Log in to find your claims. You’ll see a status for each claim, saying what stage of the claims process it’s in.
Preapproval (also known as precertification, prior authorization or preauthorization) is the process used to confirm if a proposed service or procedure is medically necessary. If you have a question, call the customer service number on your member ID card.
Not sure if a medication is covered? Search your plan’s drug list or call the customer service number on your member ID card.
More information about health care costs and payments.
If you are pregnant and choose to breastfeed your newborn, we want to ensure you have the information, tools and support you need to be successful.
Many benefit plans offer pregnant women access to personal use, standard, double electric breast pumps through many of our contracted equipment suppliers at no cost to them. It is always important to check your member benefits to confirm coverage of a breast pump.
We want to make sure the process to access a breast pump is simple for you. If you are currently pregnant, we encourage you to talk with your physician and confirm your intention to breastfeed. Then, you may want to contact any of the following nationally contracted equipment providers to order your breast pump, or you may also call one of our many other contracted equipment providers.
Though there are many quality options available, you may have a particular brand in mind to meet your needs. Please be aware that the brands available from each equipment provider may vary. If you are not able to secure an order for the brand of your choice, please call the customer service number on the back of your member identification card to obtain assistance.
When contacting equipment providers please have your Anthem Member Identification number available, as well as your physician contact information. Some of the nationally contracted equipment (DME) providers are below:
Edge Park
800-321-0591 (phone)
330-425-4355 (fax)
Monday-Friday, 8 a.m. to 9 p.m.
Saturday, 9 a.m. to 3 p.m.
Byram
877-773-1972 (phone)
800-521-6291 (fax)
Monday-Friday, 8 a.m. to 6 p.m.
Medline Industries, Inc.
877-791-0064 (phone)
337-628-2240 (fax)
It is always important to check your member benefits to confirm coverage of a breast pump. A breast pump is considered Durable Medical Equipment.
Please contact customer service by calling the telephone number on the back of your member identification card.
Customer service can also guide you through a variety of programs and services we offer to support breastfeeding mothers.
COBRA is a federal law that enables employees and their covered dependents to maintain their group health coverage for 18, 29 or 36 months after becoming ineligible for regular group coverage. The COBRA law does not apply to group health plans maintained by a small employer (normally fewer than 20 employees on a typical business day).
How is my HIA funded?
Your HIA is funded when you earn rewards for taking certain steps to improve your health. Check your Plan Summary for more information about earning rewards.
Your HIA is funded when you earn rewards for taking certain steps to improve your health. Check your Plan Summary for more information about earning rewards.
What type of services may I pay for with my HIA funds?
You can use the money in your HIA to pay for health care services covered by the Lumenos plan, such as doctor’s office visits, prescription drugs, and lab tests. Check your Plan Summary for more information on covered services.
What is traditional health coverage?
Similar to a PPO or HMO plan, after you meet your deductible, you pay coinsurance (a percentage of the provider’s charges) when you visit a network provider. You’ll pay more if you visit an out-of-network provider. Check your Plan Summary for more information on coinsurance amounts.
How do I check my health account balance?
It’s easy. First register then log on at anthem.com. You can keep track of your account activity and balance, and get details on your medical claims. You’ll also receive a monthly statement with your account balance, account activity, medical and prescription claim history and important messages about how you may be able to improve your health or save money.
Can I roll over all the money in my HIA at the end of each plan year?
Yes. Whatever you don’t spend on covered services will roll over to the next year, as long as you remain enrolled in the Lumenos HIA plan. You can use roll-over funds to help pay future out-of-pocket expenses.
If I leave this Lumenos plan, what happens to my HIA funds?
You cannot take your HIA funds with you if you leave the plan or your employer. The funds in your HIA stay with the health plan.
Can I have an HSA and an FSA?
You are eligible to have both an HSA and an FSA only if the FSA has been defined as either a Limited/Special Purpose FSA, which may be limited to dental and/ or vision services or dependent care only or a Limited Purpose High-Deductible FSA, which also allows for dental and/or vision services, as well as payment for the coinsurance under the traditional health component of the plan, after meeting the deductible.
