Thursday, May 6, 2021

Frequently Asked Health Care Questions

Q. How does my doctor confirm my eligibility and benefits under the Plan?
A.To service our Provider networks more effectively and efficiently, Benesys Administrators requires ALL PROVIDERS to access our Web based Provider Portal for all Eligibility, Claims Status and Summary of Benefits for Medical, Dental and or Vision.

Providers must register through this Provider Portal by going to Providers must submit any questions or requests through the Provider Portal’s Express Message feature for any claims, Eligibility and Benefits related inquiries.

Responses to inquiries will be addressed through the Portal within 24 hours of receipt. This procedure enables Providers to get up to date information on claims status, benefits and eligibility, 24-hours a day, 7 days a week, eliminating hold times on the phone.
Inquiries will be handled through this portal for increased efficiency and response turnaround time.
Q.How do I order a new ID card?
A. Please contact us. Please indicate you need a new medical card and the quantity needed.
Q.How do I file for Short Term Disability benefits?
A.You must file a Disability Benefit Fund Office, complete your portion of the claim form, have the physician complete their portion of the claim form, attach all itemized bills and return with the completed claim form to the Benefit Fund Office within 90 days after the claim was incurred.
Q.How do I become eligible for medical benefits?
A. Initial Eligibility. An Active Employee not eligible on the Restatement Effective Date will become eligible on the first day of the month following any period of not more than five (5) consecutive calendar months during which the employee works a total of at least three hundred (300) hours.

Continuation of Eligibility. An Active Employee will continue to remain covered as long as his/her hour bank account contains at least one hundred forty (140) hours of work credits.
Q.I paid out of pocket for medical treatment, how do I get reimbursed through the Trust Fund Office?
A. Complete a Claim Form.
Q.How do I obtain a precertification for treatment?
A. Effective March 1, 2015 contact the Medical Management Program through ERS Medical Management at (800)708-3765, 1240 Fairway St., Bowling Green, KY 42102.