticket(s) with the dates and costs of travel, and the
boarding pass(es) as proof that the travel took place. Travel
benefits are subject to medical deductible and eligibility
requirements.
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If You or Spouse are
Eligible for Medicare
Part A of Medicare
covers general hospital expenses and Part B covers physicians and
medical expenses. If you are eligible for Medicare and fail to
enroll, BENEFITS UNDER THE RETIREE MEDICAL PLAN(S) WILL BE REDUCED
AS THOUGH YOU WERE ENROLLED IN BOTH PARTS A AND B OF MEDICARE. This
means benefits would be paid on assumption that you are enrolled in
both parts A and B of Medicare; and if you have not enrolled, you
could incur significant uncovered out-of-pocket expenses. We
strongly encourage all retirees to contact Social Security to
determine the procedures and timetables for enrollment in Medicare.
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May Medicare-eligible participants use the Wellness and Minor Care
program?
Expenses normally covered by Medicare are not covered under the
Wellness and Minor Care Plan.
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What is the penalty for using a non-preferred provider (within the
Municipality of Anchorage)?
If you use a health care provider within the Municipality
of Anchorage that is a not a preferred provider, the Plan will base
your reimbursement on the preferred provider rate and will then
reduce your regular reimbursement rate by 20%. In addition to these
reductions, a $1,000 penalty will be imposed to each inpatient
admission to a non-preferred provider.
For example, you live in Anchorage and need to
have a certain treatment. The preferred provider charges the Plan
$100 for this type of treatment. A non-preferred provider in South
Anchorage charges $200 for this type of treatment. You have already
met your deductible for the year and the Plan usually reimburses at
75%.
If you have this treatment at a preferred
provider, the Plan will pay $75 ($100 X 75%). Your out-of–pocket
expense will be $25.
If you have treatment at the non-preferred
provider, the Plan will pay $55. First, the $200 expense is marked
down to the preferred provider rate of $100, then the reimbursement
rate is reduced by 20%. ($100 X 55%) Your out-of-pocket expense
will be $155.
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Who are my preferred providers in the Municipality of Anchorage?
Your preferred providers within the Municipality of
Anchorage are as follows:
| Service Needed |
Preferred Provider |
| Inpatient hospital
stays |
Alaska Regional Hospital |
| Outpatient lab and x-ray
services |
Alaska Regional Hospital
|
| Physical therapy services |
Chugach Physical Therapy
|
|
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What
area does the Municipality of Anchorage include?
The Municipality of Anchorage is comprised of the area
from Girdwood to the Knik River Bridge including the Anchorage bowl
area.
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How
do I know where my labs and x-rays are being sent?
Ask! It is your responsibility, as a plan
participant, to educate your physician(s) and medical care
providers, as well as your dependents, regarding your preferred
providers. Let your physician know who your preferred
providers are and he/she will make arrangements for labs and x-rays
to be performed at your preferred provider.
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What is Multi-Plan (for services outside the Municipality of
Anchorage)?
Multi-Plan is a nationwide group of contracted
preferred providers that offer considerable discounts to the Plan
for use of their facilities, groups, and doctors. When you select a
preferred provider from the Multi-Plan network, you will save money
and the Plan will save money. You may call 1-877-478-1246,
option 5, or review
Multi-Plan’s website, to find a Multi-Plan provider near you.
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What is the penalty for using a non-preferred provider (outside the
Municipality of Anchorage)?
The Plan uses Multi-Plan providers nationwide.
If you use a facility that is not Multi-Plan and it is within 25
miles of a Multi-Plan provider, the Plan will reduce your
reimbursement rate by 20%. You can search for a Multi-Plan provider
near you on
Multi-Plan’s website, or by calling 1-877-478-1246,
option 5.
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