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	Employee Benefit Program
Claims Administrator FAQs

	Important Questions and Answers About Your New Claims Administrator:

QUESTIONS	ANSWERS
Where do I call if I have benefit questions?	Call your third party administrator. This number is located on your new ID card.
What is my new group number?	The group number for your employer group is #####.
What is the name of our new Claims Administrator?	Your plan is administered by ABC Health Plans. You will find the name, address and telephone number on the back of your ID card. When you visit your physician next, please make sure they retain a copy of your new ID card and update their records with the recent PPO change.
Do I still need to call for precertification?	Yes. If you have outpatient surgery (not performed in the physician’s office) or an inpatient hospital stay, you or your medical provider will need to call to pre-certify. The number is on your ID card. If the service is scheduled, please call within 5 day prior to the surgery or inpatient hospitalization. Otherwise, if you have an emergency, you will need to call within 48 hours.
Do I need to file a claim? Where are the forms?	If you utilize a network provider or provider facility, the claim will be filed for you. If you receive treatment outside of the network, you may need to file the claim yourself.
Who do I call if I have a question regarding claims payment (either on old or new claims)?	ABC Health Plans is your claims administrator and can be reached at (123) 456-7890. Effective June 1, we will handle all of your claims needs.
What do I do in the event of an emergency?	The most important thing to do is get help. The plan will consider charges as “in-network” if services are for an emergency or life-threatening situation.
Am I covered when I travel out of the country?	You are covered while traveling on business or vacation, however, if you travel specifically to obtain services, there are no benefits available. In most countries, you will be required to pay services up front and then submit claims for consideration.
Who do I call to find out if my doctor or hospital is in the network?	There are several ways you can look for this information. 1) PPO Directory; 2) On-line access; or 3) toll free number.
What if my regular doctor isn’t on the provider list?	Benefits are available at the non-PPO level if you choose to stay with your physician. To obtain a higher level of reimbursement, please contact your PPO network to find a provider within your area and specialty.
How long are my dependent children covered under the plan?	Dependent children are covered under the plan to age 19. They can then be covered to age 25 if they are a full-time student or on a religious mission inside the US. ABC Health Plans will need verification of either of these situations either faxed or mailed to the office. The best way to verify student status is with a student transcript from the school they are attending. A letter from the religious organization will verify status too.
Has there been a change to my prescription service?	No, there are currently no changes to your benefit with Advance Paradigm.

QUICK REFERENCE

Company	Telephone	Contact	Contact For	Web & E-Mail Links
Provider #1	800-111-1111	Betty Smith	Customer Service	www.provider#1.com bsmith@provider#1.com
Provider #2	800-222-2222	Susan Stevens	Customer Service	www.provider#2.com sstevens@provider#2.com
Provider #3	800-333-3333	Carrie Conner	Customer Service	www.provider#3.com cconner@provider#3.com
Provider #4	800-444-4444	Sarah Davis	Customer Service	www.provider#4.com sdavis@provider#4.com
Provider #5	800-555-5555	Tom Johnson	Customer Service	www.provider#5.com tjohnson@provider#5.com

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