Once you have attained eligibility in the Local 282 Welfare Plan, you will have to choose between the HIP Health Plan of New York, an EmblemHealth company or the self-insured plan which is jointly administered through Anthem Blue Cross/Blue Shield. If you choose the self- insured option, you must pre-certify for benefits by calling Alicare at 1-877-540-6663. A list of those services requiring pre-certification has been mailed to each participant in the Plan, and a copy is available for download from here. If you choose the HIP Health Plan option, you will receive information regarding the Plan directly from the HIP Health Plan.
Answer: Depending on the type of provider you visit will determine the co-payment. The co- payment must be paid to your provider for each date of service, regardless of the number of services provided on that date. The co-payment for treatment provided by a primary care provider will be $20 per visit. The co- payment for treatment provided by a specialist will be $30 per visit. Medical specialists are doctors who have completed advanced education and clinical training in a specific area of medicine (their specialty area). Examples of medical specialists are allergists, cardiologists, gastroenterologist, hematologist, neurologist and rheumatologist, to name a few.
Answer: There is a $100 co-payment for emergency room visits. This co-payment will be waived if you or your eligible dependent is admitted to the hospital. There is no co-payment payable to hospitals for inpatient or outpatient services.
Answer: Non-participating provider claims are payable at 80% of the Maximum Allowable, subject to a $400 individual and $800 family deductible. Many non-participating provider charges exceed the Maximum Allowable for the services provided, therefore it is highly recommended that you use Blue Cross/ Blue Shield participating providers whenever possible, to avoid excessive balance billing.
Answer: When you use a Blue Cross/Blue Shield participating provider, they are responsible for submitting their claim directly without a claim form from you. If you use a non-participating provider, you will need to complete an Anthem Claim Form to submit with your itemized bill. You may download the form here or contact the Fund Office Medical Department. Please keep a copy of all documents you submit to Blue Cross/Blue Shield for your records.
Answer: When you visit a participating Blue Cross/Blue Shield provider, they cannot request payment at the time of service, other than your $20 co-pay ($30 for specialists). If you go to a non-participating Blue Cross/Blue Shield provider, they can request payment in full at the time of service. You would be responsible for submitting the claim to Blue Cross/Blue Shield.
Answer: In most cases, providers of service will submit claims on your behalf directly to Anthem Blue Cross/Blue Shield. However, there may be occasions, especially if you use a non- participating provider, that you may be asked by the provider to pay at the point of service and submit your own claim for reimbursement. If that is the case, you may download the form from this website (see home page), or contact the Fund Office.
Answer: Not necessarily. To be sure, you should ask your doctor if he/she is a “participating provider in the Blue Cross/Blue Shield provider network.”
Answer: By calling the Provider Access Information number found on the back of your Blue Cross/Blue Shield ID Card, which is 1-800-810-BLUE, or by accessing their website at www.bcbs.com
