Health Benefits and Claims
Q: Are routine or well benefits paid by the Plan?
Q: How do I know if a medical service is considered “routine”?
Q: What is my deductible?
Q: Have I met my deductible yet this year?
Q: What is the difference between my deductible and my co-pay? Does my co-pay apply to my deductible?
Q: What is my out-of-pocket maximum?
Q: Can I see how much out-of-pocket I have remaining?
Q: How do I determine if an immediate family member over age 19 qualifies as a dependent?
Q: Why can’t I get information on my loved one’s benefits?
Q: Does my co-pay apply to all office visits?
Q: Where do I send my claims?
Q: What is my Group # and ID #? Do I need to use both when filing a claim?
Q: Does my dental plan cover orthodontia?
Q: How do I file a claim?
Q: How long do I have to file a claim?
Q: How do I find out what I owe for health care services?
Q: How do I find out what is covered under the plan?
Q: If hospitalized, do I need to call for pre-certification?
Business Partnerships
Q: What is the Lab Card?
Q: How do I use my Lab Card?
Q: What if the doctor or the office staff hasn’t heard of the Lab Card Program?
Q: Why should I use Lab Card?
Q: What tests are covered with Lab Card?
Q: Are there any tests not covered by Lab Card?
Q: Do I need to use Lab Card when my doctor orders laboratory tests?
Q: What if I use my Lab Card but still receive a bill for laboratory testing?
Q: What is VSP?
Q: Am I enrolled in VSP?
Q: What do I tell my doctor regarding VSP?
Q: I don’t have Christian Brothers vision coverage. Do I qualify for VSP?
Q: What is Medco?
Q: Where can I find my Medco ID card?
Prescription Drugs
Q: How do I find out if a prescription drug is preferred or non-preferred?
Q: Which prescription drugs require prior authorization?
Q: What do I need to know about refill limits?
Q: Can I fill a prescription at any pharmacy?
Q: How do I fill a prescription at a retail pharmacy?
Q: How do I fill a long-term prescription using Medco By Mail?
PPO Providers
Q: What is a PPO?
Q: How do I verify that my health care provider is a member of my PPO?
Q: If I have a PPO plan, do I need a referral to see a specialist?
Q: How do I find a dental PPO provider?
EOBs
Q: How do I access my online EOBs?
Q: I did not get an EOB for a recent health care visit. How can I get it?
Participant Web Page Access
Q: How do I login to the Participant Web site?
Q: How do I register for the Participant Web site?
Q: What is my username and where can I find it?
Q: Can I change my Password?
Q: Can my spouse register on the Participant Web site?
Q: How do I sign up for e-mail correspondence?
Q: I am having trouble logging in to the Web site. What should I do?
Member ID Cards
Q: What is my ID number? Where can I find it?
Q: Can I change my ID number?
Q: How can I get a replacement member ID card?
Q: Where can I find my prescription drug card?
Q: What number do I call if I need pre-certification for hospitalization?
Claims Review Process
Q: If a claim is partially or completely denied, what is the appeal process?
Q: When I call about a claim, why does the claims representative ask if I’ve been injured at work?
Health Benefits and Claims
Q: Are routine or well benefits paid by the Plan?
A: Routine benefits have always been paid by your Plan. In addition, the Plan provides an annual limited preventive benefit paid at 100% for PPO providers. After this limited benefit has been paid, routine services are still covered at normal Plan benefits. Please visit Your Employee Benefits booklet and refer to the Medical Summary of Benefits in the Medical section for more information. The routine benefits covered at 100% by your Plan are described under the heading Preventive Care Benefit - PPO Providers Only.
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Q: How do I know if a medical service is considered “routine”?
A: Routine services are described as annual visits to your physician’s office for routine check-ups, well-child visits, immunizations, routine annual gynecological exams and some lab work.
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Q: What is my deductible?
A: Your deductible is listed in the Your Employee Benefits booklet. Refer to the Medical Summary of Benefits in the Medical section of your booklet, under the heading Deductible Requirement Amount.