Contributions to your Health Savings Account (HSA)
How is my HSA funded?
Your HSA is funded by your own pre-tax contributions, up to a certain annual limit. You may also contribute post-tax money to your HSA. Others (including your employer) may contribute to your account as well. You can earn additional dollars for your HSA by taking certain steps to improve your health. The total of all contributions cannot exceed the maximums defined by the U.S. Treasury and the Internal Revenue Service (IRS). (See the question below: How much can I contribute to my HSA? for details.)
You are eligible to have both an HSA and an FSA only if the FSA has been defined as either a Limited/Special Purpose FSA, which may be limited to dental and/ or vision services or dependent care only or a Limited Purpose High-Deductible FSA, which also allows for dental and/or vision services, as well as payment for the coinsurance under the traditional health component of the plan, after meeting the deductible.
Contributions to your Health Savings Account (HSA)
How is my HSA funded?
Your HSA is funded by your own pre-tax contributions, up to a certain annual limit. You may also contribute post-tax money to your HSA. Others (including your employer) may contribute to your account as well. You can earn additional dollars for your HSA by taking certain steps to improve your health. The total of all contributions cannot exceed the maximums defined by the U.S. Treasury and the Internal Revenue Service (IRS). (See the question below: How much can I contribute to my HSA? for details.)
How do I make contributions to my HSA?
The easiest way is through pre-tax payroll deductions, if allowed by your employer. However, you may also contribute directly to your HSA post-tax, by sending a check to the address printed on your HSA checkbook.
The easiest way is through pre-tax payroll deductions, if allowed by your employer. However, you may also contribute directly to your HSA post-tax, by sending a check to the address printed on your HSA checkbook.
How much can I contribute to my HSA?
For 2010, the annual contribution maximum set by the U.S. Treasury and the IRS is $3,050 for individual coverage and $6,150 for family coverage. The contribution maximums set by the U.S. Treasury and the IRS may be increased for inflation annually. Check anthem.com for the most current maximum amounts.
For 2010, the annual contribution maximum set by the U.S. Treasury and the IRS is $3,050 for individual coverage and $6,150 for family coverage. The contribution maximums set by the U.S. Treasury and the IRS may be increased for inflation annually. Check anthem.com for the most current maximum amounts.
Can I ever contribute more than the annual limit?
Yes, people age 55 and older who are not enrolled in Medicare are eligible to contribute an additional $1,000 above the regular limits (called a catch-up contribution). These individuals can make catch-up contributions each year until they enroll in Medicare. On
Under normal circumstances, a qualified employee leaves employment can "elect coverage" under COBRA to continue in their company's health plan for up to 18 months, provided they pay the full premium, and payment is received on time. For COBRA qualifying events affecting a spouse or dependent children, such as separation, divorce, death or children leaving the plan due to age, the election period is up to 36 months. Individuals determined to be disabled by the Social Security Administration may extend their group benefits to 29 months if the Social Security administration determines that their disability date (first day the disability began) occurred within the first 60 days of their COBRA coverage.
To help you better understand your benefits, you can access your Evidence of Coverage. Simply Login to your secure account and view your plan documents. Your Evidence of Coverage or Member Certificate Booklet will provide information on these important topics:
- Accessing health care for different types of services
- Coverage while traveling
- When to obtain emergency care and when to use 911 services
- How to file a claim
- How to voice a complaint or appeal a decision, including the right to independent external appeal
- How to resolve a concern you are having with Empire
- Understanding your Pharmacy Benefit Program
- Covered benefits and exclusions
- Your copayments and other cost sharing information that you are responsible for
- How to obtain information about doctors who participate in our network
- How we evaluate new technology for inclusion as a covered benefit
When you applied for coverage with us, you were asked to provide information about any additional health insurance you or your covered dependents may have. We will use the information you provided to work with your other health plan to help ensure you receive the benefits you are entitled to while avoiding overpayment by either carrier. This process is called Coordination of Benefits. Log in or Register today to learn more!
