|
Home > Working at the Y > Employee Benefits > Frequently Asked Questions
Frequently Asked Questions
Medical Insurance
General Questions
Q. How many hours per week must a part time employee work to be eligible
for benefits?
A. Employees must work between 25-34 hours per week
for part-time health
insurance.
Q. At what age are children eligible as dependents?
A. Up to age 19, unless he/she is a full-time student, then up to age 25.
Q. How often may I switch between the Kaiser plans?
A. You may switch once per year at the open enrollment period.
Q. Why would an employee choose the Triple Option plan over the HMO
plan?
A. Some people like the flexibility of the Triple Option
plan since you can choose to use and select your own provider for most services.
The Triple Option plan has both in-network (PHCS) and non-network (any provider
of your choice) benefits. The Kaiser HMO plan requires you to use Kaiser providers
for all services.
Q. Why would an employee choose the HMO plan over the Triple Option
plan?
A. Under the HMO plan you will have lower out-of-pocket
expenses (lower copays) than the Triple Option. The Kaiser plan only requires you to pay
a copay for services at a Kaiser facility. Under the Triple Option 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 $500 copay for all charges. Under the
Triple Option you will be responsible for 30% of the total charges up to a calendar year
maximum of $4,000. So a $5,000 hospital stay will cost you $500 with the HMO and
$1,850 with the Triple Option. See summary below for details.
Kaiser Side-By-Side Plan Summary
Q. What if I don’t enroll in the health plan when I’m first eligible?
A. You and/or your dependents are a late applicant
if you don’t enroll yourself and/or your dependents within 30 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 30 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 employment or reduction in the number of hours of employment;
or
- Termination of employer’s contribution for the other plan’s coverage.
Q. Do I need to choose a Primary Care Physician (PCP)?
A. No, the Kaiser plans do not require you to choose
a PCP.
Q. 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?
A. 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, or call 911. As soon as possible contact Kaiser to let them know you've needed emergency service outside the service area and ask for instructions.
Q. Must I see a Kaiser provider to receive benefits?
A. 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 Option plan
you have three options:
Q. Where do I go to get prescriptions filled?
A. Please contact member services (303-338-3800) or
use Kaiser's Web Site to locate the
Kaiser pharmacy closest to you.
Q. Where do I get information regarding Kaiser providers and locations?
A. Please contact member services (303-338-3800) or
use Kaiser's Web Site or if you are
enrolled in the Triple Option plan go to www.phcs.com.
Q. Does the Kaiser plan offer vision benefits?
A. Yes. The plan does allow employees to see a Kaiser
eye doctor for an eye exam for a $20 copay per visit. The $20 copay covers the cost
of the exam and does not include the cost of lenses, frames or contacts.
DENTAL INSURANCE
Q. I never got a Dental Insurance card, what do I take to the Dentist?
A. Call toll free 1-877-236-9622 and select option #2.
Q. What number do I call for assistance regarding Dental Coverage and claims?
A. Call Toll Free 1-877-236-9622 and select option #2.
Q. Where do the claim forms get sent to for payment?
A.. Aetna Dental, PO Box 14094 Lexington, KY 40512-4094. Most dentists office will submit the claim for you.
|