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Health Insurance Reimbursement Program

Details: Health Insurance Reimbursement Request. form and supporting documents are received by the SDCERA Health Plans Service Center. Health program fees. The administrative expenses of the health benefit . program are paid by each plan participant. The health benefit program expenses are divided equally among participants, resulting in a monthly fee

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FILE A HEALTH SCREENING CLAIM WITH CONFIDENCE

Details: a health screening benefit, you and your dependents are eligible to receive a benefit while insured upon filing a claim. GROUP BENEFITS HEALTH SCREENING CLAIMS THE HARTFORD MAKES IT EASY TO FILE A CLAIM JUST FOLLOW THESE STEPS STEP 1 Review the list on the back of this page to determine if your health screening may be eligible …

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Health Advocate Flyer

Details: Health Advocate is not affiliated with any insurance company or third party provider, and does not provide medical care or recommend treatment. ©2019 Health Advocate HA-CM-1708032-9FLY Turn to us—we can help. 888.724.0507 Email: [email protected]

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Health Insurance Plans Enrollment form

Details: SDCERA Health Plans Service Center, PO Box 14464, Des Moines, IA 50306-3464 or Fax: 515-365-1520 Phone: 1.866.751.0256 Please be advised that in order to enroll in an SDCERA Medical or Dental Plan, the amount of the monthly pension benefit must exceed the full cost of the premium(s) being deducted.

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High Deductible Plan

Details: health, behavioral health, or substance abuse services Outpatient services 20% coinsurance 50% coinsurance. Prior authorization required. Including benefits provided for Applied Behavioral Analysis (ABA). Non-network Non-Authorization Reduction in benefits to 50% of eligible expenses, up to a maximum of $500. 4 EAP Sessions per concern.

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Need help with healthcare

Details: Now, with Medical Bill Saver™, Health Advocate professionals also help you negotiate medical bills not covered by health insurance: You can quickly connect with board-certified, U.S. licensed health providers online for 24/7/365 access to medical care — fast: More than just cash benefits. Medical Bill SaverTM from Health Advocate Questions?

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Health Insurance Plans Enrollment Form

Details: Medicare Plans or Dental Plans pages of health.sdcera.org. You may also mail your forms to the SDCERA Health Plans Service Center, PO Box 14464, Des Moines, IA 50306-3464 or fax them to 515-365-1520. SECTION 1: Member Information . SDCERA Health Insurance Plans Enrollment . F. orm

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2021 Retiree Health Insurance Allowance Request

Details: 2021 Health Insurance Allowance Request AUTHORIZATION Submit this completed form to the SDCERA Retiree Health Program Service Center SDCERA Retiree Health Program Service Center • 866.751.0256 • health.sdcera.org • PO Box 14464 • Des Moines, IA 50306-3464 State ZIP Daytime telephone number ( ) MEMBER INFORMATION

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CRITICAL ILLNESS CLAIM FORM

Details: • detect health care fraud or abuse or for compliance activities, which may include disclosure to MIB and participation in MIB's fraud prevention or fraud detection programs. I hereby acknowledge that the insurance companies listed above are subject to federal privacy regulations.

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INSTRUCTIONS ON HOW TO SUBMIT A CLAIM FORM

Details: 4. Mail Claims to: Mercer Consumer, a service of Mercer Health & Benefits Administration LLC Attn: Claims P.O. Box 9326 Des Moines, IA 50306-9326 Page 1 of 5 Mercer 02/2015 explanation of The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries. LC-7 -1

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Health Insurance Reimbursement Request form

Details: and Health Insurance Reimbursement Program fact sheets available on the Health page of www.sdcera.org. You may make an initial request for Health Insurance Reimbursement (HIR) any time throughout the year. You must re-enroll each year to continue your reimbursement into the new plan year. If you enroll in a dental plan offered by the

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Aflac Group Accident

Details: having to answer health questions). • Benefits are paid directly to you, unless otherwise assigned. • Coverage is available for you, your spouse, and dependent children. • Coverage is portable (with certain stipulations). That means you can take it with you if you change jobs or retire. But it doesn’t stop there.

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UnitedHealthcare/Oxford¹: Freedom Plan Direct/Freedom/Non

Details: other special health needs Home health care 20% co-ins 25% co-ins Limited to 40 visits per calendar year Pre-Authorization required for Non-Network or benefit reduces to 50% of allowed Rehabilitation services $40 copay per visit 40% co-ins Depending on the type of therapy, there is a limit of 60 visits per condition per lifetime. Pre-Authorization

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Aflac Group Critical Illness

Details: HEALTH SCREENING BENEFIT (Employee and Spouse only) We will pay $75 for health screening tests performed while an insured’s coverage is in force. We will pay this benefit once per calendar year. This benefit is only payable for health screening tests performed as the result of preventive care, including tests and diagnostic

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UnitedHealthcare® MedicareRx for Groups (PDP)