Once you're logged in, you can find a good amount of info on your claims or benefits by selecting the Claims or Benefits items in the menu. You can also find some basic info by looking on the back of your ID card.
If you don't find answers to your questions, please call Member Services at the number listed on your ID Card.
How is my HRA funded?
Your employer makes an annual, upfront deposit to your Health Reimbursement Account (HRA). The amount of your annual allocation depends upon your employer, and whether you have individual or family coverage. You also have the opportunity to earn additional dollars for your HRA by taking certain steps to improve your health.
Your employer makes an annual, upfront deposit to your Health Reimbursement Account (HRA). The amount of your annual allocation depends upon your employer, and whether you have individual or family coverage. You also have the opportunity to earn additional dollars for your HRA by taking certain steps to improve your health.
Does MyIncentive Account cost me anything?
No. It's being offered and funded by your employer to encourage healthy habits and to help you meet health care expenses.
No. It's being offered and funded by your employer to encourage healthy habits and to help you meet health care expenses.
Will I get taxed on this money?
No, funds in your account do not count as taxable income.
No, funds in your account do not count as taxable income.
I still have questions. Who can I call?
Our customer service representatives will be happy to help answer them all. Just call the number on the back of your member identification card.
Our customer service representatives will be happy to help answer them all. Just call the number on the back of your member identification card.
An EOB shows how your benefits work - what we paid, how much you'll need to pay, etc. If you didn't get one, it could be:
- You may not need to pay anything. If a service is covered fully by your benefits (or you paid a copay and that's all you owe), we will not send you an EOB. We only send one when there's action you need to take.
- We may not have gotten your claim yet.
What's the best, quickest way to solve this?
Log in to empireblue.com and click the Claims tab. If your claim isn't there or you still have questions, click Customer Support and choose how you'd prefer to contact us. Or call the Member Services number on your member ID Card.
Log in to empireblue.com and click the Claims tab. If your claim isn't there or you still have questions, click Customer Support and choose how you'd prefer to contact us. Or call the Member Services number on your member ID Card.
How can I stop getting EOBs in the mail?
It's easy to stop getting EOBs by mail - and only get them by email. Just log in to empireblue.com and click on the Profile tab, then select Email Preferences toward the top of the page. Scroll down to choose the way you'd prefer to get your EOBs.
It's easy to stop getting EOBs by mail - and only get them by email. Just log in to empireblue.com and click on the Profile tab, then select Email Preferences toward the top of the page. Scroll down to choose the way you'd prefer to get your EOBs.
Generally, individuals become eligible to enroll in Medicare when they reach age 65, or are disabled and have been receiving Social Security Disability Income (SSDI) checks for 24 months, or have a diagnosis of either end-stage renal disease or ALS (Lou Gehrig’s Disease).
While the law allows people to maintain their group health coverage and coordinate it with Medicare, anyone covered by a group plan who is planning on enrolling in Medicare should check their group plan's eligibility rules to find out their plan’s rules regarding Medicare enrollment, and to determine which insurance is primary (pays first), and which is secondary. Watch the relevant dates carefully, and beware that eligible individuals only have 80 days to enroll in Medicare Part B after their group health benefits end, or face paying a higher Part B premium as penalty.
Yes. You get discounts through our SpecialOffers program - just for being a member. It's easy. Log in and visit our Discounts page.
Where can I access additional discounts on dental products and services not covered through my plan?
You get discounts through our SpecialOffers program - just for being a member. It's easy. Log in and visit our Discounts page.
Consumer-driven health plan (CDHP) is a high-deductible plan that also includes a tax-free health savings account (HSA), health incentive account (HIA) or health reimbursement account (HRA). You may put tax-free money into your account, or your employer might put money in - sometimes as a reward for steps you’ve taken for better health, depending on your plan. Then you use that money for your share of care costs, like your deductible or coinsurance.
It’s called consumer-driven because it puts you in the driver’s seat of your health and health care spending. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.
Health Savings Account (HSA) plan is a high-dedutible plan that also includes a tax-free HSA. You can put tax-free money into it. Then use that money for your share of care costs, like your deductible or coinsurance. You can see all of the types of costs you can cover with money in your HSA. But remember that only cost your plan covers will go toward paying down your deductible.
