Medical / FAQs

Medical FAQs

How does my deductible work?: You must meet your annual deductible before the plan begins to pay a share of your costs. Certain services, such as covered preventive care, will be paid at 100% regardless of whether you have met your deductible.

Will I be protected if I experience a catastrophic illness or injury?: Yes. Once you reach the Out-of-Pocket Maximum, the Plan will pay for all eligible medical expenses for the remainder of the Plan year. Remember, although you may have reached your Out-of-Pocket Maximum, Out-of-Network providers can still send you bills for charges that are not covered by the plan. To keep your expenses lower, you should try and receive care from in-network providers to the extent possible.

What medical services are covered at 100%, not subject to my deductible?: Covered preventive care services received by an In-Network provider are covered at 100% regardless of whether you have met your deductible. Learn more about covered preventive care here.

What medical services are subject to my deductible?: In general, all medical services—with the exception of covered preventive care services—are subject to your deductible. Once the deductible is met, medical services will be subject to a copay or coinsurance. Medical services may include hospital, surgical, diagnostic, mental health and prescription medications. See the SBC or SPD for details.

What is the difference between preventive care and diagnostic care?: Preventive care includes certain immunizations and screenings for prevention and early detection of conditions or diseases (e.g., the flu or breast cancer). If a medical condition is diagnosed or considered probable, even during a preventive exam, any follow up visits or treatment will be considered diagnostic. When you visit your doctor for a check-up, always be sure to confirm whether the visit and services you receive are considered preventive or diagnostic.

Does my lifetime orthodontia limit reset if I move from the Enhanced plan to the Select plan or vice versa?: No. Your lifetime orthodontia will travel with you from plan to plan, it will not reset if you switch plans.

What do I do when I receive care?: If you visit an in-network provider, simply present your vision ID card. Your vision benefit will automatically be calculated. However, if you go to an out-of-network provider, you will be responsible for paying the provider in full at the time of service and then filing a reimbursement claim. Note, you will receive an ID card upon your initial enrollment. You will not receive a new ID card each year.

EyeMed Vision Care will reimburse you directly up to the allowed amount. Claim forms are available from EyeMed at www.eyemed.com. You can also contact them directly at 1-866-723-0514.