Since my health insurance will be provided by PrestigePEO, who will issue my medical card and physician directory, and when will I get them?
You will receive your medical cards approximately 4-6 weeks after your effective date. If you have an immediate need for medical services prior to receiving your cards, we will supply you with the group numbers you can use to provide evidence of coverage until the cards arrive. Physician Directories can be accessed online through the specific carrier’s website.
When can I enroll on the Medical and Dental plans?
Employees may elect to enroll in the benefit plans once their waiting period has been met. Benefits start the first of the month following the waiting period.
What is my company’s waiting period?
Each employer has their own waiting period. To find your specific waiting period please refer to your employee handbook. If you cannot locate your handbook, please contact your Human Resources Business Partner who will be able to provide you with a copy.
If I do not enroll when initially eligible is there another time I can enroll?
For benefits not previously elected, you may elect to participate at open enrollment or upon a qualifying event.
Can I make changes to my benefits mid year?
Changes are only allowed at Open Enrollment or in the event of a qualifying life event.
What is a qualifying event?
There are some life events that will allow you to elect benefits or add dependents after initial eligibility and not wait for open enrollment. Examples of qualifying events are loss of prior coverage, marriage, and birth of a child.
How long does it take before I receive my ID card?
Cards will arrive at the home address you provided 7-10 business days after your enrollment has been processed. This time frame also applies to all replacement ID cards.
I have not received my ID card yet and I need to see my doctor. What do I do?
If your doctor will agree to see you without your card, you can call your Benefit Specialist for your policy number and your ID number. Once you have that information your provider can verify your coverage with the carrier. You can register as a member at the carrier’s website to obtain the information as well or even print a copy of your ID card.
How can I find a doctor/dentist that participates with my plan?
The carrier websites have links to their network providers. There is no need to register as a member to look up network providers. You can also explore employee benefits and link directly to providers via our PrestigeGO mobile app.
I lost my ID cards. How can I get a replacement?
Contact your Benefit Specialist via the PrestigeGO mobile app or call us at 516-692-8505. You can also print your ID from the carrier website when registered as a member.
What does out of network mean?
Out of network is a provider that does not participate with your plan.
What is a deductible?
A deductible is the amount you are responsible for paying before your plan pays its portion.
What is a Copayment (or copay)?
The fixed amount a member pays per visit to a provider for in-network health care services. The co-payment may vary per plan and per service.
What is co-insurance?
Co-insurance is the amount you are responsible for paying after the plan has paid its portion.
What is co-insurance maximum?
The most you will have to pay in out-of-pocket costs for co-insurance on covered services during a calendar year.
What is a PCP?
A PCP (Primary Care Physician) is a doctor selected by the member to be the first physician contacted for any medical problem. The doctor acts as the member’s regular physician and coordinates any other care the member needs, such as a visit to a specialist or hospitalization.
What is a drug formulary?
A formulary is a list of generic and brand name prescription drugs covered by your health plan. Your health plan may only help you pay for the drugs listed on its formulary. It’s their way of providing a wide range of effective medications at the lowest possible cost.
What can i do if my prescription is denied?
- Contact your Benefits Specialist who will research why the drug was denied.
- There may be limitations as to pre-authorization, step therapy, or quantity limits.
- Depending on the issue, the Benefits Specialist will contact the Providers office to have them reach out to Medical Management.
What is the Health Insurance Portability and Accountability Act (HIPAA)?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was prompted by federal regulations which require physicians to ensure they are protecting the privacy and security of patients’ medical information and using a standard format when submitting electronic transactions, such as submitting claims to payers.
What is a Flexible Spending Account (FSA)?
An arrangement through your employer that lets you pay for many out-of-pocket medical and/or dependent care expenses with tax-free dollars. There are 2 types of FSA’s.
- Healthcare FSA
- Dependent FSA