It gives you the flexibility of a PPO - you can often go to doctors in and out of your network, though you’ll get better rates with in-network doctors. HSA plans tend to have lower monthly premiums than similar PPOs, and sometimes even HMOs.
It’s sometimes called a consumer-driven health plan (CDHP) because you’re in more control of your care spending at first. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.
You (or sometimes your employer) can put tax-free money into your health savings account (HSA). Then you use that money to pay for your share of care costs, like your deductible or coinsurance. Some people cover for all their care costs with their HSA dollars - since your checkups and other preventive care are already covered at 100%. Also, your plan comes with tools to help you find quality care at a lower cost.
If you still have money left in your account, it stays in there for next year and beyond. And you can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.
A health incentive account (HIA) is a health account set up by your employer health plan. You earn dollars in your account when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.
Your employer puts money into your health incentive account (HIA) when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.
Yes. The three main types of FSAs are:
1. Health care FSA for qualified medical, dental, vision or other health care costs, including insurance deductibles, co-payments and co-insurance.
2. Dependent care FSA for child, elder or other dependent care.
3. Limited purpose FSA for qualified dental and vision care costs only when combined with a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).
To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. You must elect to participate in the FSA during your employer's open enrollment.
For a Dependent Care Flexible Spending Account (DCA), you must have children under the age of 13 (if divorced, you must be the custodial parent) or you must claim an adult dependent on your tax return who’s physically or mentally unable to care for themselves.
Yes, you’ll need to elect to participate in an FSA each plan year during your employer's open enrollment.
Qualified individuals must meet one of the following criteria: children under the age of 13 or any adult you can claim as a dependent on your tax return who is physically or mentally unable to care for themselves.
For more information, view IRS Publication 503.
To qualify for a DCA, you must be the custodial parent, even if you don’t claim your child as a tax dependent.
For more information, view IRS Publication.
Typically anyone whose employer offers a DCA can participate. As a rule, your DCA can only cover expenses incurred during work hours. Ask your employer’s benefits team to verify eligibility.
For more information, view IRS Publication.
To qualify, dependent care must be essential for you and a spouse (if applicable) to work, look for work or attend school full-time. Typical eligible expenses include:
- Before and after school care programs
- Preschool or nursery school
- Extended day programs and summer day camp
- Babysitter (in or out of your home)
- Nanny and au pair services
- Daycare and eldercare facilities
Expenses not related directly to care of the dependent (i.e. tuition, food, etc.) aren’t eligible. Examples include:
- Educational expenses (summer school and tutoring)
- Tuition for kindergarten and above
- Overnight camp
- Field trip expenses and fees
- Housekeeping services
- Dependent care expenses incurred if your spouse doesn’t work, unless your spouse is a full-time student or is disabled
The work related expense test is the standard the Internal Revenue Service uses to determine if expenses are work related for a DCA. An expense isn’t considered work related just because you had it while you were working. Expenses are considered work related only if both of the following are true:
- They allow you (and your spouse if filing jointly) to work or look for work
- They’re for a qualifying person’s care
For more information, view IRS Publication 503.
Contribution maximums are defined by the U.S. Department of the Treasury and the Internal Revenue Service and may increase for inflation annually. Visit www.irs.gov for the most current maximum amounts.
Your spouse can also contribute up to the annual contribution maximum to their separate FSA. Visit www.irs.gov for the most current maximum amounts.
The entire amount you’ve elected to put into your FSA is available on day one of your plan, even if you’re contributing a portion each month. You can use your funds by logging into your FSA administrator’s website or by using your FSA debit card, if you’ve been provided one.
Your employer determines how your plan works. Employers can elect to offer a carryover. Carryover is a dollar amount (up to the Internal Revenue Service limit) of unused funds to use your new plan year. Any balance after that is forfeited to your employer. A grace period is extra days to incur new expenses and use funds after the plan year ends. Employers can’t have both; they must only select one option. After that, any unused balance for the previous year goes back to your employer. Check your plan documents for what is allowed by your employer.
