Insurance Coordinators believes in empowering our agents and customers by providing easy access to information, enabling them to better serve their customers and employees. Following are some of the most common questions from customers to educate and inform you. These questions are more typical of post-sale customer service. For questions regarding purchase of these products, please contact your agent, Employee Benefit Specialist or Insurance Coordinators directly at 866-449-9777. If you don’t find your question or answer please email it to wecare4u@icmont.com and we will personally assist you.

As a general rule the most successful person in life is the person who has the best information.

General Information

Claims
What information do I need in order for a claim to be processed or to check on the status of a claim?
It differs depending on the type of claim, but the general information required for any claim is date of service, provider, insured's name, patient's name, insured's id number, and policy or group number. If you are checking the status of an existing claim, please have this information available.

Where do I send claims?
All claims should be sent to the applicable carrier. See each Carrier in this section or the Customer Service section for more details.

Enrollments
Where do I send enrollments for new employees?
Mail or fax add-on enrollments for all products to:
Insurance Coordinators
101 N Last Chance Gulch, Suite A
Helena, MT 59601
406-495-0322 (fax)

Forms
How can I get Enrollment and Claim forms?
There are several ways to obtain enrollment forms.
1. Easiest and Quickest: visit the Forms section on this website.
2. Visit the Forms Download section of the Carrier website.
3. Call Insurance Coordinators at 866-449-9777.
4. Email Insurance Coordinators.
5. Contact the carrier directly.

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Assurity Life Insurance Company
Administration
Employer
How do I add/terminate employees?
Send new employee applications to Insurance Coordinators at 101 N Last Chance Gulch, Suite A, Helena, MT 59601. Insurance Coordinators will prepare transmittal and submit to Assurity.

When will new policies arrive?
If there are no problems on the application, new policies take about one month from submission to carrier to issue. They will be sent to Insurance Coordinators and we will then mail the policy to either the agent or the employer.

Do I need to submit premium for new employees?
If you are an employer, you do not need to submit premium. After a policy is issued the new employee will be added to your list bill by Assurity.

Employee/Individuals
I lost my policy. How do I obtain a new one?
Call Assurity Customer Service at 866-289-7337 to request a new policy. You will have to provide your policy number.

Where do I send my premium payments?
For policyholders on an employer-sponsored plan, your premiums will be payroll deducted and your employer will send in the premium payments. For individual policyholders, your premiums are typically automatically withdrawn from your bank account. Otherwise, mail premiums to: Assurity at Work, PO Box 80926, Lincoln, NE 68501-0926.

Are there different billing options?
Yes. If you want to pay monthly, automatic bank draft is required. Quarterly, bi-annual and annual premium payments are also available through list billing from Assurity.

How long can I keep my policy?
The Hospital Indemnity policy is guaranteed renewable to age 65. The Accident Expense policy is guaranteed renewable to age 70.

I just got married. Can I add my spouse/dependents to my policy at this time?
You can add or drop dependents to your policy at anytime.If you are changing your coverage level (i.e., from Employee Only to Family) you must complete a Change of Status form. Send form to: Assurity at Work®, PO Box 80926, Lincoln, NE 68501-0926.

If you are not changing your coverage level (i.e., you already have family coverage and just want to add a dependent), you may call Assurity Customer Service toll free at 866-289-7337 to make the change.

How do I notify Assurity of a name change?
You must complete a Change of Status form. Send form to: Assurity at Work®, PO Box 80926, Lincoln, NE 68501-0926.

How do I cancel my policy?
Send written request to: Assurity at Work®, PO Box 80926, Lincoln, NE 68501-0926. Be sure to include your policy number and the date you wish coverage to stop. After Assurity receives your request they will send you a letter acknowledging the cancellation of your policy.


Benefits
How do I verify benefits?
You may call Assurity Customer Service toll free at 866-289-7337 to verify benefits.

Are there exclusions?
Exclusions are detailed in your policy or you can call Assurity Customer Service toll free at 866-289-7337.


Claims
How do I submit claims?
Complete the Application for Individual Benefits claim form and fax to Assurity at Work at 402-437-4592. This form may also be found at the back of your Assurity policy. You may call Customer Service toll free at 866-289-7337 for further assistance. Claims will be paid directly to you, your beneficiaries, or your estate.


Eligibility
How do I verify eligibility?
You may call Assurity Customer Service toll free at 866-289-7337 to verify eligibility.

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Dental Network of America (DNOA)
Administration
Employer
How do I add new employees to the dental plan?
Fax completed application to Insurance Coordinators 406-495-0322. This form is state specific so please see the Forms section on this website for the correct form.

How do I terminate employees from the dental plan?
Every billing statement contains a Membership Change Report. Put terminating employee’s name, date of termination, and coverage end date on the report and fax to DNOA’s Membership Department at 630-495-0575. It is best to do this as soon as you know the employee is terminating in order for DNOA to make the billing adjustments as soon as possible. Do not send it in with your premium payment or wait until the end of the month to notify DNOA of employee terminations.

What is the difference between a Scheduled Benefit Plan and an R&C Plan?
The Scheduled Benefit Plan is a voluntary dental insurance plan that is available to groups of at least 2 enrolled employees. Rates are determined based on the size of the group either 2-9 lives or 10+ lives . If a group applies for the 10+ rates but has less than 10 lives upon enrollment, the rates will be adjusted accordingly. Coverage is provided for only the procedures listed in the coverage schedule, and the scheduled dollar amount represents the maximum benefit to be paid, not to exceed actual charges.

The Reasonable and Customary Benefit Plan is a voluntary dental insurance plan that is available to groups of at least 30 enrolled employees. Coverage is provided for only the procedures listed in the coverage schedule, and payment will be based on the stated benefit percentage applied to the lessor of: 1.) dental provider's actual charges; or 2.) the maximum allowable charge for the procedure.

Employee
Are there ID cards?
Each employee will receive an ID card as part of their dental booklet. It is inside at the bottom of the first page. If you have not received your dental booklet yet, Insurance Coordinators has supplied your employer with temporary ID cards with the necessary insurance information you can give your dentist.

What is my member ID?
Unless otherwise specified on your application, your member ID is your social security number.

Benefits
If an employer selects takeover rates, is continuity of coverage included?
Continuity of coverage would be included. Only Insureds covered under the employer’s prior plan will have the probationary period waived for services covered under the prior plan. If the prior plan did not cover certain procedures and services, Insureds must satisfy the probationary period. New enrollees and new employees must still satisfy the probationary period.

Is there a provider network?
There is no provider network. The DNOA Voluntary Dental plan allows for employees to utilize the dental provider of their choice.