Details: outpatient health care) or Medicare Part D (prescription drugs). Your doctor may need to provide the plan with more information about how this drug will be used to make sure it’s correctly covered by Medicare. HRM - High Risk MedicationThis drug is known as a high risk medication (HRM) for Medicare members 65 and older. This

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Oxford Health Plans The Freedom Plan MetroEPO

Details: coordinated with the benefits of any other group health plan to which the individual is entitled. Medicare is the primary coverage and Oxford Health Plans is secondary for employees with Medicare in firms with fewer than 20 employees. Preexisting Conditions– A preexisting condition is a disease or a

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Annual Notice of Changes

Details: based on their health needs. MyHealth Advantage This program sends regular reminders about needed care, tests or preventive health steps to keep you healthy. It also offers prescription drug cost-cutting tips and access to health specialists who can answer your questions. Care and support with Aspire Aspire Health is a community-based

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Sandia Total Health (claims administered by Kaiser

Details: Total Health Program at any time without prior notice, subject to applicable collective bargaining agreements. The Sandia Total Health Program’s terms cannot be modified by written or oral statements to you from human resources representatives or other NTESS personnel.

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Health Insurance ClaimForm INSTRUCTIONS ON HOW TO …

Details: Health Insurance ClaimForm Before completing, please read all instructions carefully to insure fast, accurate processing. INSTRUCTIONS ON HOW TO SUBMIT ACLAIM FORM. 1. The form must be completed with all requested information, and sign and date the reverse side of form. 2.

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2022 MEDICARE PLANS Medicare plans Health Net HMO …

Details: Health Net physician you select from a list of providers. Medicare benefit must be assigned to the plan, or a higher premium and traditional Kaiser HMO benefits apply. You are required to use Kaiser Permanente physicians and facilities. This plan provides coverage in California, Arizona and Nevada. Medicare benefit must be assigned to the plan.

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Glossary of Health Coverage and Medical Terms

Details: health care facility licensed, certified or accredited as required by state law. Reconstructive Surgery . Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Rehabilitation Services .

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Hallmark's Self-Insured Minimal Essential Coverage Health

Details: The Hallmark Minimal Essential Coverage Health Care Plan provides a Prescription Drug Plan. This prescription drug program is an independent program, separate from the medical plan and covers preventive prescriptions as mandated under the Affordable Care Act (ACA).

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CATASTROPHE MAJOR MEDICAL PLAN CLAIM FORM

Details: § Itemized invoices from your health care providers. This will provide the claim processor with information important to your claim. 5) Mail your claims to: Mercer Consumer PO Box 10362 Des Moines, IA 50306-0362 Questions: 888-386-9788 Important: Claims must be filed within five (5) years of incurring the claim expense.

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UnitedHealthcare/Oxford¹: Metro/Freedom/Gated Coverage

Details: health, behavioral health, or substance abuse needs Mental/Behavioral health outpatient $40 copay per visit 30% co-ins services Limited to 30 visits per calendar year. Biological Outpatient is Unlimited. Pre-Authorization required for Non-Network or benefit reduces to 50% of allowed $500 copay per day 30% co-ins up to 5 days. $2,500 max per

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Employee Enrollment Application Association Health Plan

Details: Association Health Plan Coverage Kentucky LG_ASSOC_EE_KY Rev. 1/20 Life and Disability products underwritten by Anthem Life Insurance Company. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee of the Blue Cross and Blue Shield Association.

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FREQUENTLY ASKED Q UESTIONS What is critical illness

Details: [The Health Screening Benefit is not available in all states. See your certificate for any applicable waiting periods. There is a separate mammogram benefit for MT residents and for cases sitused in CA and MT.] 12. Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain

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Information Request For AFA Member: Here’s the TRICARE

Details: Mercer Health & Benefits Administration LLC AFA Insurance Plans Administrator License #8704140 P.S. As an AFA member, you have a guaranteed right to this benefit, and it’s easy to get today. Just complete and return the enclosed Enrollment Form. Then you can enjoy the supplemental TRICARE insurance

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2022 Retiree Health Insurance Plans

Details: The Health Insurance Allowance (HIA) helps offset the cost of premiums for medical, dental and prescription plans. In addition to the allowance, $93.50 may be reimbursed to offset the cost of Medicare Part B. You are eligible for HIA if you are a retired Tier I or Tier II Member who has at least 10 years of SDCERA service credit

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Glossary of Health Coverage and Medical Terms

Details: health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered . Coinsurance Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you

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Affordable hearing aids through hi HealthInnovations.