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Q: Have I met my deductible yet this year?
A: Please refer to your most recent Explanation of Benefits (EOB). Your EOBs are now available online. The box on your EOB labeled Remaining Deductible shows the amount of any deductible remaining for the calendar year.
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Q: What is the difference between my deductible and my co-pay? Does my co-pay apply to my deductible?
A: Your deductible is the amount you are responsible for before the Plan begins to pay benefits for eligible charges. The deductible will apply to all charges except those where you have a co-pay.
Your co-pay is the amount you are required to pay a provider at the time of service. This co-pay does not apply to your deductible or your out-of-pocket limit.
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Q: What is my out-of-pocket maximum?
A: Your out-of-pocket maximum is described in the Your Employee Benefits booklet. Please see the Medical Summary of Benefits at the front of the booklet, and look for the heading Out-of-Pocket Expense Maximum per Calendar Year.
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Q: Can I see how much out-of-pocket I have remaining?
A: Please refer to your most recent Explanation of Benefits. The box labeled Remaining Out-of-Pocket Expense will provide you with the amount of any out-of-pocket amounts remaining for the calendar year.
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Q: How do I determine if an immediate family member over age 19 qualifies as a dependent?
A: Eligibility for dependent coverage is described in the medical portion of the Your Employee Benefits handbook, under the heading Eligible Dependents. The family member must be your natural child or under your legal guardianship, as well as be unmarried and a full-time student at an accredited school. Additionally, this family member must not be serving in the Armed Forces and must not be eligible as an employee under the Plan. Your family member may qualify as a dependent if s/he is incapable of self-sustaining employment due to a physical disability or handicap and is chiefly dependent upon you for support.
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Q: Why can’t I get information on my loved one’s benefits?
A: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) dictates that health plans like the CBEBT cannot legally share an adult member’s protected health information (PHI) with any outside party, unless we have written permission to do so. If your loved one would like you to have access to his or her PHI, please click here to obtain a printable authorization form, which can be sent to us by mail or fax.
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Q: Does my co-pay apply to all office visits?
A: The co-pay applies to each physician office visit. The co-pay does not apply to special providers such as chiropractors, optometrists, mental health providers, etc.
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Q: Where do I send my claims?
A: Most health care providers will file medical claims on your behalf. You must ask your provider if you are unsure this service is provided. If you need to file a claim yourself, refer to the claims information on the back of your identification card:
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Q: What is my Group # and ID #? Do I need to use both when filing a claim?
A: Both numbers are needed for claims to be properly submitted for payment. Your group/account # begins with N35222 and your ID # begins with a 9, which then may be preceded by letters.
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Q: Does my dental plan cover orthodontia?
A: Orthodontia is not part of a standard dental plan. If your employer has elected to add coverage for orthodontia, you will find a full description in the Summary of Benefits located in the dental portion of the Your Employee Benefits booklet
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Q: How do I file a claim?
A: Depending on your specific medical plan, there are two ways to file a claim:
- Through your health care provider: Providers can forward claims to us electronically or through the mail with standardized medical claim forms. Check with your provider to see if s/he files claims automatically on your behalf. Have paper claims sent to the address on your ID card.
- By mail: If you have paid for your medical charges at the time of service, but your health care provider will not submit the billing and you are eligible for reimbursement, you must first obtain an itemized statement of services from your provider. Make copies for yourself and mail the originals to us at the address on your ID card. You do not need to complete a claim form to submit your charges. Please make sure your privacy identification number (PIN), provider’s tax ID number, date of service, CPT codes and diagnosis codes appear on the statement from your provider.
The average turnaround time for claims is seven to 10 business days from the date of receipt to the issue date unless added information is needed.
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Q: How long do I have to file a claim?
A: Claims should always be filed as quickly as possible but must be filed within 12 months of the date of service.
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Q: How do I find out what I owe for health care services?