What is the annual deductible?
Both the Scheduled Benefit Plan and the Reasonable and Customary Dental Plan have an annual deductible of $50 per person per calendar year, $150 per family per calendar year, exclusive of preventive and diagnostic services.

What is the annual maximum per calendar year?
The annual maximum per calendar year is $1000 per each covered individual.

What constitutes a calendar year?
A calendar year is defined as a year beginning January 1 through December 31. If a group signs on December 1, the group would receive the full deductible and full annual maximum benefit for one month and then the process would start over on January 1.

How many dental cleanings and exams are allowed each calendar year?
A member may receive benefits for two dental cleanings and exams per calendar year.

Claims
How do I submit claims?
Typically, your dentist will submit the claim for you. If there is a circumstance where you need to file a claim, have your dentist complete a dental claim form and mail to:DNOA, Claims Department, PO Box 23060, Belleville, IL 62223, or fax to DNOA Claims Department at (618-222-6333).

Does the dental product coordinate with other benefits?
Dental claims are coordinated with other benefits. If an insured is covered by more than one dental plan, then the primary carrier is determined. The contracted member always retains his or her own insurance as primary. If he or she has additional coverage through a spouse, that insurance is considered secondary. When a dependent child has dual coverage, the parent with the earlier birthday in the calendar year provides the primary benefit for the child.

How does coordination of benefits work?
Coordination of benefits (COB) works the same for all procedures including orthodontics, if applicable. DNoA will request a copy of the primary carrier’s EOB. DNoA will then calculate the normal benefit that the plan will pay. This amount is the amount that DnoA will pay, as long as the combined payments do not exceed the provider’s charges or the annual/lifetime maximum. If the combined payments exceed the provider charges or the annual/lifetime maximum, the payment will be adjusted.

Will DNoA honor claims for services rendered outside the U.S.?
DNoA will honor claims for services rendered outside the country. Usually the member will pay the provider and submit a bill to DNoA for reimbursement. It is helpful if the charges and procedures performed are translated prior to submitting to DNoA for reimbursement. DNoA can adjust the payment based on the exchange rate, if necessary.

Does either voluntary dental plan require or allow a pretreatment estimate?
These plans do not require pretreatment estimates. However, insured members are encouraged to have a pretreatment estimate anytime services over $200 are being considered or if there is a question regarding benefits and coverage.

Does either the Scheduled Benefit Plan or the Reasonable and Customary Benefit Plan provide coverage for TMJ procedures?
The coverage schedule provided with the certificate of insurance lists the accepted dental procedures. Many of the ADA codes and procedures associated with TMJ are not included in either plan. Please review the full list of codes and procedures to determine if a particular service or treatment is covered under the selected plan. (May vary in some states)

Eligibility
Employer
If an employee works in one region but lives in another, which coverage schedule would apply for that individual?
A coverage schedule based on the employer’s location is applicable for the entire group, regardless of an individual’s location.

What happens if an employee is disabled, takes a leave of absence, is laid-off or goes on strike?
The employer determines eligibility as per the contract. As long as the premiums are paid, the employee’s coverage will be continued.

Employee
Are dependent children covered?
Yes, dependent children are covered to age 19, to age 25 for full-time students. Handicapped dependents are eligible as long as they were incapacitated before the age limit was reached. There is no age limit for coverage on handicapped dependents. Supportive documentation on handicapped status may be requested.

Are domestic partners covered?
No, a domestic partner is not a spouse and is not covered under the dental policy.

Can an employee enroll at any time throughout the year?
An employee can only enroll at the time of eligibility or during the policyholder’s scheduled annual enrollment period.

If a qualifying event occurs, can an employee add a spouse and/or children during the year and if so, what are the requirements?
An employee can add coverage only if there has been a qualifying event. Examples of a qualifying event include: marriage, birth/adoption of a child, divorce, change in insurance status etc. Each individual will have his or her own probationary period. Additionally, the employer will have final determination so as not to disrupt the benefit and payroll deduction process. Many employers only allow changes during annual enrollment periods, except under specific guidelines. If there is not a qualifying event, the employee must wait until the next annual enrollment period.

Are probationary periods waived for the treatment of accidental injuries?
Probationary periods will not be waived for the treatment of accidental injuries.

Orthodontia
What is the maximum for orthodontic coverage?
Orthodontic coverage, available only on the Gold Plan, has a $1000 lifetime maximum for dependent children under the age of 19 for orthodontic services after the probationary period has been completed. 50% of reasonable and customary covered orthodontic diagnostic procedures and treatment costs will be covered, up to the $1000 lifetime maximum allowance.

Is orthodontic coverage available under both plans?
Orthodontic coverage is available under the Scheduled Benefit Plan and the Reasonable and Customary Benefit Plan, but only with the selection of the Gold Plan option. 50% of the covered orthodontic diagnostic procedures and treatment costs will be covered, up to the $1000 lifetime maximum allowance.

What is considered the official start of orthodontia treatment?
Orthodontia treatment is considered to have started on the date the appliance or bands are inserted or on the date a one-step orthodontic procedure is performed. There is a 12-month probationary period for orthodontic coverage. If appliances or bands are placed prior to the insured being eligible, no benefits will be paid.

Can the initial consultation for orthodontia treatment be prior to the actual 12-month probationary period?
The initial consultation for orthodontia treatment can be prior to the completion of the 12-month probationary period, but that visit will not be a covered benefit.

How is the payment method for orthodontia claims determined?
Quarterly payments are made based on the total cost of treatment and the expected time of treatment. For example: a $1000 case over 24 months would be paid as $125 per quarter over the 24 months of treatment. This payment can be made either to the provider or the insured.

Please see DNOA Q&A document for more Frequently Asked Questions.

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Employee Benefit Resources (EBR)
Administration
Can I change my cafeteria plan elections?
Generally, participants may not change their cafeteria plan elections in the middle of the plan year. However, in certain situations, the IRS does allow mid-year election changes (refer to your plan document as not all plans allow mid-year election changes).

Benefits
What Medical Expenses are allowable?
Allowable Expenses incurred by the participant or participant's dependent that may be reimbursed using a health care reimbursement account are: medical doctor's fees, eye examinations, prescription drugs, hospital services, surgery, false teeth, acupuncturists, annual physical examinations, eyeglasses, x-rays, chiropractors, ambulance service, psychiatrists, orthodontists, dental examinations, contact lenses and solutions, lab fees, hearing aids, nursing home costs, psychologists, and weight loss programs.

IRS Publication 502, Medical and Dental Expenses, has a checklist of medical expenses that may and may not be deducted and therefore reimbursed under this plan.

