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Helpful Hints for Members New EnrolleesRegarding Pre-Existing: Most plans have a provision that excludes benefits for conditions that were present and/or treated prior to enrollment. These are called "pre-existing conditions". However, the Health Insurance Portability and Accountability Act (HIPAA) provides that previous/current healthcare coverage (including Medicaid, Medicare, Blue Cross, Tricare, etc.) can be credited toward the pre-existing time period in this plan. (Exception: As allowed by statute, some public entities can still apply their pre-existing provision even if you have previous creditable coverage.) When an individual terminates coverage, that healthcare plan is required to provide a "Certificate of Creditable Coverage". In order for that previous coverage to be credited toward this plan’s pre-existing provision, we must have a copy of that Certificate. PLEASE PROVIDE YOUR CERTIFICATE OF CREDITABLE COVERAGE UPON ENROLLMENT UNDER THIS NEW PLAN. This will enable us to process your claims promptly upon receipt, rather than going through the time-consuming process of determining if a pre-existing condition exists. Timely Filing If complete information is provided with your claim, most reimbursements are mailed within fourteen calendar days of receipt. EOB and Comments A GENTLE REMINDER. Your first claims of the year will have deductible applied. If you receive an EOB and no check, it may have all been applied to your calendar year deductible. CHECK THE COMMENTS SECTION OF YOUR EOB. Accident Claims Note too, that there are also rules regarding dependent children and how primary coverage is determined when they are covered under two plans. To assure accurate processing of all claims –-and to reduce the chance of you having to refund any money due to overpayments -– please be sure to provide all information regarding any other health insurance coverage. If another insurance plan is primary, wait until the primary insurance has completed processing the claim. Then, when you’ve received their "Explanation of Benefits (EOB), send it along with a copy of the itemized bill (HCFA form 1500 or UB-92) to us for further consideration under this secondary plan. Please do not submit "statements." The statement does not provide the information necessary to process the claim. Your dependent must be a full-time student at the time charges are incurred to be considered by the plan. It is not uncommon for a college student to drop a class after the semester begins, resulting in a change from "full-time" to "part-time" status. COBRA continuation of coverage is available if notice is given to your employer that your child is no longer an "eligible" dependent within 60 days of the "qualifying event" (drop from full-time to part-time student status or graduation). However, if this notice is not given within the 60 days, insurance will automatically terminate for the student, and the ability to elect continued coverage under COBRA is lost. Make sure your college student understands the impact this change can have on their eligibility for benefits. Customer Service
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