A: After you have received a service, you will receive an Explanation of Benefits (EOB) from us. This EOB is not a bill. If applicable, you will receive a bill from your provider for the balance due at a later date. The EOB will reflect total charges for the services provided and the benefits paid by your plan. If the provider for the service is a PPO member, the EOB will show in the remarks box what, if any, financial charges you will be responsible for. If you wish to confirm the amount due to your provider, please contact our customer service department toll-free at 800-807-0400.
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Q: How do I find out what is covered under the plan?
A: Please refer to the Your Employee Benefitsbooklet, which details what is covered under your plan. If there is a particular service you are wondering about and cannot find it in your booklet, our customer service department will be able to assist you. Contact a representative toll-free at 800-807-0400. If you do not have a copy of Your Employee Benefits, please see your employer.
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Q: If hospitalized, do I need to call for pre-certification?
A: If you are scheduling a hospitalization, you must call for pre-certification. Please call the toll-free number on the back of your medical ID card. In an emergency situation, you or a family member must call within two working days of admission. If you do not call for pre-certification or if you fail to call after an emergency admittance, your benefits will be reduced by 25% to a maximum of $2,000 per year.
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Business Partnerships
Q: What is the Lab Card?
A: The Christian Brothers Employee Benefit Trust entered into an agreement with LabOne, also known as Quest Diagnostics, to bring you the Lab Card Program. This program provides Trust members physician-ordered covered lab work free of charge. The Lab Card facility is a fully accredited and certified laboratory, licensed by the U.S. Department of Health and Human Services. Your CBEBT identification card with the Lab Card logo approves you for free lab services. Click here to be directed to the LabOne/Quest Diagnostics Web site.
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Q: How do I use my Lab Card?
A: When your doctor orders lab tests, show your CBEBT ID card with the Lab Card logo to the office manager and the person collecting your specimens.
LabOne/Quest Diagnostics will pick the specimens up at your doctor’s office, test them at their laboratories and send the results to your doctor, usually within 24 hours.
If your doctor’s office does not collect lab specimens, call LabOne/Quest Diagnostics toll-free at 1-800-646-7788 from your physician’s office to locate a collection site near you. At the collection center, show the office staff and medical professionals your doctor’s test order, along with your CBEBT ID card with the Lab Card logo, and ask that the Lab Card be used
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Q: What if the doctor or the office staff hasn’t heard of the Lab Card Program?
A: Ask them to call LabOne at 1-800-646-7788 to speak with a client service representative who will explain the Lab Card Program and the quality of the lab. The LabOne representative will immediately fax the materials needed to use the Lab Card Program. You can also call LabOne before your visit to the doctor’s office and ask that they contact your physician ahead of time.
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Q: Why should I use Lab Card?
A: Christian Brothers Employee Benefit Trust will pay for lab tests covered by the Plan. That means when you show your Lab Card before your specimens are collected, any lab tests eligible under the Plan are covered at 100%. With Lab Card, any covered lab tests are not subject to deductibles, coinsurance or co-payments.
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Q: What tests are covered with Lab Card?
A: Lab Card covers most outpatient laboratory testing included in your health insurance plan, provided the tests have been ordered by a physician and processed at LabOne.
Outpatient lab work includes:
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Blood testing
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Urine testing
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Cytology and pathology
- Cultures
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Q: Are there any tests not covered by Lab Card?
A: Lab Card does not cover lab work ordered during hospitalization, on an emergency (STAT) basis and time-sensitive, esoteric outpatient laboratory testing, such as fertility testing, bone marrow studies and spinal fluid tests. It also does not cover non-laboratory work, such as mammography, x-ray, imaging, dental work and lab work performed by another lab.
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Q: Do I need to use Lab Card when my doctor orders laboratory tests?
A: Use of your Lab Card benefit is voluntary. If you decide not to use Lab Card, your laboratory tests are subject to your regular co-pay or deductible and coinsurance. Please keep in mind that the Christian Brothers Employee Benefit Trust has partnered with LabOne to bring you this benefit as a way to save money for both you and the Trust.
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Q: What if I use my Lab Card but still receive a bill for laboratory testing?