What qualifies for Dependent Care expenses?
To qualify, your dependents must be 1) a child under the age of 13, or, 2) a child, spouse, or other dependent who is physically or mentally incapable of self-care and spends at least 8 hours a day in your household.

IRS Publication 503, Child and Dependent Care, describes dependent care expenses that may be included in calculating your tax credit for child and dependent care expenses. These expenses may instead be claimed for reimbursement under a cafeteria plan. These expenses must also be incurred during the plan year.

Claims
How do I submit a claim?
Claim forms for Medical Care Reimbursement, Dependent Care Reimbursement, or Insurance Premium Reimbursement can be printed from this website or from www.ebrworld.com. On all claim forms:
1. Please indicate the business name of your employer, your name and Social Security Number.
2. Provide the information regarding the expenses you wish to be reimbursed - date of service, provider, description of expenses, person for whom the expenses were incurred, and the amount of out of pocket expenses.
3. You may wish to make a copy of the claim form and documentation for your records.
4. Claims may be mailed to Employee Benefit Resources, LLP, P.O. Box 1193, Helena, MT 59624, faxed to 406-442-5089, or claims dropped off at our Helena, Montana office located at 828 Great Northern Boulevard, 3rd Floor.

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MedAmerica
Administration
Are there different payment modes?
There are payment modes: monthly (EFT or credit card only), quarterly, semi-annual, or annual.

Can I change my coverages?
Changes may be made within the same product. Any increase in benefit selections requires a new application and medical underwriting. The changed policy will be issued at the new age and with a new effective date.

Any decreases to one or all benefit selections requires a Policy Change Form OR the Policyholder’s Written Request. The changed policy is issued at the original issue age and effective as of the Paid to Date of the original policy.

How do I cancel my policy?
All refund requests must be in writing and sent to MedAmerica, 165 Court Street, Rochester, NY 14647. Every request should be dated and signed by the Policyholder. When a request to cancel is received, the Agent is notified and given 10 days to conserve the business. If it is within the Free Look Period the refund check for the full amount of submitted premium is mailed directly to the applicant. A notice of cancellation is sent to the policyholder and the agent. After the Free Look Period the refund check will be prorated. If there is no state regulation, no refund is made. A notice of cancellation is sent to the Policyholder and the Agent.

Can I reinstate my policy?
The Company needs to receive a written request to reinstate from the Policyholder or lapse designee. The Company will review the request, as per Policy language.

Benefits
How is this different from other long term care insurance?
The traditional long term care insurance plans require you to submit provider bills, go through an approval process, and have limits on the services you can receive or the amount you can receive each date. With Simplicity, whether you want to stay in your home or need nursing facility care, as long as you are eligible and need care, you will receive a monthly cash benefit.

What happens when I need to use my benefits?
After you are determined eligible and have fulfilled your elimination period, you need only submit one request for payment each month.

Is there a provider network?
There is no provider network. You can get any service, anywhere, from anyone.

What can I use the benefits for?
You can get whatever you need, including every service covered under traditional plans, as well as nursing home, assisted living, home care, respite care, bed reservation, alternate care, caregiver training or equipment.

Claims
How do I submit a claim?
Submit a monthly request for benefits to MedAmerica, 165 Court Street, Rochester, NY 14647.


Eligibility
How is my issue age determined?
The age of the applicant on the day the application is signed will determine the issue age and the associated premium. If the application is signed on the client’s birthday, the new age will be used.

Is this policy renewable?
This policy is guaranteed renewable as long as you pay your premiums on time.

Can my premiums ever change?
Where applicable, premiums may increase but must be approved by the Department of Insurance. Any changes in the premium rates must apply to all similar policies issued in your state. You cannot be singled out for an increase because of any change in your age or health, however, our rates may go up based on the experience of all policyholders with a similar policy.

Is there a Waiver of Premium?
Premium payments will be waived on a monthly basis starting the day after the date your elimination period is satisfied. The Waiver of Premium will end on the date you are no longer Benefit Eligible.

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Fort Dearborn Life Insurance
Administration
Employer
What will I receive from Fort Dearborn Life when I enroll?
The Employer’s Benefits Administrator will receive the following:
• Welcome letter from Fort Dearborn Life
• Copy of policy and enrollment forms
• Benefit booklets to distribute to employees + supply for future employees
• For List-Billed groups, the bill will be sent under separate cover 7-10 business days after the administrative materials.
• For Self-Administered groups, the online billing user ID and password will be received with the administrative materials. All membership will be keyed in by FDL for groups up to 200 lives.

How do I enroll new employees?
Mail or fax completed, signed, dated employee application to Insurance Coordinators, 101 N Last Chance Gulch, Suite A , Helena, MT 59601, fax 406-495-0322. Be sure to include employee ssn, hire date, birth date, employer name, group policy number and employee salary if benefit is salary-based.

How do I notify Fort Dearborn Life of terminated employees?
Send in notification with your premium payment either by written request or by deleting the employee off the enrollment list. Be sure to include the date you want the coverage to end.

I am out of benefit certificate booklets. How can I get more?
You may fax a written request to Fort Dearborn Life, Certificate Reorders, 216-898-0682. Include group name, policy number, group contact, type of product, and number of booklets required.

Billing
Employer
When will I receive my first bill?
You should receive your first bill within 30-45 days of submission of paperwork. Fort Dearborn Life bills are received around the 15th of the month.

I am having problems with my bill. Who can I call for help?
You may call the Fort Dearborn Life Billing Department toll free at 800-348-4512.

I am having problems with my self-administered billing diskette. Who can I call for help?
You may call the Fort Dearborn Life Self-Administered Billing Department toll free at 800-782-8524.

I am interested in Web-based Billing. Who should I contact?
You may call the Fort Dearborn Life Self-Administered Billing Department toll free at 800-782-8524 or Insurance Coordinators at 866-449-9777. Online Billing Registration Forms are available on the Fort Dearborn Life website at www.fdl-life.com/forms_fdl/downloads.html.

Benefits
How do I know what my benefits are?
After enrollment, Fort Dearborn Life will send the employer a welcome and administration packet containing certificate booklets to be distributed to each enrolled employee. For voluntary products, the employer will receive copies of the approved applications and should provide the employee with a copy of their application. This is the only document they will have showing what benefit has been approved.

When will my Voluntary Life insurance premium change?
If your group is self-billed and you move to the next age band on your birthday, your premium will be adjusted at the policy anniversary date. If your group is list-billed by Fort Dearborn Life your premium will be adjusted the month following your birthday. Contact your employer to determine when your premium will change.

