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.
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.
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.
A health savings account (HSA) is a bank account that can be used to pay for health expenses. You or your employer can put tax-free money into your HSA. 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, it stays in there next year and beyond. You can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.
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).
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).
Log in to find your claims. You’ll see a status for each claim, saying what stage of the claims process it’s in.
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).
To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. But you must elect to participate in the FSA during your employer's open enrollment.
For dependent care FSAs, you must also have children under the age of 13 (if divorced, you must be the custodial parent). Or if you have an adult you can claim as a dependent on your tax return, who’s physically or mentally unable to care for themselves.
For dependent care FSAs, you must also have children under the age of 13 (if divorced, you must be the custodial parent). Or if you have an adult you can claim as a dependent on your tax return, who’s physically or mentally unable to care for themselves.
Yes, you will need to elect to participate in the 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 that is physically or mentally unable to care for him/herself.
You must be the custodial parent, even if you don’t claim your child as a tax dependent, to use your Dependent Care FSA.
Typically anyone whose employer offers a Dependent Care FSA can participate. As a rule, your Dependent Care FSA can only cover expenses incurred during work hours. Ask your employer benefits team to verify eligibility.
Qualified medical expenses include medical, dental, vision and prescription expenses. Make sure to check IRS Publication 502 for the complete list of what is covered by your Health Care FSA.
The IRS does not allow Health Care FSA funds to be used for over-the-counter (OTC) medicines without a prescription. We encourage you to talk to your doctor and request a letter of medical necessity for any over-the-counter medicines or supplies that you frequently need to utilize. Also check IRS Publication 502 for a complete list, including OTC items, of what is covered by your Health Care FSA.
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
- Day care and elder care facilities
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.
Expenses not related directly to care of the dependent (i.e. tuition, food, etc.) are not 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 does not work, unless your spouse is a full-time student or disabled
The work-related expense test is the standard the IRS uses to determine if expenses are work related for a Dependent Care FSA. An expense is not 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 are for a qualifying person’s care
The IRS limits contributions to your Health Care FSA to $2,550 per year. If you are married, each spouse may contribute up to $2,550 to his or her own Health Care FSA, even if both have the same employer.
Your spouse can contribute $2,550 to his/her separate Health Care FSA.
The entire amount you’ve elected to put into your Health Care 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 in to this site. You’ll see info on your FSA — you can select health care claims you want to pay with those dollars. You can also pay expenses then submit a reimbursement form with a receipt.You must use your FSA dollars by the end of your plan year. Most plans will give you a grace period of a month or more to submit expenses that you incurred during your plan year. If you don’t use all of the money in your account, you forfeit it.
Unused funds typically don’t roll over. There may be a run-out period when you can continue to submit expenses from the plan year, or your employer may allow up to $500 to carry over to the next plan year. Any balance after that is forfeited to your employer. Some plans offer a grace period that lets you both continue to make purchases and submit reimbursement requests after the end of the plan year. After that, any unused balance for the previous year goes back to your employer.
The run-out period is the time limit for submitting receipts to your Health Care FSA for expenses incurred during the plan year.
All Health Care FSA carryover funds will be available no more than thirty days after the run-out period.
Does the carryover amount limit my future year Health Care Flexible Spending Account (FSA) election?
No.
No, your employer offers a Limited-Purpose FSA, which can be used with an HSA. Your Limited-Purpose FSA can be used for qualified dental or vision expenses only.
You can contribute $5000 per household into your Dependent Care FSA each plan year.
No, Dependent Care FSA contributions cannot total more than $5000 per plan year, per household.
Your Dependent Care FSA withholdings are reported on your W-2.
Once you log in to anthem.com, you have access to your complete FSA info. You can view balance and transactions, pay a claim or get reimbursed and more.
The reimbursement claim form is available through your online account.
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. If used for prescribed over-the-counter items, you must also include a letter of medical necessity detailing the condition being treated, medication type and dosage, and duration of the treatment. Letters of medical necessity must be renewed each year.
Substantiation means to provide a receipt that clearly shows eligible items or services were purchased with your FSA. Substantiation may be requested to document some FSA debit card transactions.
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 this date will not be approved.