A: If you show your CBEBT member ID card with the Lab Card logo before laboratory tests are performed, you should not be billed. Verify from your EOB we sent you, that Lab Card or Quest Diagnostics was paid and all lab tests were covered by the Plan. If they were, you should have no liability. If you are receiving a bill from a lab other than LabOne, you may wish to check with your physician and ask if he or she sent your specimens to LabOne. Also, certain tests are not covered by the Lab Card Program. Check the list of tests covered by Lab Card to make sure your test is among them. If you are still not sure why you’ve been billed for lab tests or think you have been billed by mistake, please contact a CBEBT customer service at 1-800-807-0400.
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Q: What is VSP?
A: VSP (Vision Service Plan) is a vision discount program provided to most Plan participants who are enrolled for medical coverage. The program allows eligible members to receive a discount when visiting a VSP network doctor. With or without the Plan’s vision coverage, this discount program will reduce your ultimate out of pocket costs.
Discounts include:
For more information on VSP, visit the VSP Web site at www.vsp.com or call 1-800-877-7195.
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Q: Am I enrolled in VSP?
A: Some Trust employers currently have their own separate agreements with VSP. If your employer has such an agreement, you are not covered by the Trust VSP Eyecare Discount Program. All other participants of the Trust who are enrolled for medical coverage are also automatically enrolled in the VSP Eyecare Discount Plan.
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Q: What do I tell my doctor regarding VSP?
A: When you visit your doctor, let him or her know that you are a VSP member. If your doctor is a VSP network provider, they will contact VSP to verify your eligibility for the Eyecare Discount Plan. If you would like to locate a VSP eyecare professional in your area, visit the VSP Web site at www.vsp.com or call 1-800-877-7195.
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Q: I don’t have Christian Brothers vision coverage. Do I qualify for VSP?
A: The VSP program is a discount plan -- it is not vision coverage. VSP discounts apply to members who are enrolled for medical coverage and do not have a separate vision plan with their employer.
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Q: What is Medco?
A: Medco is the pharmacy benefits manager for the Trust and the leading pharmacy benefit manager in the United States. Our partnership with Medco allows us to offer our members prescription drug discounts that rival those of very large employers. Through Medco, we are able to bring you a prescription drug program you can count on for the lowest prices available. Click here to learn more about Medco.
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Q: Where can I find my Medco ID card?
A: There is no separate Medco ID card. Your CBEBT member ID card identifies you as a member of Medco.
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Prescription Drugs
Q: How do I find out if a prescription drug is preferred or non-preferred?
A: When you enroll as a CBEBT member, you will be provided with a Preferred Prescriptions® Member Guide created by Medco, our prescription drug benefits manager. This guide contains a list of drugs preferred by your benefits program, a list of non-preferred drugs and possible preferred alternatives for you to discuss with your doctor. If you did not receive this guide or need a replacement, please click here.
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Q: Which prescription drugs require prior authorization?
A: Drugs requiring prior authorization include contraceptives prescribed to treat medical illnesses, amphetamines and central nervous system stimulants, anabolic steroids and androgens, hormone altering medications, acne medications, specialty drugs and growth hormones. If you do not seek prior authorization before filling prescriptions for these medications, the pharmacist will advise you that prior authorization is required.
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Q: What do I need to know about refill limits?
A: Under all of our prescription drug plans, a 30-day supply of medication may be filled at a retail pharmacy. However, if you use a drug on a long-term basis (more than 90 days), you may have the drug filled through Medco By Mail, Medco’s home delivery pharmacy. Learn more about Medco by Mail by clicking here, and then click on Medco Mail Order.
To encourage use of Medco By Mail, your prescription drug plan may only allow a purchase of the same medication at a retail pharmacy three times without increasing your co-pay. Check the prescription drug section of the Your Employee Benefits booklet for details about your specific Plan.
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Q: Can I fill a prescription at any pharmacy?
A: Your prescription drug benefits manager, Medco, networks with 99% of retail pharmacies. To find a participating pharmacy near you, click here. Then click on Locate a Pharmacy. Refill limits may apply when you fill prescriptions at a retail pharmacy. For long-term prescriptions, consider using Medco’s mail order pharmacy, Medco By Mail, rather than a retail pharmacy.