Is my insurance convertible?
Both group and voluntary life can be converted to an individual whole life policy without evidence of insurability if an employee’s life insurance or a portion of it terminates. See your policy for the amount available for conversion. Conversion is not available if the master policy changes or terminates and the insured has been insured under the policy for less than five years. The amount of the conversion cannot exceed the maximum amount set by the state law (usually $2,000 or $10,000). AD&D is not convertible.

How do I convert my life insurance?
Complete the Application to Convert Group Life Insurance and submit to home office within 31 days of termination of insurance coverage to: Fort Dearborn Life Insurance Company, c/o Administrative Office, PO Box 655403, Dallas, TX 75265-5403. The first modal premium must be submitted with your application. Premiums are billed directly on a quarterly, semi-annual or annual basis.

Is my insurance portable?
Group life is not portable. Voluntary life insurance for employee, spouses and dependents can be continued without evidence of insurability if coverage terminates. Portable coverage will continue as long as premiums are paid and the covered person remains eligible. This policy retains the features of the Master policy. AD&D is not portable.

How do I port my life insurance?
Complete the Application for Portability and submit to home office within 31 days of termination of insurance coverage to: Fort Dearborn Life Insurance Company, c/o Administrative Office, PO Box 655403, Dallas, TX 75265-5403. The first modal premium must be submitted with your application. Premiums are billed directly on a quarterly, semi-annual or annual basis.

Claims
How do I submit a disability claim?
Complete STD Claim Form (MT, ID, OR, WY) or LTD Claim Form (MT, ID, OR, WY) and send to Claims Department, Fort Dearborn Life Insurance Company, 20445 Emerald Parkway, Suite 400, Cleveland, OH, 44135. All disability claim questions should be directed to the Medical Life Claims Department at 800-782-8533.

How do I submit a death claim?
Employer needs to complete Death Claim Form (MT, ID, OR, WY) and submit along with a notarized death certificate and a copy of the employee’s enrollment form.

If your life insurance is billed by Insurance Coordinators, mail documents to Insurance Coordinators, 101 N Last Chance Gulch, Suite A, Helena, MT 59601. Insurance Coordinators will complete necessary information needed for Medical Life to process the claim and submit to Medical Life.

If your life insurance is billed by Medical Life, mail documents to Claims Department, Fort Dearborn Life Insurance Company, 20445 Emerald Parkway, Suite 400, Cleveland, OH, 44135. Questions regarding status of death claims should be directed to the Fort Dearborn Life Claims Department at 800-782-8533.

Eligibility
When does the Evidence of Insurability (EOI) have to be completed by an employee?
There are several scenarios where EOIs are required. For Contributory Group Life (the employee pays a portion of the premium) an EOI is required for all late enrollees. A late enrollee is an employee that is past their probation period. For Voluntary Life, any new employee applying for over the guarantee issue amount (defined by your policy) is required to complete an EOI. An existing employee applying at open enrollment is required to complete an EOI.

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Mountain Vision
Administration
Employer
How do I enroll new employees?
Fax enrollment form to Insurance Coordinators at 406-495-0322. Please indicate coverage start date.

How do I notify Mountain Vision of an employee termination?
You may fax termination request to Insurance Coordinators at 406-495-0322 or email Insurance Coordinators at ltuck@icmont.com. Include the group name, employee name, ID number and requested date of termination, as well as the reason.

Can an existing employee terminate their coverage?
Members may not voluntarily cancel coverage prior to their two-year anniversary date.

Benefits
When I leave employment, can I take my coverage with me?
A terminating employee may convert their coverage to an individual policy. The employer should fax or email to Insurance Coordinators at 406-495-0322 or ltuck@icmont.com a notification that the employee wants to continue individual coverage. Please include the employee's current address in the communication. REDS Administration will then mail conversion information to the individual.

Is there a provider network?
You must visit a Mountain Vision doctor to get coverage. There is no coverage for out of network vision care. Visit the REDS Administration website at www.edmondsgroup.com/providers/default.asp to locate a provider in your area.

Is there a refractive surgery benefit?
Mountain Vision provides a discount of 20% toward the usual and customary surgical of the Participating Provider to a maximum discount of $200 per eye. This discount can only be used if the eyeglass or contact benefit has not been used.

Claims
How do I submit a claim?
Your vision care provider will submit all claims for you. If you have questions regarding the claims process you may call REDS Administration at 888-515-1573.

Will Mountain Vision coordinate benefits?
REDS Administration will work with other companies. Make sure your vision provider has information for both insurances before submitting a claim.

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Symetra/Select Benefit Administrators of America (SBAA)
Administration
Employer
How do I notify Symetra of terminated employees?
If there are employees being terminated during the billed month, employers must mark the change with a single line through the employee’s name to be terminated and write the termination date next to the name. Terminations are only made at the beginning of the month. Employers may fax the termination notice to SBAA at 715-682-5919. They need to include the employee’s name, group number and date to be terminated.

Employers cannot make any changes to the amount due. Terminations show up on the following month’s bill as a retro termination and employers receive credit on that bill. Any retro additions will appear with the premium due.

How do I notify Symetra of changes in coverage, name, or beneficiary?
Call SBAA Customer Service at 1-800-497-3699.

When will I receive my first bill?
Symetra generates bills on the 15th of the month. Premium is due by the 1st.

I am having problems with my bill. Who can I call for help?
Call SBAA Customer Service at 1-800-497-3699.


Benefits
Will I get an ID card?
Two to four weeks after enrollment you will receive a certificate coverage along with ID cards from your employer.

Who are the participating providers?
There is no provider network. You may see any doctor you want.

How does the RX Co-Pay plan work?
If an employer elects an RX co-pay plan option, the employee’s pharmacy benefit can be accessed with the same ID card used for filing medical claims. When filling a prescription, the employee takes this card to a participating pharmacy that will process it at point of service. Along with their ID card, employees receive a pamphlet explaining the pharmacy mail-in option. (This applies only to the co-pay plans.) This pamphlet includes RESTAT’s toll-free number. RESTAT’s website is http://www.restat.com/. They can also call 800-497-3699 since SBAA staff has direct access to the RESTAT online information.

What about the RX Discount plan?
To access the discount plan, the employee must go to a participating pharmacy. The discount will vary due to formulas used to calculate the discount. SBAA does not discount reimbursement on prescriptions; service must be accessed directly through the pharmacy.

How do I find out where I can fill my prescriptions if my plan includes Prescription Drug coverage?
Refer to the pharmacy list included with your employee certificate. You may also contact the SBAA toll-free number at 1-800-497-3699.

How do I find out where I can fill my prescriptions with the Pharmacy Discount Program?
You may call the SBAA toll-free number at 1-800-497-3699.

