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- Who do I contact when I have questions?
- How can I find a provider?
- How can I nominate a provider to the East End Health Plan network?
- What are my In-Network benefits?
- What are my Out-of-Network benefits?
- How are my laboratory benefits covered?
- How I am covered for emergencies?
- How am I covered for Inpatient Hospitalization?
- If I need other outpatient services, how much will I be responsible for?
- Who may I confidentially speak with regarding my Mental Health or Substance Abuse Treatment benefits and their limitations?
- What if I am away on vacation or business and I have an emergency?
- What if I have a student in my family over the age of 19?
- How is Coordination of Benefits handled?
- How can I get information about my Flexible Benefit Plan?
- What are the eligible health care expenses for my Flexible Spending Account?
- What are the qualifying expenses for my dependent care reimbursement account?
1. Who do I contact when I have questions?
United Health Care:
Customer Service: 1-866-223-5802 or visit their website.
Vision Coverage:
Davis Vision Customer Service: 1-800-999-5431 or visit their website.
Caremark Prescription Drug Coverage:
1-800-345-5413 or visit their website.
2. How can I find a provider?
You can look on the United Health Care website. By answering a few questions at the site you will be able to narrow your search and make a choice for a provider. A link can be found on this EEHP website for the UHC Provider Network.
3. How can I nominate a provider to the East End Health Plan network?
If your provider is not a member of the network, you may nominate that person. Tell your Health Plan Coordinator at your school to pass along your nomination to United Health Care. UHC will do its best to get the provider in network. UHC will contact him/her in order to determine if that person would like to become an in-network provider. If the provider consents, UHC will begin the credentialing process. The credentialing process will take a few months.
4. What are my In-Network benefits?
When you use a participating East End Health Plan provider your benefits are paid at 100% after a co-payment of $15 in most cases. In some cases, there is no co-payment necessary. For details, please see your East End Health Plan Document, available on this website.
5. What are my Out-of-Network benefits?
Your plan provides coverage when you seek medical attention outside of network.. All payments are subject to reasonable and customary (R &C) amounts. First, you must meet the individual calendar year deductible of $350 or the maximum family deductible of $700. After the deductible is satisfied, you will begin paying coinsurance of 20% up to the maximum coinsurance amount ($1,500). Once the $1,500 out of pocket maximum is met, you will be covered at 100% of R & C. Any charges, which exceed the $1,500 amount, will be excluded from the Out of Network benefits. The provider can balance bill you if the charges exceed what is covered under the plan. This is why you receive the most from your plan when a participating provider renders your services.
6. How are my laboratory benefits covered?
If you have laboratory tests done at Labcorp Diagnostic Facility, there is no co-payment necessary. If you choose to use another lab, there is a $15 co-payment. There are a limited number of other laboratory facilities that do not require a co-payment and are in network. Please call the facility or contact UHC to find out.
7. How I am covered for emergencies?
You are covered at 100% for emergency room charges for emergency diagnosis after paying a $50 co-payment.
8. How am I covered for Inpatient Hospitalization?
Inpatient hospitalizations are covered, both in and out of network at 100%. You must pre-certify inpatient hospitalization by calling the member services number and pre-certifying with the Care Management Department. Pre-certification is required as follows:
30 days prior to an elective (scheduled) admission to the hospital; within 48 hours of emergency or urgent admission; and upon confirmation of Pregnancy. You must obtain pre-certification at least two days prior for some other services, such as; home nursing, ambulance, and medical equipment. Please check your Benefit Sheet or Summary Plan Description for specific services.
9. If I need other outpatient services, how much will I be responsible for?
Outpatient services are subject to a $35 co-payment in network and subject to deductible and coinsurance out of network.
10. Who may I confidentially speak with regarding my Mental Health or Substance Abuse Treatment benefits and their limitations?
Member can contact the customer service telephone number found on the back of their UnitedHealthCare card, to be placed in touch with United Behavioral Health (UHB). UHB is available to assist during mental or substance emergencies, and to answer questions regarding concerns and benefits. UHB can also provide guidance to in Network providors and help to reslove problems or concerns about treatment they receive.
11. What if I am away on vacation or business and I have an emergency?
In cases of emergency, you should seek care from the nearest hospital or non-hospital outpatient facility.
12. What if I have a student in my family over the age of 19?
Full-time college students are covered up to the age of 25. Effective January 1, 2003, an unmarried dependent student, 19 years of age or older but under the age of 25, who graduates from an accredited secondary or preparatory school, college or other educational institution, may continue coverage for up to 3 months following the end of the month in which course requirements for graduation are completed. Verification of the dependent student's graduation must be provided for this extension in coverage.
For dependents that leave school (cease to be full time students), but do not graduate, coverage ends on the last day of the month in which the dependent last attended school.
A parental affidavit must be signed as evidence that the dependent is a full time student. An affidavit must be sent twice a year ( each semester) in order to maintain coverage. A copy of this form can be found on this web site and downloaded or see your health plan coordinator at your school for a copy.
13. How is Coordination of Benefits handled?
If you have coverage under another health plan through a spouse, the primary plan will pay benefits and then the secondary plan will pay benefits.
If you are retired and over age 65, Medicare is your primary carrier. Medicare will pay the claim and then the East End Health Plan will pay for any additional benefits.
Once you reach age 65, you must enroll in Medicare. Failure to enroll may drastically reduce your benefits under the East End Health Plan.
If either you or your spouse is actively working, the East End Health Plan is primary.
14. How can I get information about my Flexible Benefit Plan?
Flexible Benefit Plan FAQs
15. What are the eligible health care expenses for my Flexible Spending Account?
Healthcare Expenses That Are Eligible
16. What are the qualifying expenses for my dependent care reimbursement account?
Qualifying Expenses - Dependent Care Reimbursement Account
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