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Q: How do I fill a prescription at a retail pharmacy?
A: When you fill a prescription at a retail pharmacy for the first time, present your CBEBT identification card with the Medco logo.
Each time you have a prescription filled at a retail pharmacy, you will be required to pay the applicable retail co-pay for either generic, brand-name preferred or brand-name non-preferred drugs.
If you do not have your CBEBT ID card with you, tell the pharmacist that you are a Trust member and give him or her your privacy identification number (PIN). This information should help the pharmacist verify your coverage through Medco. If the pharmacist cannot verify your coverage and you need to fill your prescription right away, pay for the prescription and submit a claim for reimbursement through Medco. If you cannot pay for the prescription but need it immediately, contact Medco for assistance at 1-800-718-6601, or contact our customer service department at 1-800-807-0400. If necessary, an exception might be made at that time.
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Q: How do I fill a long-term prescription using Medco By Mail?
A: If you would like to use Medco By Mail for a long-term prescription, you and your health care professional must send a new, original prescription along with the Medco By Mail order form you received with your Medco orientation materials. Make sure to provide all the information requested on the form, including your privacy identification number (PIN), group ID number, name, address and telephone number. Additional order forms are available by clicking here.
If the medication you are requesting is available at the Medco facility, your prescription will be filled within five business days of the receipt of your prescription. If Medco has run out of stock for your medication, a Medco representative will notify you of any available alternatives. Standard shipping for Medco By Mail is free.
You can also choose to sign up for Medco By Mail online. To register, click here and follow the instructions under Medco Mail Order. Medco will contact your health care provider to transfer your existing prescriptions to Medco By Mail.
If you have further questions about filling prescriptions through Medco, you may contact Medco member services at 1-800-718-6601, or call our customer service department at 1-800-807-0400.
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PPO Providers
Q: What is a PPO?
A: PPO stands for Preferred Provider Organization. A PPO is a network of health care providers who agree to supply discounted services for the benefits providers with whom they contract. Patients who choose providers within the PPO network receive discounts on health care services, while patients who use out-of-network providers do not receive the discounts.
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Q: How do I verify that my health care provider is a member of my PPO?
A: The name of your PPO and the provider verification telephone number are listed at the front of the Medical section of the Your Employee Benefits booklet. Please call this number to confirm that your health care provider is part of your PPO network.
You will find the most up-to-date PPO information by clicking here. You should verify PPO status with your health care provider prior to your visit, in case the status has changed.
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Q: If I have a PPO plan, do I need a referral to see a specialist?
A: PPO plans do not require a referral to see a specialist. If you need assistance in finding a specialist in your PPO network, please click here.
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Q: How do I find a dental PPO provider?
A: Call 1-800-832-4450 or click here to visit our Participants Page. Under the Participants header, click on Find PPO Providers.
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EOBs
Q: How do I access my online EOBs?
A: Follow the steps below to access your EOBs:
1. Click here to visit our participant site.
2. Under Participants on the menu to the left, click Online EOBs. You will then be transferred to the personal login Web site for Principal Financial, the company that maintains EOBs for CBEBT members.
3. Log in to the Principal Web site using your username and password. If you have never visited the Principal site before, click the link that says Establish your new username and password.
4. Follow the directions to set up your username and password.
5. Access your online EOBs.
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Q: I did not get an EOB for a recent health care visit. How can I get it?
A: Your EOBs are available online and can be reprinted at will. Please follow the instructions here to retrieve your EOB.
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Participant Web Page Access
Q: How do I login to the Participant Web site?
A: In order to login and access all the functions of the Participant section, you must register as a CBEBT member. Go to the Participant section of our Web site. Then select the Register button found beneath the username and password fields.
Once you have registered, you can login to the Participant Web site at any time by visiting the Participant section, entering your username and password, and then selecting Login. If you are having problems with logging into our system, please visit Participation Login Assistance or click here.