Does this coordinate benefits with my health insurance?
This is an indemnity plan and pays regardless of any other coverage you may have.

Can I convert my policy?
The life insurance portion of your benefit can be converted to an individual policy. You must complete an Employee Conversion Information Request form. You may contact SBAA directly at 800-497-3699 for assistance.

How do I make changes to my coverage?
Complete a new application, marking it "change requested" and fax to Symetra Select Benefit Administrators Customer Service Department at 715-682-5919.

Claims
How do I file a health claim?
Typically the provider will be submitting all claims. However, if you pay for the service and need to be reimbursed you can submit a copy of the itemized bill from the provider listing dates of service, procedure codes and diagnosis codes. Ask the health care provider for Health Care Financing Administration (HCFA) forms for doctor’s office visits and Universal Billing (UB92) forms for hospital care. Mail claim to SBAA Claims Department, PO Box 440, Ashland, WI 54806 or fax claim forms to SBAA Claims Department at 715-682-5919.

Do the checks come to me or to the provider?
If you present your insurance to the provider, the provider can submit the claim and be reimbursed directly from Symetra. If you pay the provider for the service, you are responsible for submitting the claim and you will be reimbursed directly from Symetra.

How do I file a pharmacy claim?
Select Benefits current prescription plan administrator is RESTAT. All claims are processed at the point of service/participating pharmacy.

How do I submit a life claim?
Call SBAA at 800-497-3699 and ask for a Life Claims Representative.

How do I submit a disability claim?
Call SBAA at 800-497-3699 and ask for a Disability Claims Representative.

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The Benefit Group
Flexible Spending Accounts
Administration
Can I change my contributions during the year?
Only if you have a change-in-status such as: marriage, birth, adoption, or a change in your or your spouse's employment status.

What happens to my accounts if I terminate my employment?
You will be able to request reimbursement for healthcare and daycare expenses that you incurred prior to your termination. Check your summary plan description for any additional rights or benefits provided by your company's plan.

What if I don't use all of the money I set aside in my account(s)?
Carefully review your estimated expenses before making the decision to participate. Any contributions that are not used during the plan year may not be paid to you in cash or used in a later plan year.


Benefits
What Medical Expenses are allowable?
Common expenses that qualify for reimbursement include: doctor visits; co-payments; deductibles; prescriptions and medical supplies; over-the-counter drugs that are medically necessary like allergy medications, aspirin, or antacids; dietary supplements and vitamins with doctor's letter of medical necessity; dental services and orthodontics; eye surgery, glasses, and contacts; weight-loss programs with a doctor's letter of medical necessity; weight-loss over-the-counter drugs with doctor's letter of medical necessity; chiropractic services; vitamins with doctor's letter of medical necessity; psychiatric care and psychologist's fees; smoking-cessation programs; smoking-cessation over-the-counter drugs.

What qualifies for Dependent Care expenses?
To qualify, your dependents must be 1) a child under the age of 13, or, 2) a child, spouse, or other dependent who is physically or mentally incapable of self-care and spends at least 8 hours a day in your household.

IRS Publication 503, Child and Dependent Care, describes dependent care expenses that may be included in calculating your tax credit for child and dependent care expenses. These expenses may instead be claimed for reimbursement under a cafeteria plan. These expenses must also be incurred during the plan year. Please visit www.tbgco.com for more information.

Claims
How do I submit a claim to get reimbursed for my expenses?
Once you have completed the Enrollment Form, you will receive a claim form and instructions on how to file your claim. Simply complete the form, attach a copy of the healthcare or dependent care bill, and mail or fax your form to your Plan Administrator. Within a short time, you will receive your reimbursement.

Do I have to wait for the money to be deposited in my account in order to make a claim for reimbursement?
The amount you set aside each year for the Healthcare Reimbursement Account is available to you at any time throughout the plan year. The amount available to you from your Dependent Care Account is the amount you have contributed to date.

How do I know how much is available in my accounts?
Each time you receive a reimbursement, a statement (attached to your reimbursement check) will show the dollar amount you have set aside as well as the amount you have been paid to date. Or you may check your account online. Please visit www.tbgco.com for more information.

Premium Only Plans
Administration/Benefits/Eligibility
What benefits are covered by a Premium Only-125 plan?
Contributory group insurance premiums for health, term life up to $50,000 of coverage, dental, and disability are qualified benefits. Essentially, the Employer will decide what benefits to include in its Plan. Then the Employee is automatically enrolled in the Premium Only-125 Plan, though the Plan permits employees to ‘opt out’ of all or some of the benefits. Some employees may desire to ‘opt out’ because of their particular tax planning.

What if my life insurance coverage is over $50,000?
Employees may be taxed on the cost of coverage in excess of $50,000 (reduced by any amount you pay toward the cost of coverage), but only if the insurance is provided under a policy carried directly or indirectly by the Employer. The Employer conducts certain tests to determine what amount, if any, will be included in the employee’s income.

May an employee change his/her election during the plan year?
Employees may change their elections during the plan year if they have a change in their family status such as one of the following:
- change in marital status such as marriage, divorce or legal separation
- birth or adoption a child
- death of their spouse or child(ren)
- their child no longer qualifies as a dependent for a 125 benefit
- their spouse commences or terminates employment
- a spouse’s employment status changes
- a spouse takes an unpaid leave of absence
- a spouse has a significant change in health care coverage attributable to his/her employment
- dependent(s) change residence

When can I terminate my enrollment in the plan?
All elections to participate are irrevocable during a Plan Year except due to changes in status. Prior to the beginning of any Plan Year, the Employer will have an “election period”. During this election period, an Employee will be automatically re-enrolled unless an election to ‘opt out’ is completed.

What happens if employment terminates?
Subject to any rights to continue your insurance coverage under COBRA, participation in the 125 Plan continues only for the period for which premiums have been paid prior to the termination date. The employee’s insurance coverages may continue after termination date if so provided by the terms of the insurance or benefit plans of the Employer; however, participation in the Premium Only-125 Plan ends as of the employment termination date.

Are there limitations on who can participate?
In general, the percentage of employee contributions and benefits for “highly compensated participants” or “key employees” cannot exceed the contributions of other employees by a certain percentage. The Plan Administrator may reduce the benefits to such employees to comply with federal law so that the Plan as a whole does not unfairly favor those who are highly paid. Employees will be notified if these limitations affect them. Please visit www.tbgco.com for more information.

Claims
How do I submit a claim?
There are no claims with a premium only plan. The premiums are payroll deducted and no out of pocket expenses are incurred by the employee.
Please visit www.tbgco.com./pages/winflex125.html for more information.

