FREQUENTLY ASKED QUESTIONS
MEDICAL INSURANCE
General Questions
- How many hours per week must an employee work to be eligible for benefits?
- Employees must work between 25-34 hours per week for part-time health insurance.
- At what age our dependent children eligible as dependents?
- Up to age 19, unless he/she is a full-time student, then up to age 25.
- How often may I switch between the Kaiser plans?
- You may switch once per year at the open enrollment period.
- Why would an employee choose the Triple plan over the HMO plan?
- Some people like the flexibility of the Triple plan since you can choose to use an can select your own provider for most services. The Triple plan has both in-network (United providers) and non-network (any provider of your choice) benefits. The Kaiser HMO plan requires you to use Kaiser providers for all services.
- Why would an employee choose the HMO plan over the Triple plan?
- Under the HMO plan you will have lower out-of-pocket expenses (lower copays) than the Triple. The Kaiser plan only requires you to pay a copay for services at a Kaiser facility. Under the Triple plan you can be responsible for an annual deductible and a percentage of the total bill. For example an inpatient hospital stay with Kaiser will cost you a $250 copay for all charges. Under the Triple you will be responsible for 20% of the total charges up to an calendar year maximum of $4,000. So a $5,000 hospital stay will cost you $250 with the HMO and a $1,320 with the Triple. See summary below for details.
Kaiser Side-By-Side Plan Summary
- What if I don’t enroll in the health plan when I’m first eligible?
- You an/or your dependents are a late applicant if you don’t enroll yourself an/or your dependents within 31 days of the date you and/or your dependents become eligible for coverage. Late applicants may only enroll during Open Enrollment once per year and they may be subject to the plan’s pre-existing conditions limitations, if any. However, if you and/or your dependents fit one of the following categories, you may enroll outside of Open Enrollment as long as you enroll within 31 days of the following events you and your dependents will not be considered late applicants:
- Exhausting the maximum period of COBRA coverage; or
- Legal separation, divorce, death of a spouse; or
- Marriage, birth, adoption; or
- A qualified court order requiring you to cover dependent coverage; or
- Termination of the employment or reduction in the number of yours of employment; or
- Termination of the employer’s contribution for the other plan’s coverage.
- Do I need to choose a Primary Care Physician (PCP)?
- No, the Kaiser plans do not require you to choose a PCP.
- What should I do if one of my family members becomes ill or gets injured on the weekend, during a holiday, or while we’re on vacation?
- If you are experiencing a life or limb-threatening emergency (i.e. difficulty breathing, profuse bleeding, broken bone, etc.), go to the closest emergency room. Be sure to have someone call your doctor within 2 working days or as soon as possible. Your benefits will be paid at the highest level. If you are not experiencing an emergency, call your doctor first. The “on-call” provider will instruct you to the appropriate care. Your benefits will then be paid at the highest level.
MEDICAL INSURANCE
- Must I see a Kaiser provider to receive benefits?
- YES, in order to receive benefits under the Kaiser HMO plan you must seek care from a Kaiser provider or at a Kaiser facility. This does not apply to emergency situations.
NO, if you are enrolled in the Triple plan you have three options:
- Utilize a Kaiser facility or provider
- Utilize a MMA facility or provider
- Any provider of your choice.
Kaiser Side-By-Side Plan Summary
- Where do I get information regarding Kaiser providers and locations?
- Please contact member services (303-338-3800) or use Kaiser's Web Site.
- Where do I go to get prescriptions filled?
- Please contact member services (303-338-3800) or use Kaiser's Web Site to locate the Kaiser pharmacy closest to you.
- Are Where do I get information regarding Kaiser providers and locations?
- Please contact member services (303-338-3800) or use Kaiser's Web Site or if you are enrolled in the Triple plan go to www.mmanetwork.com.
- Does the Kaiser plan offer vision benefits?
- Yes. The plan does allow employees to see a Kaiser eye doctor for an eye exam for a $10 copay per visit. The $10 copay covers the cost of the exam and does not include the cost of lenses, frames or contacts.
DENTAL INSURANCE
- I never got a Dental Insurance card, what do I take to the Dentist?
- Please contact Human Resources to obtain an ID card. This is new for plan year 2004.
- What number do I call for assistance regarding Dental Coverage and claims?
- Call Toll Free 1-877-2363-9622 and select option #2.
- Where do the claim forms get sent to for payment?
- Aetna Dental, PO Box 14094 Lexington, KY 40512-4094
For more information contact:
Steve Homburger
Assoc. VP of Human Resources
Tel: 720-524-2715
Email: hr@denverymca.org
