| |
|
|
| |
 |
Who is eligible to make GOLDEN HEALTH PLAN contributions? |
 |
| |
To be an eligible individual and qualify for a GOLDEN HEALTH PLAN you must - |
|
|
Have no other health coverage except what is permitted under health coverage, defined below. |
|
Not enrolled in any other Medical Insurance. |
|
Not claimed as a dependent on someone else's tax return. |
|
Other health coverage. You generally cannot have any other health coverage. You can have additional insurance that provides benefits only for the following items. |
| |
|
Liabilities incurred under workers' compensation laws, or liabilities related to ownership or use of property. |
| |
|
A specific disease or illness. |
|
A fixed amount per day (or other period) of hospitalization. |
|
Accidents, Long Term Care, Disability, Vision and Dental Care. ( Subject to Approval ) |
| |
|
|
|
| |
|
|
| |
|
How can I track my account balance and activity? |
|
| |
You can track your GOLDEN HEALTH PLAN account through mybanksharemic.com, mybanksharemic.com, enables consumers to: |
|
|
Instantly track and review medical claims and other health account information |
|
Access a consolidated, interactive snapshot of your benefits plan |
|
Perform on-line transactions such as ordering medications; ( if opted for additional Pharmacy Coverage |
| |
|
Access on-line information about participating physicians via our Web-linked provider directory; |
|
Receive personalized investment and health news |
|
Research health and wellness information |
|
Use tools and other resources to help make informed health care decisions. |
| |
|
|
|
| |
|
How does BANKSHARE™ pay claims? |
|
|
When you see your doctor, you do not have to pay anything at the time of the office visit. Instead, your doctor sends your claim directly to BANKSHARE™ GOLDEN HEALTH PLAN. |
| |
|
BANKSHARE™ GOLDEN HEALTH PLAN processes the claim and sends you an Explanation of Benefits (EOB) that tells you |
| |
|
If your plan covers the services you received; and |
|
If so, what portion of the covered services your plan pays; and |
|
If not, how much you owe |
|
If you have met/not met your deductible and whether there is a balance due. |
|
If there is money in your Health Plan , your doctor is paid directly from the fund. You and your doctor receive EOBs explaining that payment has been made from your fund. Your EOB also tells you how much money is left in your fund. |
|
If there is no money in your Health Plan, or if the expense is not eligible for payment from the fund, you receive an EOB letting you know that the payment cannot be made from the fund and that you are responsible for paying the bill. |
| |
|
If you receive a bill from your doctor, you should always make sure it has been sent to BANKSHARE™ GOLDEN HEALTH PLAN for processing before you pay it. You can check by: |
| |
|
reviewing your fund activity on myBANKSHARE™mic.com |
|
determining whether you've received an EOB |
|
Calling the toll-free number on your BANKSHARE™ GOLDEN HEALTH PLAN ID Card. |
| |
|
|
|
| |
|
Do I need to file claim forms? |
|
|
No, not if you've seen an in-network provider. Most out-of-network providers will submit claims on your behalf, too. But if not, claim forms are always available on BANKSHARE™mic.com |
| |
| |
|
|
|
| |
|
Can I see any doctor I choose? |
|
|
Yes. If you choose doctors who participate in the BANKSHARE™ network, your costs are lower. If you see providers outside the BANKSHARE™ network, your Account will still pay for covered services, but not at the discounted rate. |
| |
| |
|
|
|
| |
|
Which services are covered by GOLDEN HEALTH PLAN and which will I have to pay for myself? |
|
|
Because covered services vary from plan to plan, it's important to read your plan materials. Typically, you'll be responsible for paying: |
| |
|
monthly / yearly premium contribution |
|
any costs for services not covered by your plan |
|
any costs for services received after the fund is depleted and before the deductible is met |
|
Co- insurance or co-payments after your plan coverage begins.
If all your medical expenses are for covered services, and their total cost doesn't exceed the number of rupee in your fund, you won't have to pay any out-of-pocket costs. |
| |
| |
|
|
|
| |
|
What happens when my Health Plan rupee are spent? |
|
|
If you've used all the money in your fund before you've met your annual deductible, then you must pay for medical costs up to and including the amount of your deductible. After that, your medical plan covers services as described in your plan documents. |
| |
| |
|
|
|
| |
|
What if there are funds left over in my account at the end of the year? |
|
|
Employer’s contribution and roll over into following year's fund is not applicable. So be sure to review your plan materials for details. |
| |
| |
|
|
|
| |
|
How can I track my fund balance? |
|
|
You can monitor your fund by |
|
logging in to myBANKSHARE™mic.com here you'll find your fund balance, claim status and eligibility information housed in a secure environment |
| |
|
Read your latest EOB. It includes the fund balance from the time of your most recent transaction |
|
Call the number on your BANKSHARE™ GOLDEN HEALTH PLAN ID card; monitoring your quarterly statements for detailed information about your fund balance and claims processed during that quarter. |
| |
| |
|
|
|
| |
|
How can I figure out if a health reimbursement arrangement is right for me? |
|
|
Use our benefits calculator to estimate your total out-of-pocket expenses. It gives you recent medical cost information (and prescription drug information if BANKSHARE™ pharmacy coverage is part of your plan), as well as basic plan information. It's available on myBANKSHARE™ |
| |
| |
|
|
|
| |
|
What if I have questions about my Health Plan? |
|
|
You'll find answers to most of your questions on myBANKSHARE™, You can also contact your employee benefits office. |
| |
| |
|
|
|
| |
|
What are the expense guidelines and listings of covered and not covered items? |
|
|
Go to our Eligible and ineligible Expenses page for a listing. |
| |
|
|
|
| |
|
Can I obtain an online form? |
|
|
Yes. We provide online forms on the Website. |
| |
|
|
|
| |
|
Many of our employees will have on-going expenses. How do they submit these claims? |
|
|
Some of your eligible expenses may be ongoing and you may be filing claims for the same amount on a regular basis. Monthly bills for a child's medical care costs are an example. To receive reimbursement, it is a mandatory requirement that you submit a completed Reimbursement Request Form and receipts each time you have a claim, even though the bill may be repetitive. |
| |
| |
|
|
|
| |
|
What if an employee exceeds their goal amount for the year? |
|
|
Insufficient funds - If your reimbursement request exceeds your available account balance: |
|
Health Care - you receive reimbursement up to your annual goal amount, only if you have contributed the full amount to your account. |
| |
| |
|
|
|
| |
|
|
| |
|
|