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United Heritage
Administration
Employer
What will I receive from United Heritage when I enroll?
The Employer’s Benefits Administrator will receive the following:
• Welcome letter from United Heritage
• Certificates for employees, policy and copy of group application in black vinyl binder
• Copy of Group Administration manual
• Manila pocket folder containing claim forms, enrollment cards, admin cards, and conversion cards (if applicable)
• Pink and yellow copies of enrollment cards

How do I enroll new employees?
You may mail completed, signed, dated Employee Application to Insurance Coordinators, 101 N Last Chance Gulch, Suite A, Helena, MT 59601. Be sure to include employee ssn, hire date, birth date, employer name, group policy number and employee salary if benefit is salary-based.

How do I notify United Heritage of terminated employees?
Either call the United Heritage Group Department at 800-657-6351 or on the monthly billing statement line out the terminated employee and provide the date the termination was effective.

How do I notify United Heritage of changes in coverage, name, or beneficiary?
Have employee complete a Group Administration Card and mail to United Heritage, PO Box 7777, Meridian, ID 83680-7777.

What if an employee wants to decline non-contributory coverage?
Have employee complete a Group Administration Card and mail to United Heritage, PO Box 7777, Meridian, ID 83680-7777.

I am out of benefit certificate booklets. How can I get more?
You may call your request in to the United Heritage Group Department at 800-657-6351 or fax your request to 800-240-9734. Please include group name, policy number, product type, and number of booklets requested.

When will I receive my first bill?
The first bill will be sent within a week of United Heritage receiving enrollment applications and initial premium payment. The following bills for each month are generated the 25th of the month.

I am having problems with my bill. Who can I call for help?
You may call United Heritage toll free at 800-657-6351 and ask for the Group Billing Department.

Benefits
How do I know what my benefits are?
Employees will receive Certificates of Coverage from their employer that outline the entire policy. For voluntary life coverage under the Guarantee Issue and for Short Term and Long Term Disability, you should keep a copy of your application with your certificate booklet. If you have requested over the Guarantee Issue for voluntary life, the application will have to go through underwriting. You will receive a letter from United Heritage and a copy of your approved application to keep with your certificate. Your employer will also find the amounts applied for on the billing statement.

Is my insurance convertible?
Group Life, Dependent and Supplemental Life are convertible. Short and Long Term Disability are not.

How do I convert my life insurance?
Submit a Conversion Card to United Heritage at 1-800-240-9734. United Heritage will create a proposal for Individual Life and send to you along with an application. To elect this coverage, you must complete the application and return with the first month's premium. This whole process must be completed within 31 days from the initial date of termination.

Is my insurance portable?
United Heritage group life insurance is not portable.


Claims
How do I submit a claim?
The easiest way is to call United Heritage’s toll free number, 1-800-657-6351. To begin the claim United Heritage needs the policy number and the date of death or date disability began.

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Unum
Administration
Employer
What will I receive from Unum when I enroll?
The Benefits Administrator will receive the following:
• Plan Administrator Guide which includes welcome letter, forms explanation, billing explanation.
• Benefit Booklets for distribution to employees
• Contract will be delivered to the broker for delivery to the group
• Bill usually comes after the Contract delivery

How do I add an employee to the billing statement?
On the bill there is a section to add all new eligible employees.

How do I notify Unum of terminated employees?
On the bill there is a section to terminate all non-eligible employees.

How do I cancel an employees' coverage?
On the bill there is a section to notify Unum of cancelled employees.

How do I change an employee name?
You may complete a Request for Change form and send in with your monthly premium remittance.

How do I change social security numbers, employee addresses, or company address?
You may complete a Request for Change form and send in with your monthly premium remittance.

I am out of benefit certificate booklets. How can I get more?
You may call the Customer Service Call Center at 800-421-0344 and order more booklets. Please have your policy number handy.

Benefits
How do I know what my benefits are?
For group products refer to your certificate booklets or see your benefits administrator. For voluntary products you will receive from your employer a certificate/confirmation along with your certificate booklet. You may see your benefits administrator or call the Customer Service Call Center at 800-421-0344 for further assistance.

Is my insurance convertible?
All Life policies are convertible and/or portable. The LTD is only convertible if the provision was requested. You may refer to your certificate booklet, see your benefits administrator, or call Unum at 800-343-5406 for more information on conversion.

How do I convert my Life insurance?
Complete a Life Conversion form and mail within 30 days of last day of employment with the 1st months premium to Unum, Conversion Unit, 2211 Congress Street, Portland, Maine 04122-1350.

How do I convert my Long Term Disability insurance?
Please fill an LTD Conversion form and mail within 30 days of last day of employment with the 1st month’s premium to Unum, Portability/Conversion Unit, 2211 Congress Street, Portland, Maine 04122-1350.

Is my insurance portable?
All Life policies are convertible and/or portable. The LTD is only convertible and never portable. You may refer to your certificate booklet, see your benefits administrator, or call Unum at 800-343-5406 for more information on porting your life insurance.

How do I port my life insurance?
Complete a Life Portability form and mail within 30 days of last day of employment with the 1st month’s premium to Unum, Portability Unit, 2211 Congress Street, Portland, Maine 04122-1350. You may call 800-343-5406 for further assistance.


Billing
When will I receive my first bill?
You should receive your first bill about 30 days after Unum receives all sold paperwork.

I am having problems with my bill. Who can I call for help?
You may call the Customer Service Call Center at 800-421-0344 for all billing questions. Please have your policy number ready.

Claims
Disability Claims
How do I file a disability claim?
Complete the STD or LTD Claim Form. Submit claim to The Benefits Center, PO Box 180200, Chattanooga, TN 37401-3030. You may call 877-851-7637 for further assistance.

When will I know about my benefits?
Within five days of your claim’s assignment to a Customer Care Specialist, your specialist will contact you. With some conditions, such as standard maternity leave or a recovery following a routine surgery, your benefits may begin almost immediately. Unum may require additional medical information to better understand your claim. Depending on how quickly they receive the additional information, your benefits determination could take longer. In such a case, your Customer Care Specialist will provide you with a written update on the status of your claim request at a minimum of every 30 days until decided.

Life Claims
How do I get the claim process started for a Death claim?
The employer is responsible for completing the Notice of Claim form. The employer will submit the completed claim with a certified death certificate and a copy of employee’s enrollment form. Claim can be faxed to Unum, Group Life/Special Risk Benefits Center at 207-575-6096, or mailed to Unum, Group Life/Special Risk Benefits Center , PO Box 9061, Portland, ME 04104-5046. You may call 800-445-0402 for further assistance.