The run-out period is the time limit for submitting receipts for expenses incurred during the plan year. Check your plan documents for the run-out period allowed by your employer.
Does the carryover amount limit my future year Health Care Flexible Spending Account (FSA) election?
No.
Internal Revenue Service guidelines state that you can’t have both an HSA and a FSA. During open enrollment, if you elect an HSA plan, you may not re-enroll in an FSA. If your employer offers a Limited Purpose FSA, you may enroll in it.
Visit www.irs.gov for the most current maximum amounts.
No. The combined DCA contributions can’t total more than the Internal Revenue Service maximum per plan year, per household.
Your DCA withholdings are reported on your W-2.
By logging onto your administrator’s member portal.
By logging onto your administrators member portal.
You must submit documentation. It can be an itemized receipt, invoice, explanation of benefits or other, but must include the patient name, name of the provider/pharmacy, the service/item purchased, date of the service/transaction and dollar amount.
When you use your FSA debit card, sometimes you may get an email or letter that asks you to “substantiate” a charge or claim. That just means supporting documentation is needed to make sure your FSA funds were used for eligible expenses.
You can submit a claim to your FSA that occurred anytime within the plan year up until the run-out period. Any claims submitted after the run-out date won’t be approved.
You can only enroll and set how much you’re putting into it during your employer’s open enrollment period. However, if you have a change in your life such as getting married or divorced, a new child, moving, etc., contact your company’s human resources department. You may qualify for a special enrollment period and you’ll be able to make changes to your FSA.
Your employer decides if your FSA has a run-out period. During a run-out period, you can submit a claim for expenses from the FSA plan year. Unused funds will be forfeited. Contact your employer for details.
Each FSA administrator is different, however, many offer an FSA debit card, a paper form for reimbursement or a member portal for electronic reimbursement requests.
Reimbursements can be requested when a qualified expense is incurred during the plan year and before the end of the FSA run-out period (or grace period if applicable).
FSA plans typically include a time past the plan year for reimbursement requests for expenses during the plan year (known as a run-out period) or expenses up to the end of the extension (known as a grace period). Contact your employer for details.
The deadline for using DCA funds is the last day of the plan year.
Elections for DCA are made during open enrollment and can’t be changed unless you experience a qualifying life event. Contact your employer for details.
Once we receive enrollment data from a state health insurance exchange marketplace, we process the information as quickly as possible and mail a payment letter to you as the customer. This payment letter serves as your receipt of enrollment. When everything works smoothly, this should only take about 10 days. However, sometimes processing the data can take time, especially if we need to go back and make sure any of the information is correct. There can also be issues with the initial application that keeps us from being able to process it, which will need to be corrected at your state’s health insurance exchange marketplace. If you’ve been waiting longer than a couple of weeks to receive your letter, you will want to check on the status of your application - either with us or with the health insurance exchange marketplace. Click on the Contact Us tab to speak with an Anthem representative.
You should receive your ID card within about 10 days of paying your first premium. If you need care and you haven’t gotten your ID card yet, ask your doctor to call us to confirm your benefits -and to make sure they’re in your health plan network.
Yes, if you have individal or family coverage. You can make your initial premium payment securely through our website.
Call us at the number on the back of your Anthem ID card. There is a grace period to help you avoid having your coverage canceled. If you pass the grace period, your policy is canceled from the date you stopped paying. Any claims you had during that time will be denied and you will be responsibile for full payment of the health care services you received. You can re-enroll during the next yearly open enrollment.
Log in and go to your profile. You can change your preferences for how we communicate with you.
Once you receive your payment letter, it will share directions for you to pay the first month’s premium. Payment of the first monthly premium is required to start the policy according to the details shared in your letter. You must take this step to activate your policy before your health insurance identification cards (ID cards) can be mailed.
If you’re the primary person on your policy, you can view your info as well as some of your dependents’. When dependents are over 18, we have certain privacy rules in place that may restrict your access. But you can always change that by having that dependent log into their own profile and change who can view their info.
