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Updated February 6, 2002 - Health Benefits Homepage
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Frequently Asked Questions (page 2) |
| Health Benefits...Any
Questions? According to Lorraine Simpkins, PEF Health Benefits Specialist, members frequently ask the following questions about their health insurance coverage. |
| QUESTION: How do I find out whether a service or item is covered under my plan? |
| ANSWER: General benefit information is in the plan's benefit booklet or member handbook. To obtain more specific benefit information, the plan's member or customer service department should be contacted. Empire Plan enrollees who want to know beforehand how much United HealthCare (UHC) will pay for a medical service or item may submit a Pre-determination Request form. |
| QUESTION: How can I find out which doctors participate in the Empire Plan? |
| ANSWER: Members who need help finding par providers may call UHC at 1-800-942-4640. UHC's representatives can provide the information over the telephone or a printed listing can be generated upon request. The par provider directory is also available on the NYS Department of Civil Service web site. Enrollees should always confirm a provider's participation status at the time they schedule an appointment. |
| QUESTION: What benefits are available if I go to a non-par provider? |
| ANSWER: Services received from a non-par provider are eligible for consideration under the Basic Medical Expense Program. The member is responsible for paying the provider and filing a claim with UHC. S/he will then be reimbursed for eligible expenses less any deductible and coinsurance amounts applied on the claim. |
| QUESTION: Are there any limitations on the number of copayments I have to pay an Empire Plan par provider for services received during any single office visit? |
| ANSWER: There are two instances where the number of copayments are limited. First, if a par provider bills for both an office visit charge and an office surgery charge in any single visit, only one copayment will be imposed for these services. Second, when outpatient radiology services and diagnostic laboratory services are performed by the same par provider during a single visit, only one copayment will be imposed for these services. However, if the par provider sends a sample/specimen to another par provider because s/he can't perform the necessary lab services, another copayment will be imposed for the lab services performed by this provider. |