How quickly can I expect to hear from Unum about the claim?
Most claims (more than 80%) are paid within five business days of our receiving completed claim forms and appropriate documentation the employer. If Unum is unable to make a formal decision within this timeframe, they will notify the beneficiary in writing with the reason for the delay and will copy the employer, as the group policyholder, on all communications.

Long Term Care
When am I eligible for long term care benefits?
You are eligible for benefits when you become chronically ill or disabled.

What is an elimination period?
The elimination period is a specific number of days during which no long term care benefits are payable by Unum.

Must I satisfy an elimination period before I file a long term care claim?
No, you are not required to satisfy an elimination period prior to filing a long term care claim. Long term care claims should be filed as soon as you begin receiving long term care.

Where can I get a claim form?
You can access a long term care claim form on Unum's website at www.unum.com/products/individual/ltc.aspx. You can also call Unum's Benefits Center at 1-800-693-4988 and we can fax or mail a claim form to you within two business days.

Where do I send the completed Long Term Care claim form?
After reviewing the claim form completely, sign and mail the form to:
Unum Long Term Care Benefits Center, 2211 Congress St., Portland, ME 04122-2300.

For more Frequently Asked Questions from Unum visit www.unum.com/products/individual/indivClaims.aspx

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USAble Life
Administration
Employer
What will I receive from USAble Life when I enroll?
The Benefits Administrator will receive:
• Welcome Letter from USAble Life
• Group Policy
• Certificates of Coverage booklets for employees
• Administration Manual
• Small amount of supply of forms
• Group bill if list billed or billing disk if self administered

How do I enroll new employees?
Mail or fax completed, signed, dated Employee Application to Insurance Coordinators, 101 N Last Chance Gulch, Suite A, Helena, MT 59601. Be sure to include employee ssn, hire date, birth date, employer name, group policy number and employee salary if benefit is salary-based. This form can be downloaded by going to www.usablelife.com/Tools/FormFinder/MapPage.htm, and selecting your state.

How do I add an employee to the billing statement?
To pay for insured's not yet listed on the billing statement, write names, Social Security numbers, product type and premium amounts at the bottom of the invoice and add total additional premium to the Total Due. Please ensure that applicants have turned in an application.

How do I notify USAble Life of terminated employees?
For terminating employees, please draw a line through the name and product type, indicate “terminated”, and deduct the amount from the Total Due. (This information is also included on the back of the premium statements.)

For reasons other than leaving employment, please draw a line through the name and product type, indicate the reason for cancellation, and deduct the amount from the Total Due.

How do I cancel an employees' coverage?
For all USAble Life products, the employer should terminate the employee from the billing statement. If individual employees contact USAble Life to cancel coverage, they will be referred to their employer so that the payroll deduction may be stopped and coverage terminated from the billing statement.

How do I change an employee name?
USAble Life can accept name changes one of three ways.
1. The name change may be noted on the billing statement by lining through the old name and listing the new name just below. Depending on the type of product the employee has, USAble Life can either automatically make the change, or will mail a change form to the employee home address.

2. Have the employee complete a Request for Change form. It should be signed and dated by the employee and include a witness signature. To download form, please go to the www.usablelife.com/Tools/FormFinder/MapPage.htm, select your state, and look under All Products, Other Forms.

3. Have the employee complete a Group Enrollment/Change Form. This form can be downloaded by going to www.usablelife.com/Tools/FormFinder/MapPage.htm, selecting your state, selecting "All Products" and "Enrollment Forms", then selecting Group Enrollment/Change Form.

How do I change social security numbers, employee addresses, or company address?
You may notify USAble Life in one of three ways.
1. By making a notation on the billing statement (lining through the old address and listing the new address just below); or

2. Submitting a request in writing to USAble Life Customer Service; or

3. E-mailing USAble Life Customer Service at custserv@usablelife.com your company name, group number(s), new address and date of change.

I am out of benefit certificate booklets. How can I get more?
You may fax a written request to 501-378-3333 or email custserv@usablelife.com. Please include group name, number, product, number required.

Billing
Employer
When will I receive my first bill?
You should receive your first bill within 30-45 days of submission of paperwork. USAble Life bills are generated around the 15th of the month.

I am having problems with my bill. Who can I call for help?
You may call the USAble Life Customer Accounts department at 800-648-0271.

I am interested in Web-based Billing. Who should I contact?
You may call the USAble Life Customer Service department at 800-370-5856.

How am I notified of rate changes on voluntary life, std and ltd?
If benefits are list billed, your are sent a letter and roster of premium changes approximately 60 days in advance of the rate adjustments. If benefits are self-administered (using the self-billing disk), adjustments are noted on the disk approximately 60 days in advance of the rate adjustments. USAble Life Customer Service is available to help verify if a premium change has taken place due to an age bracket increase.

Benefits
How do I know what my benefits are?
After enrollment, USAble Life will send the employer a welcome and administration packet containing certificate of coverage booklets to be distributed to each enrolled employee. For voluntary life the employee’s approved application will be attached to their certificate of coverage. This is the only document they will have showing what benefit has been approved.

When will my Voluntary Life, STD or LTD insurance premium change?
Rates for voluntary life, std and ltd are determined by the age of the applicant. Your premium will be adjusted at the policy anniversary date that is based on the effective date, not the renewal date. For example, a group will buy their policy on July 1, the policy effective date, but have it renew January 1, the policy renewal date. The age-based voluntary premiums will be adjusted on July 1, the policy anniversary date.

Is my life insurance convertible?
An employee may convert all or part of their group or voluntary life to a Whole Life plan upon termination of employment. Covered dependents may convert upon the termination of employment or death of the employee. AD&D is not convertible.

How do I convert my life insurance?
Complete a Conversion Application and send to USAble Life, PO Box 1650, Little Rock, AR 72203-1650. Contact USAble Life Customer Service at 800-648-0271 or Insurance Coordinators at 866-449-9777 for assistance in obtaining forms.

Is my life insurance portable?
Group life is not portable. If the portability option is part of the Voluntary Life Master Policy, then an employee terminating employment with the sponsoring employer may continue coverage up to the amount in effect at VGTL type rates and be sent a direct bill (semi-annual or annual). To be eligible for portability an employee may not be disabled or retired and must be under age 70. Unless limited by state regulation, a spouse’s coverage may be continued or “ported” up to the amount in effect, if the employee also continues coverage. In other words, a spouse may not “port” coverage if the employee’s coverage is not continued. Children are not eligible for portability. However, they may convert coverage. AD&D is not portable.

