How To Effectively Use The Plan
Suggestions To Make The Plan Work Effectively
Prepared By
The Employee Benefit Service Center
11 Provide Your Certificate of Creditable Coverage
If you are a new employee and had previous coverage, provide a Certificate of Creditable Coverage to your new plan. If the coverage is creditable, it will help reduce the impact of limits on payment for pre-existing conditions.
12 Don't Panic On First Billing Statement
Providers often bill the Plan at the same time they bill the patient with a statement similar to the following: "Your Insurance Has Been Billed And Not Responded". Since your benefit Plan is just receiving the claim, of course there has been no response. It takes between 15 and 35 days to process claims that are complete when received or that have no issues that delay the claim for further research.
If you receive a bill from your medical provider within 40 days of your service date, we suggest that you ignore the bill and wait for us to take action. It is likely that we will be contacting you in the near future with action taken on the claim.
13 What To Do When You Receive The Second Billing Statement
If for some reason you receive a second billing statement from your medical care provider, we suggest the following:
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Call your provider and check where the claim was filed. If it was not filed to the address on your ID card, ask them to file it to the proper address.
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If the claim was filed to the proper address, contact us by phone or through the Inquiry Section of this Web Site and provide the following:
14 Watch For Claim Denial Due To A Pre-Existing Condition
If you have been on the Plan for less than a year, we suggest that you carefully review the section of this Web Site titled, Your First Year On The Plan. This location has important information that may impact your coverage and result in a claims denial if certain action is not taken by you.
15 Watch For Claim Denial As A Potential Accident Claim
If we receive a claim that could have been caused by a third party in an accident, we will ask for accident details. An example of this is a claim for a broken bone or laceration. Since many claims for these conditions are caused by an accident, we will suspect that your claim may be caused by an accident. Before we complete the claim, we will ask for "accident details" on the Explanation of Benefits (EOB). Please respond in writing, either through the mail or through this Web Site at Provide Accident Information.
16 Watch For A Claim Denial On An Over-Age Dependant Student
If we receive a claim for one of your dependents over the limiting age of your Plan (usually over age 19), we will ask for confirmation that the dependent is a full-time student. Please provide some record from the school-, such as a paid receipt, course record or schedule that proves that the dependent is a student.
Send the documentation in writing, by mail or by fax; See Contact Us. If you have the ability to scan the document, Email it to us at customer.service@ebscenter.com.
17 Keep And Read Your Summary Plan Description
The Summary Plan Description is provided to you at the time of your enrollment and when the Plan makes periodic updates. Please keep it and become familiar with the description of benefits. It describes in detail the eligibility requirements, the benefit coverage and other important information and is the document used by the claims administrator to determine if an individual or a service is eligible for coverage.
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Notice: This information is prepared exclusively for the use
of clients of The Employee Benefit Service Center
