Wednesday, February 4, 2026

Frequently Asked Health Care Questions


Q.

Who is eligible to become a Participant in the Plan?

A.

Active Employees, Retirees, Dependents, COBRA participant, Surviving Spouse, and Disabled Participant.

Q.

What if I'm required to make a premium payment as a retiree and I don't make that payment?

A.

Your eligibility as a retiree would be terminated on the first of the month following the month the premium was due but unpaid.  You would then be offered coverage through COBRA which requires an election of coverage and separate premium to be paid within the required time-frame.  COBRA eligibility generally extends for a period of 18 months.

Q.

How do I maintain my monthly Health Care coverage?

A.

Continuous employment at a contributing employer or the payment of any premium due as a retiree will maintain your eligibility under the Plan.

Q.

How do I make a payment towards the continuation of my Health Care coverage?

A.

Only retirees and members on Cobra can make payments.  Self-payments can be made to the fund office at:

NEHP

P.O. Box 670459

Detroit, MI 48267-0459

Q.

Whom should I call if I have questions about my Health Care eligibility?

A.

You can contact BeneSys, the NEHP administrator with any questions at 248 641-4970 or 866 614-2856.

Q.

Who are my eligible dependents?

A.

Spouse, Domestic Partner, Natural Child, Step-Child, Adopted Children

Q.

Will my child(ren) who is/are age 19 through age 26 be covered under the Plan?

A.

Yes.  Federal regulations require that children be covered under their parent's Plan until their 26th birthday. 

Dependents in the state of Florida are eligible until the age of 30 as long as:

1. Child is unmarried and does not have a dependent of their own.

2. Is a resident of Florida or full-time/part-time student

3. Does not have coverage through other insurance

Q.

How do I add my new baby or spouse to my insurance plan?

A.

You must notify BeneSys within 30 days of a life event.  

Q.

Whom should I contact if I'm getting a divorce and what documents do I need to submit?

A.

First contact the Human Resources department at your employer, then call BeneSys at (248) 641-4970 or (866) 614-2856 to update your family information.

Q.

How do I obtain a replacement Medical and Prescription Card?

A.

Contact BeneSys at (248) 641-4970 or (866) 614-2856.

Q.

How do I inquire about the status of my medical claim?

A.

Contact the insurance carrier (BCN, Blue Cross, Humana, etc.) at the number listed on the back of your ID Card.

Q.

Who is the Prescription Drug Benefit Manager?

A. For most NEHP participants, the Prescription Benefit Manager (PBM) is Blue Cross Blue Shield.
Q.

How can I contact the Prescription Drug Benefit Manager?

A. Contact Blue Cross Blue Shield at (877) 790-2583
Q.

If a service I need requires Prior Authorization, who do I (or my provider) contact?

A. The number for you or your health care provider to contact for any prior authorization appears on the back of your Medical ID Card.
Q.

If I need to utilize Mental Health or Substance Abuse benefits, who do I contact?

A. Contact your provider directly for care and call BeneSys at (248) 641-4970 or (866) 614-2856, to help determine the level of coverage you are eligible for under the Plan.  
Q.

How do I find a dentist or find out if my dentist participates with DenteMax?

A. Visit the DenteMax web site at www.Dentemax.com.
Q.

If I have Medicare, who does my provider submit the claim to?

A. Your provider will know where to submit your Medicare Claim(s).  For most NEHP retiree participants that would be to Blue Care Network, but for some it may be Humana or United Health Plan.  But again, your care provider will know the proper way to submit claims for you.
Q.

Who are my Vision benefits through and how can I contact them?

A. Vision Benefits are administered by EyeMed which can be contacted at www.eyemed.com.
Q.

Eligibility: How do I become eligible for Disability Benefits?

A.Generally, if you are eligible for Medical Benefits under the NEHP and not a Retiree Participant, you are automatically eligible for Disability Benefits at the same time.
Q.

Does the fund offer any extensions? 

A.There are certain instances where a participant may qualify for one or more extensions of the Disability Benefit. Consult Section IV of your Summary Plan Description (SPD) or contact BeneSys at 248 641-4970 or 866 614-2856.
Q.

How much does the Disability Benefit Pay per week? 

A.The NEHP offers several Short Term Disability Benefit Levels.  Consult with the Human Resources department at your employer to determine which level is offered through your company.  
Q.

How long can I collect a Disability Benefit? 

A.Disability benefits begin on the first day of an accident or the 8th day of a sickness and are paid for up to 26 weeks.
Q.

Are there any Death Benefits Available?  How do I qualify for Death Benefits?

A.Yes. Benefits are paid in accordance with the applicable schedule of benefits to a designated beneficiary or spouse (if married).
Q.

Is there a filing limit for Death Benefits?

A.Generally claims must be filed within one year from the time of the participant's death.
Q.

Who is Eligible for the Death Benefit? 

A.The employee participant and in some cases (depending on your place of employment) the participant's spouse and children may be covered.
Q.

How Much Does the Benefit Pay?

A.The NEHP offers various levels of coverage through the Plan.  Consult your Human Resources Department for the level your employer has opted for.