How do I port my life insurance?
Complete a Portability Application and send to USAble Life, PO Box 1650, Little Rock, AR72203-1650. Contact USAble Life Customer Service at 800-648-0271 or Insurance Coordinators at 866-449-9777 for assistance in obtaining forms.

What other coverages can I continue if I leave my current employer?
The following policies may be continued upon leaving employment:
• CancerCare
• Accident
• Universal Life
• Critical Illness
• Heart & Stroke
• Hospital Indemnity
• ICU/CCU
Payments for these policies may be made through bank draft from your checking or savings account, or you may choose to receive a bill monthly, quarterly, semi-annually, or annually at your home address.

How do I continue those coverages?
Your employer's payroll office will notify us that you have terminated employment and within 30 days we will mail you instructions on how to continue coverage.

Claims
I have a CancerCare policy. How do I submit a wellness claim?
You do NOT need a claim form to file a wellness claim. Follow these 3 steps to prompt payment of your wellness claim.
1. Mail the ITEMIZED bill for the test.
2. Write on the itemized bill:
• Mailing address check should be sent to
• Insured name and Social Security Number
• Policy Number (very important)
• Patient's Name, Date of Birth and Social Security Number
• Date of Service

3. Mail to USAble Life Claims Dept., PO Box 1650, Little Rock, AR 72203-1650.
You may call the USAble Life Claims Department at 800-648-0271 or Insurance Coordinators at 866-449-977 for further assistance.

How do I submit a claim other than wellness?
Obtain claim form from your employer or the USAble Life website at www.usablelife.com/Tools/FormFinder/MapPage.htm. Follow instructions to complet and mail to: USAble Life Claims Dept. PO Box 1650, Little Rock, AR 72203-1650. You may call the USAble Life Claims Department at 800-648-0271 or Insurance Coordinators at 866-449-977 for further assistance.

Eligibility
When does the Evidence of Insurability (EOI) have to be completed by an employee?
There are several scenarios where EOIs are required. For Contributory Group Life (the employee pays a portion of the premium) an EOI is required for all late enrollees. A late enrollee is an employee that is past their probation period. For Voluntary Life, any new employee applying for over the guarantee issue amount (defined by your policy) is required to complete an EOI. An existing employee applying at open enrollment is required to complete an EOI.

USAble Life forms can be downloaded from www.usablelife.com/Tools/FormFinder/MapPage.htm.

For more Frequently Asked Questions from USAble Life visit www.usablelife.com/MAIN/usable_policyholder_faq.html#001

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Administration
Employer
Where do I send my premium?
Mail with payment with statement to: Insurance Coordinators, 101 N Last Chance Gulch, Suite A, Helena, MT 59601.

How do I add employees to the vision plan?
Fax Employee Application to Insurance Coordinators at 406-495-0322. Be sure to include all required information.

How do I terminate employees from the vision plan?
Fax termination notice to Insurance Coordinators at 406-495-0322. Be sure to include employer name, employee name, type of coverage and coverage end date.


Employee
Are there ID cards?
There are no ID cards for the VSP product. Just tell the provider you are a VSP member and they can look you up in the system by your member ID. Members can print their own ID card from the VSP website.

What is my member ID?
Unless otherwise specified on your application, your member ID is your social security number.

What is my group number?
There are no group numbers. VSP tracks members individually by their member ID.

Benefits
Employer
For new groups, will benefits start over at effective date, or do previous benefits received count?
It is up to the group to specify whether past service carries over or not.

Employee
How do I check benefits?
Go to www.vsp.com, select the “Members and Consumers” square, enter ID, first and last name in the login section and select “Sign On”. Here you can check available benefits.

To what age are dependents covered?
Dependents covered until age 19, 25 if full time student.

Is a laser vision exam covered?
The Laser Vision Screening exam is complimentary. The pre-surgery comprehensive exam is part of the surgery fee and is covered at a discounted rate. If the patient elects to not have the surgery after the comprehensive exam is done, the doctor can charge patient as much as $100 for the exam.

Does VSP coordinate benefits?
Yes they do. Your VSP provider can assist.

If an employee is covered under two VSP plans, will they be able to purchase benefits under both plans?
They can utilize their benefits separately for 2 pairs of benefits. (EX: 2 eye exams, 2 sets of materials, etc. (depending on plan designs)).

OR

They can coordinate their benefits together. Each member would be primary on their own plan, and they would need to provide both members ID's to the provider at the time of service. There are set allowances to pick up out-of-pocket expenses, depending on each member's plan - the doctor can specify at the time of service.

Please note, depending on the spouse's plan, some groups give specific directions to VSP that they cannot coordinate benefits with another VSP plan. With this in mind, the spouse will need to confirm with their Benefit Administrator if coordination is allowed.

Does VSP have lasik providers in Canada?
There are no lasik providers in Canada at this time.

Not all member eye docs do participate in this portion of the VSP contract. VSP recommends that the customer call the 800 # for customer service and they can run them through a listing of doctors in the region that participate in all procedures.

How does the refractive surgery discount work?
1. Go to your VSP provider for the pre-surgery evaluation exam.
2. The VSP doctor will refer you to a VSP surgery center
3. VSP contracts give 15-20% percentage off surgicenter fees with an $1800 cap. (% varies nationwide.)
4. If the surgicenter is offering a promotional discount, the VSP member should get additional 5% off discounted price.

Are progressive lenses (unlined bi- and tri-focals) covered?
Progressive lenses are covered at the lined bi- and tri-focal levels when visiting a VSP Provider. The client is responsible for paying any remaining costs.

Claims
Employee
How do I submit claims?
If you go to a VSP provider, they will submit claim for you. If you go outside the VSP network, the Member pays 100% of services and submits receipt to VSP with the following information: Patient name and member name; Member ID (social security number); Address; Relationship to member. You will be reimbursed up to their out-of-network allowable. Applicable copays will apply. Send receipt with required information to: VSP, PO Box 997105, Sacramento, CA 95899-7105.

Where do I get a claim form?
A claim form is not required (see above), however, a claim form can be completed electronically on the VSP website by the member and then printed out and mailed or faxed to VSP.

Eligibility
Employer
Are retirees eligible for coverage?
Retiree eligibility is evaluated on a case by case basis. Please contact your agent or Insurance Coordinators.

What is the minimum work hours requirement to be eligible?
There is no minimum work hours requirement for VSP eligibility. Employer defines the eligibility criteria.

Employee
How do I verify eligibility?
Go to www.vsp.com, select “Members and Consumers” square, enter ID, first and last name in the login section and select “Sign On”. Here you can check which benefits you have used, which you are eligible for, and future dates of eligibility for used benefits.

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