Important Information Regarding the SGU Faculty Health Plan: You asked us We listened

Transcription

1 Important Information Regarding the SGU Faculty Health Plan: You asked us We listened Who is WEA? Worldwide Expatriate Association LTD manages the overall plan administration. They work alongside the claims processor to deliver the benefits platform. Is WEA recognized in the United States? Yes, the provider associated with WEA in the United States is International Healthcare Administrators (IHA). Who is IHA? International Healthcare Administrators provides claims administration services to WEA. They provide WEA s customers the highest level of customer service. They are known as the healthcare provider in the United States and are backed by A+ rated re-insurers. Who is covered underneath the WEA plans? All SGU Grenada Faculty would be covered under the scope of the plan regardless of location and country of citizenship (see plan Eligibility for details). How do I sign up for coverage? If you are a new employee please see Margaret Duncan for enrollment information. If you are an existing employee and have a qualifying event, then you would complete a Qualifying Event Form (QEF) and send it to Georgette Noriega or Patricia Cordero of Crystal & Company, the insurance broker of record for St. Georges University s Health Insurance Plans. If you do not have a qualifying event then you will need to wait till open enrollment to sign up for the plan. Open enrollment is in September. The SGU Faculty Health Insurance Plan is effective from October 1 st 2013 through September 30 th Georgette Noriega, GBM, GBA, CMS Patricia Cordero Senior georgette.noriega@crystalco.com patricia.cordero@crystalco.com Direct: (305) Direct: (305) Fax# (305) Fax# (305) You will receive confirmation upon receipt to verify that your form has been sent to process. What is a Qualifying Event? A Qualifying Event allows faculty to make mid-year election changes when a change in a participant s status occurs. Examples of Qualifying Events for SGU faculty are as follows: Change in marital status Change in number of dependents Change in Employment Status Loss of Coverage from prior plan

2 What network is used in the United States? If you visit a facility in the States, they will recognize the name International Healthcare Administrators. IHA is the coverage that WEA provides. In the States, the WEA plan utilizes the United HealthCare Options PPO Network. This is merely your network but is not your insurance carrier. You can see a listing of in-network providers (in the States) by visiting the United Healthcare Options PPO network: You will find this to be a huge network and you should not have any difficulties in finding coverage. What if I can t find my current provider in the UHC online system? You can contact SGU s benefits broker directly at: St. George s University Benefits Broker: Georgette Noriega, GBM, GBA, CMS Patricia Cordero Senior georgette.noriega@crystalco.com patricia.cordero@crystalco.com Direct: (305) Direct: (305) Fax: (305) Fax: (305) You can also contact WEA directly at: International Healthcare Administration (IHA): Call: (305) (local) or (from within the USA) or (International) Prompt options: a. Spanish (7) b. Emergency pre-certification (4) c. Benefits & Claim Status (3) d. Repeat the menu ( * ) e. Operator (0) When will I receive my ID cards? Once the registration period has closed for the year, all Faculty who have enrolled in a policy will receive an with login details to their own personalized Member Portfolio. An SGU Members Portfolio Manual is located on the My SGU website for your review. Once logged in, you will be able to access your ID cards, submit claims online, have direct access to all of your policy details, have access to the message center to communicate directly with a claims processor, and much more. It is important to note that no ID cards will be sent to your physical mailing address.

3 Who can I contact for benefits questions throughout the year? For all questions, you can contact SGU s benefits broker directly at: St. George s University Faculty Benefits Broker: Georgette Noriega, GBM, GBA, CMS Patricia Cordero Senior georgette.noriega@crystalco.com patricia.cordero@crystalco.com Direct: (305) Direct: (305) Fax: (305) Fax: (305) After hours emergencies should be directed to WEA at (305) You can also contact IHA directly at: International Healthcare Administration (IHA): Call: (305) (local) or (from within the USA) or (International) Prompt options: f. Spanish (7) g. Emergency pre-certification (4) h. Benefits & Claim Status (3) i. Repeat the menu ( * ) j. Operator (0) Claims@iha-assist.com for the following: a. Pre-certification b. Claim Status c. Benefit clarification d. Anything relating to claims/benefits or status of reimbursement e. Submit claim via f. Submit medical records You can also contact WEA directly at: Worldwide Expatriate Association (WEA): Support@weadirect.com for: a. Assistance with login b. Assistance changing address c. Assistance with website d. General questions not claims related