You can only enroll and set how much you’re putting into it during your enrollment period at your company. However, if you have a change in your life such as getting married or divorced, a new child, moving residence, etc. - contact your company’s Human Resources. 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.Talk to your company’s Human Resources to see how your company’s FSA works, as soon as possible. You can also call us at the number on your Anthem ID card.
You can get your FSA reimbursement by check or direct deposit.
Reimbursements can be requested as often as 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). Consult your HR department for details.
The deadline for using Dependent Care FSA funds is the last date of the plan year.
Elections for Dependent Care FSAs are made during open enrollment and cannot be changed unless you experience a qualifying life event. For more information contact your HR department.
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.
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.
How is my HIA funded?
The health plan makes an annual allocation to your HIA. You also have the opportunity to earn extra money for your HIA by taking certain steps to improve your health. If you joined the plan after your company’s benefits became effective, your HIA allocation may be prorated. You will still need to meet the plan’s full deductible before your traditional health coverage begins. Check your Plan Summary for information about your annual HIA allocation.
The health plan makes an annual allocation to your HIA. You also have the opportunity to earn extra money for your HIA by taking certain steps to improve your health. If you joined the plan after your company’s benefits became effective, your HIA allocation may be prorated. You will still need to meet the plan’s full deductible before your traditional health coverage begins. Check your Plan Summary for information about your annual HIA allocation.
When can I use my HIA allocation?
Your HIA funds are available on your first day of coverage.
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 in to this website. You can keep track of your account 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.
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
Log in or register and choose your Profile tab. Click “Other Insurance."
Preauthorization, sometimes referred to as "pre-certification," is the process used to confirm if a proposed service or procedure is medically necessary. Whenever possible, preauthorization should occur before treatment is received. For additional questions on preauthorization, please call the Member/Customer Services number listed on the back of your ID card.
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.
Preauthorization, sometimes referred to as "pre-certification," is the process used to confirm if a proposed service or procedure is medically necessary. Whenever possible, preauthorization should occur before treatment is received. The physician who schedules an admission or orders the procedure or service is responsible for obtaining preauthorization. Providers should contact the Provider Authorization number on the back of the health plan ID card to confirm if preauthorization is required. You may also contact Customer Service at the number on the back of your health plan ID card to determine if a proposed test, equipment, service, or procedure requires preauthorization. It is important to know if your provider has obtained preauthorization, particularly when visiting an out-of-network provider who may or may not be familiar with Empire's policies and requirements.
What services or procedures require preauthorization?
Please refer to your certificate and Health Plan Description Form for details about covered benefits, copayments, coinsurance, deductibles and exclusions. Many of the services you may receive require preauthorization, even if the physician office visit itself does not require a referral. The physician who schedules an admission or orders the procedure or service is responsible for obtaining preauthorization. In-network providers will know how to contact Empire at the Provider Authorization number on the back of your health plan ID card for benefit coverage information and to obtain preauthorization for the care you may be scheduled to receive. Out-of-network providers may not always know Empire's specific preauthorization requirements. We recommend that you confirm with your out-of-network provider(s) that preauthorization (or "pre-certification"), if required, has been obtained. Typically, services requiring preauthorization include:
- Overnight stays at a facility, such as a hospital or rehabilitation facility, or continued stays past the number of days authorized.
- Emergency Admissions. HMO members must notify their health plan within one business day, if reasonably possible, after being admitted to a hospital.
- Surgical procedures, radiology tests, and occupational, speech and physical therapy visits.
- Behavioral health (mental health) care and alcohol/chemical dependency rehabilitation services. You or your physician must contact Empire Behavioral Health toll free at 800-424-4012 to obtain preauthorization or otherwise coordinate these services.
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
Creditable coverage is any amount of time you were covered under most types of health insurance policies, HMO plans or publicly-sponsored programs such as CHAMPUS, provided there is no more than a 63-day break in coverage from the time you left your old plan and enrolled in your new one. To prove creditable coverage you’ll need a certificate of coverage from your former employer or the group health plan that provided the previous coverage. You should also provide prior coverage information on your application when enrolling in a new health plan.
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!
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.
If you have a question about preapproval (also known as precertification, prior authorization or preauthorization) 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.
When your doctor 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 ongoing medicines you take, you may be able to get them sent right to your door.
You can log in and use our Find a Doctor tool to help you find a pharmacy. You can also see and manage your prescription benefits or start home delivery.
