- Who do I notify for family status or address changes?
- Notify your Treasurer Personnel Department on an Enrollment/Change Form of the following changes within 31 days of the event:
- Loss of medical or dental coverage due to
Divorce
Death
Spouse’s coverage ends with employer due to termination or reduction of hours
COBRA exhausted
- Marriage
- Adoption
- Qualified Medical Child Support Order
- Child turns 19
- Child gets married
- Address or phone number change
Special Provision: Newborns are covered at the moment of birth ONLY if you enroll your new baby in our Plan within the 60 days immediately following birth.
Your medical claim payments may be delayed or denied if you do not notify your Treasurer Personnel Department. Visit "Eligibility/Enroll/COBRA" page and click the question "Family Status Changes, Qualifying Events, District Enrollment Contacts " for district contacts.
- Do I have coverage while I am on vacation?
- Yes. Emergency or Urgent Care claims away from home for plan members are paid as if in-network of usual and customary charges. When traveling or attending college out of the local PPO network area, call the national PPO network, MultiPlan, at 1-800-672-2140. Claims will be paid at the in-network rate.
- Traveling Abroad! Do You Need Medical Evacuation Insurance?
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Although some health insurance companies may pay "customary and reasonable" hospital costs abroad, very few will pay for medical evacuation back to the United States. Medical evacuation can easily cost $10,000 or more, depending on your location and medical condition. One of the main advantages of health and emergency assistance policies is that they often include coverage for medical evacuation to the United States. BHP covers urgent and emergency care abroad, but not medical evacuation. If you want medical evacuation back to the United States, you should consider medical evacuation insurance for your trip.
- How do I know what is covered by the BHP plan?
- Your BHP Medical Plan Document and Dental Plan Document explains who can be covered, how payments are made, how to file a claim and other important information on how your Plan works. You may also call Allied at 1-800-288-2078 for dental and medical benefit questions. You may contact Express Scripts at 1-866-275-0044 for prescription drug benefit questions.
- Does my ID card work outside the USA?
- Some medical providers in foreign countries may not accept your ID card, particularly third world countries or providers in very rural areas. You could be asked to pay for your care by cash or credit card. If this occurs, you may file a claim for covered services with Allied for reimbursement. YOU must get a DETAILED & itemized bill for the service with the current rate of exchange in English.
For prescription drugs, get a detailed receipt in English complete with drug name, strength, etc. and submit the claim to Express Scripts for reimbursement.
- What is a Usual & Customary charge?
- A u/c charge is the amount usually charged by the majority of doctors, dentists or providers in a geographic area for services. Because BHP has a PPO network of providers that have agreed to pre-negotiated fees for their service, there is no "balance billing" or U/C charge. If you receive service from an out-of-network provider, you are not protected from U/C. Since there is no dental network, the dentist may charge you for U/C.
- I'm a new employee. I do not have my ID card yet. How do I get coverage?
- Prescription drugs: You will need to pay the full price, but reimbursement will be made to you after you receive your ID card. Send a copy of your receipt with a direct reimbursement claim form to Express Scripts.
Medical Claim: A provider may verify that you were hired and have medical coverage with your school district by calling your employer's office. When you receive your ID card, all verifications of benefits should be made by calling Allied Customer Service at 1-800-288-2078.
- Can pre-existing clause be waived?
- Yes, through the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This federal law allows all or part of your pre-existing waiting period to be waived. HIPAA prohibits discrimination based on health status and restricts pre-existing condition exclusions and limitations as long as there is proof of uninterrupted prior medical coverage.
- What is the HIPAA?
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It is a federal law that regulates how covered entities such as health
care providers and health plans, including the Butler Health
Plan, may use and disclose protected health information ("PHI"). Many provisions of HIPAA became effective on April 14, 2003.
- How does BHP keep my health information private?
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The BHP has always respected the privacy of personal health information of individuals in the plan and handled it securely. Ohio state law has provided protection for individual's personal health information. And now, federal law provides further protection for individual's health information under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
- What is a Notice of Privacy Practices?