When your prescriber gives you a prescription for a drug, take it to a pharmacy in your network. Show your member ID card so the pharmacist can access your benefits. If you have medications that you take regularly, you may be able to have them conveniently and securely shipped to a location of your choice.
By law you’re allowed to keep your group health benefits even when you’re eligible for Medicare. Some plans work well with Medicare benefits, or there may be reasons to keep your other coverage. Send us a quick message by logging in and going to your message center. Or you can call us at the number on your ID card.
Reminder: If your group benefits end and you’re eligible to enroll in Medicare Part B, do it within 80 days after your group health benefits end - or you could pay more.
Typically, if you are the subscriber continuing with the same employer, and you move outside of the area we serve, if your place of employment is not located within the service area, your coverage and your dependents' coverage terminates as of your moving date. Potentially, your coverage may be picked up by the local Blue Plan (visit bcbs.com for details). If you are a covered dependent and you move out of the service area, you may still be eligible for coverage. Check your contract or Certificate for more information.
Check with your employer, as well as your contract or Certificate for more information. There is a federal law known as COBRA which might apply. If COBRA applies to you, you have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium. You may also be eligible to convert to an individual policy of coverage offered by Anthem. This is typically known as a "conversion privilege".
Note: If a service was authorized by us before termination, but is not rendered until after your coverage ends, Anthem is not responsible for paying benefits for such services.
Check your contract or Certificate for more information. There are several possibilities:
- If you are eligible under a federal law known as COBRA, you may have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium.
- Your employer may offer retiree coverage.
- You may have the opportunity to convert to an individual policy offered by Anthem.
- You may have the opportunity to continue coverage under your group coverage.
If you are the employee through whom you and your dependents are receiving benefits, you will need to check your contract or Certificate and talk to your employer for more information. If a covered dependent becomes disabled, coverage for that dependent may continue while your coverage is in force until the dependent is Medicare eligible. Contact your employer or Customer Care for more information and for eligibility guidelines that apply.
Typically, if your spouse was covered under your health benefit plan, he/she would cease being eligible for coverage through your contract upon the divorce. However, because of a federal law known as COBRA which might apply, your former spouse may be able to retain independent coverage under your employer's coverage for some period of time, provided he or she pays the full amount of their premium. He or she might also be able to obtain coverage through his/her employer, through other affiliations, or purchase individual coverage. He or she may also be eligible to convert to an individual policy of coverage offered by Anthem.
If new coverage is obtained within certain time frames, waiting periods and medical underwriting might not apply. Contact your employer, your Certificate or Customer Care for more information and for any guidelines that apply.
Check your contract or Certificate. If you are covered through an HMO benefit design, pre-existing conditions will be covered. In other types of product designs, it will depend on what your contract says, and whether or not you were covered by another contract prior to being covered through your current contract. Contact Customer Care for more information and for guidelines that apply to you.
We'll notify you when you have a new doctor bill available to view on our website. You’ll log in to view your bills and the amount owed to your doctor. You can make a payment by accessing the Payments & Billing page and then selecting the Pay Doctor Bill tab.
The InstaMed service accepts credit or debit card payments as well as payments from a checking or savings account. Your doctor may accept all or some of these payment types. When you enter your payment information, you’ll be able to select from the payment types available for that doctor.
We chose InstaMed as our online payment service because keeping your information secure is a top priority.
InstaMed is certified as a Level One v3.2 Service Provider with the Payment Card Industry Data Security Standard (PCI DSS), as well as the Visa Cardholder Information Security Program (CISP) and Mastercard Site Data Protection (SDP) Program.
You can review InstaMed security and compliance for further details.
Yes, the InstaMed service offers a secure digital wallet that allows you to save payment information to use for future payments.
Payments made on our website using the InstaMed service will be sent to your doctor within one to two business days. Electronic payments will be received by your doctor as soon as the next day. If your financial institution mails your payments, they will be received within seven to 10 business days.
Note: For mailed payments, your doctor must accept and process the payment they receive. If this hasn’t occurred within six to eight weeks, InstaMed will cancel the payment and credit your account for a full refund. If a refund occurs, you should contact your doctor’s office to complete payment.