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Q: How do I register for the Participant Web site?
A: Follow the steps below to register for the Participant Web site
1. Click here or visit the Participant section of our Web site.
2. Select the Register button found beneath the username and password fields, which will take you to the registration screen.
3. On that screen you will be asked to validate your eligibility as a member of the Christian Brothers Employee Benefit Trust by entering your ID#, which is found on the front of your CBEBT ID card, along with your date of birth.
4. Once you have entered your ID# and your date of birth, click the submit button. You will then be transferred to a second screen where you can enter the username and password of your choice. You will use this username and password to login to our Participant Web site.
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Q: What is my username and where can I find it?
A: You select your username when you register for the Participant section of our Web site. If you do not remember your username, you can request it from us via e-mail. Please visit our Participant Login Assistance section for more information.
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Q: Can I change my Password?
A: Once you have logged into the Participant Web site, you can change your password, e-mail address and subscription information by selecting Update Your Registration, then selecting the Edit button.
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Q: Can my spouse register on the Participant Web site?
A: Your spouse cannot register on the Participant Web site, but many items on the Participant page do not require registration and login to access. Click here to visit the Participant Web site.
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Q: How do I sign up for e-mail correspondence?
A: Once you have logged into the Participant Web site, you can change or update your password, e-mail address and subscription information by selecting Update Your Registration, then selecting the Edit button.
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Q: I am having trouble logging in to the Web site. What should I do?
A: Please visit our Participant Login Assistance section, which contains information about specific problems you might have using the Participant Web site.
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Member ID Cards
Q: What is my ID number? Where can I find it?
A: Your ID number, also referred to as a privacy identification number or PIN, is located on your member identification card. Look for the ID# label on your card, and your PIN is the nine digit number that follows.
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Q: Can I change my ID number?
A: You privacy identification number is assigned to you at the time you enroll for coverage in the CBEBT. This number will remain the same as long as you maintain coverage under the Plan.
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Q: How can I get a replacement member ID card?
A: If your member ID card is lost, please contact your employer who can request a replacement ID card by calling 1-800-807-9460.
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Q: Where can I find my prescription drug card?
A: There is no separate prescription drug card. Just present your CBEBT member ID card when filling prescriptions. This will identify our pharmacy benefits manager, Medco.
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Q: What number do I call if I need pre-certification for hospitalization?
A: Call the pre-certification telephone number on the back of your Member ID Card two days prior to a hospital admission.
If you are admitted to the hospital on an emergency basis, you or a family member must call within two working days of the admission.
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Claims Review Process
Q: If a claim is partially or completely denied, what is the appeal process?
A: We recommend you first contact customer service if you have any questions about the denial. If you feel the denial is incorrect, you have 60 days from the date of the denial to provide additional information to the Claims Supervisor.
If the denial is still maintained, you will promptly receive a letter of explanation. If you still feel the decision is incorrect, you have the right to ask the Plan Committee to re-review the decision. All requests to the Plan Committee need to be made in writing within 60 days of the original notification. Your letter should contain the reasons you feel the decision was incorrect.
If still not satisfied with the final decision, you can appeal the Committee’s decision to the Trustees within 60 days of the final decision. Please put your appeal request in writing and include reasons why you feel the Committee’s decision should be reversed or an exception made. Please address your letter to the Appeals Committee of the Board of Trustees. The Board of Trustees will furnish you with a prompt written notice of its final decision regarding the appeal.
Please direct your letters to:
Plan Committee/Appeals Committee
Christian Brothers Employee Benefit Trust
1205 Windham Parkway
Romeoville, IL. 60446-1679
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Q: When I call about a claim, why does the claims representative ask if I’ve been injured at work?
A: When certain types of services or diagnoses appear on a claim, our automated system flags that claim, indicating a type of service or diagnosis that might be related to a work injury. If the services are the result of an injury at work, these charges are not eligible under your CBEBT Plan and must be sent to your workers compensation carrier. If the workers compensation carrier denies these charges, only then may they be sent to our office with a copy of the denial for possible coverage.
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