4 You can also contact SGU directly at: St. George s University (SGU): Margaret Duncan Tel: ext. 2044/ MDuncan@sgu.edu for: a. New Employee Registration b. Payroll Deduction c. Termination of Employment What is SGU s contribution to the new health insurance plan? The SGU Faculty plan is paid 100% by the faculty member via payroll deduction. SGU administration has worked very hard this past year to negotiate an affordable comprehensive health insurance plan to provide faculty. SGU has obtained a very low rate for this plan for its Grenada based faculty. Please contact SGU Payroll Department if you have any questions on how and when they will deduct from your payroll. Where do I send my Qualifying Event Form (QEF)? You can or fax your QEF to: Georgette Noriega, GBM, GBA, CMS Patricia Cordero Senior georgette.noriega@crystalco.com patricia.cordero@crystalco.com Fax# (305) Fax# (305) You will receive confirmation upon receipt to verify that your form has been sent to process. Are there any waiting periods, clearance requirements or pre-existing conditions to consider? No pre-existing applies for those faculty members who enrolled during open enrollment for an effective date of October 1, Any members or dependents that enrolled onto the plan after the 2012 open enrollment are subject to pre-existing conditions. In order to have the pre-existing conditions waived the member or dependent must provide proof of credible coverage for approximately 12 consecutive months. There are no waiting periods on this plan. Pre Certification Requirements are as follows: The insured person must contact Our Claims Administrator indicated on the ID card at least (5) business days prior to receiving any planned In-Patient treatment, MRI, CT Scans, Out-Patient Surgery and Oncology Treatment, to obtain approval for Medical Care needed. WEA must be notified of any Emergency Treatment by the member within (48) hours of such Treatment

5 The benefits payable for Covered Expenses incurred for all Treatment, Services and supplies related to the claim will be reduced to and payable at 50% (whether or not the Out of Pocket Limit has been met), after any deductible amount which may apply, if the Insured Person or the Insured Person s Dependent(s): 1. Do not Follow the Pre-Certification Requirements 2. Use the services of Providers who are not members through out Proffered Provider Network payable at 70% of UCC, as indicated in the Schedule of Benefits (Please revert back to the Policy for further information) Does this plan include Dental & Vision coverage? At this time, SGU wanted to secure a comprehensive health insurance at an affordable rate for all Faculty members. We will be negotiating an add-on possibility for dental and vision in the future. Any dental and vision care you receive will need to be paid 100% out of pocket as these are not currently covered benefits. Can I cancel my plan at any time? No. The only time to opt out of the plan is during open enrollment or through a qualifying event. Are there different levels of coverage available for purchase? There is only one level of medical insurance available; however, you may choose to purchase the Stand Alone Evacuation insurance for yourself and dependents. Currently St. George s University has one Medical Plan available through WEA. If I choose to waive the plan during the open enrollment period, can I request enrollment at any time during the plan year? No. Once you have submitted your waiver, you are unable to make any changes without contacting Margaret Duncan at SGU or the Benefits Broker directly. All requests for changes must be submitted in writing within 31 days from the effective date of the policy (based upon your Open Enrollment period). Any request made after the 31 days would be considered invalid and the faculty member would have to wait until the next plan year to make any changes unless proof of a Qualifying Event is provided to the carrier. In the instance of a Qualifying Event, the carrier must be notified within 31 days of the event for the enrollment to be considered valid. Is there a limit on dependents (children under the age of 26)? No. You may insure all of your dependents, no matter how many, for the same low family annual premium. What is my deductible? Your deductible is $1,000 USD per policy year. If you are treated at the Student Health Clinic your deductible will be waived.

6 While outside of the US which providers can I visit? Outside of the US you can see any provider. Please give them your WEA ID Card and if they need to verify your benefits they can contact WEA at the phone numbers on the back of the card. You will be responsible for your policy year deductible. In some instances the provider has the right to request full payment at the time of service. If you have paid the provider for your services you can submit an itemized bill, paid receipt and a medical claim form for reimbursement to the carrier directly at: claims@iha-assist.com At the time of reimbursement your policy year deductible will be applied to your claim. How do I submit a claim? Once you have received access to the online Member Portfolio, you will be able to upload all of your claims electronically. The system has real time capabilities, which allows you to view the processing of your claims as they are being handled by the carrier. The site will also serve as a record keeper for where you would like any reimbursements sent, including mailed checks and direct deposits into your own bank account. The Explanation of Benefits will also be placed here immediately following the completion of your claim s processing in case you need to reference prior to receiving the mailed copy. I take prescription medications. Am I able to obtain a vacation override for more than a one month s supply? Yes. The SGU Faculty Health Plan will allow for up to a 3 month fill based on the doctor s prescription. If a vacation override is requested at the time of the fill and applicable prescriptions are provided, the plan will allow for up to a 6 month fill. If you take narcotic medications, you will need one prescription for each month (the plan will fill up to a 6 month supply). It is important to note that there is a maximum annual fill of 365 days. Do I need to contact the carrier in order to fill my prescription is it is for more than a one month supply? No. As long as you have the corresponding prescriptions (as described above), you are able to fill up to a six month supply. It is important to note that there is a maximum annual fill of 365 days.