Once you log in to view your doctor bills and the amount owed to your doctor, you can see which bills have already been paid by selecting Show All Bills I Paid on the filter selection under Show my bills with an amount I owe.
InstaMed's service lets you pay your doctor bill directly, using our website. We partnered with InstaMed to bring you simple payment options through a safe and secure service.
In general, the following treatments and services must be pre-certified. This is not a comprehensive list and coverage and/or precertification requirements may vary depending on your plan.
- Advanced Imaging (CT, MRA/MRI, PET)
- Air/Water Ambulance (non-emergency)
- Bariatric/Gastric Surgeries
- Cardiology - Cardiovascular Services and Imaging
- Endoscopies
- Enteral/Parenteral Nutrition
- Genetic Testing
- Hearing and Speech Devices
- Home Health Care
- Hyperbaric Oxygen Therapy
- Hysterectomies
- Inpatient Admissions/Services
- Infertility Treatments
- Joint Surgeries/Procedures
- Medical Oncology Drugs
- Orthotics/Prosthetics
- Out of Network Referrals/Services
- Pain Management Procedures/Injections
- Physical/Occupational/Speech Therapy
- Potential Cosmetic/Reconstructive Procedures
- Private Duty/Skilled Nursing (home setting)
- Radiation Therapy
- Select Durable Medical Equipment (DME)
- Select Injectable Therapy
- Select Mental Health/Substance Abuse Services
- Select Surgical Procedures
- Sleep Studies/Therapy
- Spinal Surgeries/Procedures
- Transplants
You can also check to see what services might require a precertification by calling Member Services at the number listed on the back of your member identification card. To find out more about how to request precertification review you can contact Member Services at the number listed on the back of your member identification card.
Please check your plan for details about covered benefits, copayments, coinsurance, deductibles and exclusions or call member services for help with your questions.
Precertification is a required review of a service, treatment or admission for a benefit coverage determination which is done before the service or treatment begins or admission date. Certain services require precertification in order for you to get benefits. Precertification includes a review to decide whether the service, treatment or admission is considered medically necessary or is experimental/ investigational under the terms of your plan.
A Consumer-Driven Health Plan (CDHP) is a high-deductible plan that also includes a tax-free Health Savings Account (HSA) or Health Reimbursement Account (HRA). Depending on your plan, you may put tax-free money into your account, or your employer might put money in, for example, as a reward for steps you’ve taken toward better health. Then, you use that money for your share of care costs, such as your deductible or coinsurance.
It’s called “consumer-driven” because it puts you in the driver’s seat of your health and health care spending. With your check-ups and preventive care likely covered at 100 percent by your plan, as well as tools to help you stay healthy and the ability to shop around for quality care at more reasonable costs, you might be able to use your CDHP to cover most if not all your health care costs.
You’re eligible to have both only if the FSA has been defined as a Limited Purpose FSA, which may be limited to dental and/or vision services.
Your HSA is funded by your own pre-tax contributions, up to a certain annual limit. You may also contribute post-tax money to your HSA. Others (including your employer) may contribute to your account as well. The total of all contributions cannot exceed the maximums defined by the U.S. Department of the Treasury and the Internal Revenue Service.
The easiest way is through pre-tax payroll deductions, if allowed by your employer. However, you may also contribute directly to your HSA post-tax by following your bank’s defined contribution process.
Contribution maximums are defined by the U.S. Department of the Treasury and the Internal Revenue Service and may increase for inflation annually. Go to www.irs.gov for the most current maximum amounts.
An HSA is a bank account you can use to pay for health expenses. You or your employer can put tax-free money into your HSA, and you’ll use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money in your HSA, it carries over into the next year and beyond. You can also take funds with you if you change health plans. Visit qme.empireblue.com for more information.
Qualified medical expenses include medical, dental, vision and prescription expenses. Visit this website for more information:
qme.empireblue.com
Yes, FSA funds can be used for over-the-counter medicines without a prescription. Visit this website for more information:
qme.empireblue.com
