Tuesday, July 23, 2019

Frequently Asked Health Care Questions


Q. Whom should I call if I have questions about my eligibility?
A. The Plan Office at 1-800-572-8975 or (248) 836-2760 (in Michigan only).
Q. How do I add my new baby or spouse? 
A. You must get a data card from the Plan Office. Fill it out and return it to the Plan Office no later than 30 days from the birth of your baby or date of marriage. A Marriage Certificate is required, and a Birth Certificate may be required.
Q. Will my child who is age 19 to age 26 be covered under the Plan? 
A. As of May 1, 2011 coverage is provided for adult dependents up to age 26, no proof of college enrollment is required. Contact the Plan Office for more information and an enrollment form.
Q. Does my Plan cover conditions related to an auto accident?
A.  No. 
Q. How can I be sure my claim will be paid? 
A. There are certain expenses that your Plan does not cover. If you are unsure about a particular expense, contact Blue Cross Blue Shield of Michigan or the Health Care Plan Office.
Q. What if my spouse also has medical coverage through his/her employer?
A. We suggest that you contact the Plan Office, and we will assist you in determining who the primary payer is. If you are secondary for your dependents, always file the claim with the primary payer, first.
Q. What is the MRA (Medical Reimbursement Account), and what does it pay for? 
A.

Currently the Plan credits you with .35 for every hour of contributions that are received on your behalf by a contributing employer. You may use this to pay for unreimbursed expenses such as:

  • Dental co-payments and expenses
  • Vision Expenses 
  • Medical expenses not covered by B/C B/S
  • Prescription drug co-payments
  • Self-payments
  • Other IRS approved medical expenses (pursuant to the Internal Revenue Code)
*Please refer to the Summary Plan Description for a complete detail of this benefit and what is required for submitting claims. Also note that claims over 1 year old are not payable. 
Q. Am I still entitled to the MRA even though I have lost eligibility through the Plan?
A. No. The MRA is a benefit like all others, you must be eligible with the Plan at the time the service is rendered in order to be entitled to any benefits.
Q. What is the address and fax number? 
A. When addressing the Plan our address is:

550 Hulet Drive Suite 104
Bloomfield Township,MI, 48302
(248) 253-1761
Q. Who do I have my prescription coverage through? 
A. Your prescription drug coverage is through Caremark.
Q. Do we have a card for our Dental coverage? 
A. No, you simply tell your dentist your dental coverage is through Delta Dental Plan. Your claims are filed under your (the Participants) social security number, and your group number is 2324.