Details: untreated, it can also lead to additional health problems such as depression and dementia, and has been linked to heart disease, diabetes and stroke.2 Fortunately, over 90% of people with hearing loss can be treated with hearing aids.3 Better hearing results are connected to earlier use of hearing aids.4 Hearing aids at a low cost to Trust Plan

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Independence Standard and Minimum PPO Plans and CVS

Details: Retiree health care coverage you choose — you can access retiree health care coverage through a private health care marketplace (sometimes referred to as a private health care exchange) administered by Mercer Marketplace 365+ Retiree. You may also choose coverage through a public health care exchange. Other coverage options are

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Sandia Total Health administered by UnitedHealthcare

Details: Sandia Health Benefits Plan for Employees Summary Plan Description. or the . Sandia Health Benefits Plan for Retirees Summary Plan Description. The Sandia Total Health Program is maintained at the discretion of Sandia and is not intended to create a contract of employment and does not change the at will employment relationship between you and

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Cigna Dental Benefit Summary Hallmark Cards Incorporated

Details: Cigna Health and Life Insurance Company. This material is for informational purposes only and is designed to highlight some of the benefits available under this plan. Consult the plan documents to determine specific terms of coverage relating to your plan. Terms include covered procedures, applicable waiting periods, exclusions and limitations.

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Mercer Health & Benefits Administration LLC Urbandale, IA

Details: Mercer Health & Benefits Administration LLC 12421 Meredith Drive Urbandale, IA 50398 Member Social Security Number: ReliaStar Life Insurance Company. SUGGESTED BENEFICIARY DESIGNATIONS Personal Beneficiaries 1. If one individual is to be designated, use full legal name thus – “Anna May Smith,” not “Mrs. John Smith.”

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Sandia Total Health administered by UnitedHealthcare

Details: • The Health Reimbursement Account (HRA) claim filing period has changed. See Section 5: Health Reimbursement Account for more information. • If you are a member who turned the pay the provider feature OFF or ON in the previous plan year, this feature no longer resets to the default (ON) at the beginning of every year.

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Aflac Group Hospital Indemnity

Details: Continental American Insurance Company (CAIC ), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage.

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Employer Application Association ealth Plan Coverage Kentucky

Details: continue health coverage under COBRA to eligible employees and . eligible dependents. 5. That statements of medical history will be required of employees, and dependents when applying for coverage within or outside the time frames . or amount of coverage limits established by Anthem. 6. That approval for this coverage may cancel any prior

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Humana Dental 2014 Summary of Benefits and Coverage

Details: each plan, and a provider locator are available by visiting the Publix Personal Plans website from PASSport or www.publix.org > Health and Well-Being > Dental Plan and clicking the Dental Insurance option. You also may call Publix Personal Plans toll-free at 1-888-374-6377. ID cards are issued to new enrollees in the dental plan.

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High medical bills

Details: from Health Advocate You can use Medical Bill SaverTM for your spouse, dependent children, parents and parents-in-law, too! Need help cutting costs? Just send in your bill. Medical Bill Saver™ is available as soon as your Aflac coverage starts. It puts an expert negotiator in your corner who will try to help you reduce

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Discover your Health Screening Benefits

Details: Health screenings are an important part of managing your health. That's why your Cr itical Illness, insurance coverage from MetLife provides an additional Health Screening Benefit1 (HSB) for covered screenings and tests. Now, everyone who's enrolled — …

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Metropolitan Life Insurance Company, New York, NY 10166

Details: 2. In the past 5 years, have you received medical treatment or counseling by a physician or other health care provider for, or been advised by a physician or other health care provider to discontinue, the use of alcohol or prescribed or non-prescribed drugs? 3.

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UnitedHealthcare (UHC) Premier PPO Program Summary

Details: UHC Premier PPO Program 1-1 Section 1. Introduction This is a summary of highlights of the UHC Premier PPO Program, a component of the Sandia Health Plan for Employees (ERISA Plan 540) and the Sandia Health Plan for Retirees (ERISA

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SDCERA Health Insurance Plans Enrollment form

Details: Health Net is a Medicare Advantage plan and has a contract with the Federal government. I will need to keep my Medicare Parts A and B. I can only be in one Medicare Advantage plan at a time, and I understand that my enrollment in this plan will …

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IMPORTANT This mailing is for those currently eligible for

Details: These policies help pay the portion of health care costs that original Medicare doesn’t cover, including copays, deductibles, and coinsurance. Medicare Supplement Plans are optional and provide additional, supplemental coverage for a monthly premium. Medicare Part D …

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Cigna Conversion of Group or Employee Life Insurance to an

Details: evidence of good health is required for a conversion policy. The converted policy will be effective 31 days from the end of coverage under the group life insurance policy. If a person insured under the group life insurance policy dies prior to the effective date of …

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2015 Sandia Health Benefits Plan for Retirees Summary Plan

Details: The Sandia Health Benefits Plan for Retirees is maintained at the discretion of Sandia. The Sandia Health Benefits Plan for Retirees is expected to continue indefinitely. However, the Sandia Board of Directors (or designated representative) reserves the right to amend (in writing) any or all provisions of the Sandia Health

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Aflac Group Hospital Indemnity

Details: or having to borrow to cover out-of-pocket-expenses health insurance was never intended to cover. Like transportation and meals for family members, help with child care or time away for work, for instance. In addition to providing you with …

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PLAN DESIGN & BENEFITS TRADITIONAL CHOICE MEDICARE

Details: Health benefits and health insurance plans contain exclusions and limitations. Not all health services are covered. State mandates may apply. See plan documents for a complete description of benefits, exclusions, limitations, and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are

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