ASEA AFSCME Local 52 Health Benefits Trust is in Alaska

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These Frequently Asked Questions (FAQ’s) are provided for your convenience, however, we encourage you to consult your Plan Booklet for more information about this Plan. In the event of a conflict between the information provide in the FAQ’s and information in the Plan Booklet, the Plan Booklet will be the governing document.

 

HOW TO USE THIS WEBSITE

 

FOR YOUR INFORMATION

 

HOW TO ENROLL: Regular Employees

 

HOW TO ENROLL: Seasonal Employees

 

HOW TO USE YOUR BENEFITS: Benefits Basics

 

HOW TO USE YOUR BENEFITS: The Plan’s PPOs (Preferred Provider Organizations)

 

HOW TO USE YOUR BENEFITS: Prescription Drugs

 

HOW TO USE YOUR BENEFITS: Travel Benefits

 

HOW TO USE YOUR BENEFITS: Precertification

 

HOW TO USE YOUR BENEFITS: Multiple Surgery Rule

 

HOW TO MANAGE YOUR BENEFITS: Payment and Claims

 

HOW TO MANAGE YOUR BENEFITS: Coordination of Benefits (COB)

 

HOW TO MANAGE YOUR BENEFITS: Appeals

 

ADDITIONAL BENEFITS: Disease Management

 

ADDITIONAL BENEFITS: Chronic Kidney Disease Management (CKD)

 

ADDITIONAL BENEFITS: Employee Assistance Program

 

ADDITIONAL BENEFITS: Health Care Reimbursement Account (HCRA)

 

ADDITIONAL BENEFITS: Telemedicine For Non-Urgent Medical Care (effective 7/1/2017)

 

ADDITIONAL BENEFITS: Elective or Non-Urgent Surgical Care Outside Of Alaska (effective 7/1/2017)

 

ANSWERS

HOW TO USE THIS WEBSITE

I lost my password to enter the secure section of the site. What do I do?

If you have already registered but lost or forgotten your password, click “Need help logging in?” to reset your password.

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Where do I find forms?

Click here for Forms.

  • If you have registered, you can submit forms online by clicking on the blue arrow. The form will automatically fill with your personal information (your name, Health Plan ID, etc.). Your personal information is protected because you must login to use this feature.
  • If you have not registered, you can submit forms via fax or mail by clicking on the PDF symbol to display the form. Save it as a document on your computer, then type in the required information. Save and print the completed form then fax or mail it to the ASEA Health Trust Administrator. The fax number and mailing address can be found on the top of the forms.

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How do I update my mailing address or other contact information?

Complete the Employee Information Form to update your contact information.

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FOR YOUR INFORMATION

As a state employee, why am I required to have a health plan?

State statute requires permanent full-time or permanent full-time seasonal employees and their spouses and eligible dependent children to have health coverage. In addition, for those groups who are in a union, contracts with the unions require health insurance. A large portion of the cost of your health premium, called the Employer Contribution, is paid on your behalf monthly by the State of Alaska as your employer. The Employer Contribution as well as the health plan coverage itself is a significant part of your monthly benefit package as a State of Alaska employee.

Permanent part-time or permanent part-time seasonal employees are not required to select a health plan – if they do select one, the state contributes one-half the benefit credit it provides to full-time employees.

Even if you don’t use your health plan today or haven’t used it very much in the past, one of the reasons to have the coverage is in case you experience an unexpected health need that could otherwise be financially devastating.

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HOW TO ENROLL: Regular Employees

I am a new employee; how do I enroll in benefits?

Enroll within 30 days of your hire date. Contact the ASEA Health Trust Administrator if you do not receive a new hire packet with enrollment information or if you have any questions.

  • Full time employees: If you do not enroll, you will be automatically enrolled in Plan A, the ASEA Health Trust’s most expensive option.
  • Part-time employees: If you do not enroll, you will not be enrolled in the ASEA Health Trust Plan.

For more information visit New and Seasonal Employees>New Employees.

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When will my coverage be effective?

When you enroll during the first 30 days of employment, you and your eligible dependents will be covered on the first day of the month following 30 consecutive days in paid status.

For more information New and Seasonal Employees.

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What is Open Enrollment?

This is your only opportunity each year to change your choice of benefit options for the next Plan Year (July 1-June 30), unless you have a qualifying event during the year. Open Enrollment usually takes place in the spring (mid-May through early June).

If you are enrolling a spouse in Plan A, you must complete an Open Enrollment form and confirm if your spouse is employed. If your spouse is employed, you will need to confirm his or her eligibility for employer-sponsored coverage.

Your current plan election will rollover to the next Plan Year if you do nothing during Open Enrollment. However, it is important to note:

  • Health Care Reimbursement Account (HCRA) elections do not rollover. You must enroll in HCRA during Open Enrollment each Plan Year.
  • If you are enrolled in Plan A and have enrolled your spouse, you MUST COMPLETE an open enrollment form and confirm if your spouse is employed and eligible to enroll in employer-sponsored coverage through their employer.
  • ALL participants MUST complete a Family Information Form at the beginning of each Plan year. Claims cannot be paid until this form is completed and submitted.

For more information visit New and Seasonal Employees.

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Can I make benefit changes any time during the year?

Normally, changes cannot be made outside of Open Enrollment. However, if your family has a qualifying event at any other time of the year, you may change your benefits by contacting the ASEA Health Trust Administrator and making a new election within 60 days of the qualifying event. Qualifying events include marriage, birth or adoption of a child, divorce or legal separation, and more. All election changes must be consistent with the qualifying event.

Please click here for Your Life Changes to help you take care of all your benefit details when you have a significant change. This helps you be sure your family is covered, your health care claims are paid on time, and you continue to receive important information without delay.

For more information, see the Qualifying Events section of the Benefits Plan Booklet.

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Can I change my enrollment choices after Open Enrollment?

You may submit an enrollment appeal to change your Plan election if there is a valid reason for doing so. The Trust will consider all change requests; however, Section 125 of the IRS tax code and interpretive IRS regulations limit the circumstances in which the Trust can allow a change.

For more information see the  Policy on Enrollment Election Appeals on this site for complete details on how to submit your appeal.

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HOW TO ENROLL: Seasonal Employees

I am a returning Seasonal Employee; when am I eligible for coverage?

If you were covered by the Trust prior to going on leave without pay or layoff, you are covered starting the first day you return to work, provided both you and your employer makes the required contribution for your coverage. Your dependents are eligible at the same time.

Returning seasonal employees may elect to defer the effective date for one or two months. To defer coverage, you must file a form with the ASEA Health Trust Administrator, postmarked within 30 days after you return to work.

For more information, see the When Coverage Begins section of the Benefits Plan Booklet.

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I am a returning Seasonal Employee; will my medical coverage be the same as when I left?

Yes, if your break in coverage was less than 12 months.

For more information, see the When Coverage Begins section of the Benefits Plan Booklet.

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I am a new Seasonal Employee; when am I eligible for coverage?

Your health coverage will become effective on the first day of the month following 30 consecutive days in paid status, as long as your health benefit contributions are reported to the Trust by your employer on your behalf.

Your dependents are also eligible at the same time. Once you are eligible, you will remain covered through the last day of the month in which you were last in paid status, or the last day of the month in which you began seasonal overtime conversion.

Seasonal employees may elect to defer the effective date of coverage for one or two months.

For more information, see the When Coverage Begins section of the Benefits Plan Booklet.

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What does it mean to defer my coverage?

It means your benefit coverage will be delayed by one or two months and will extend one or two months past the date it would otherwise end.

Seasonal employees may defer coverage by submitting a Deferral of Health Insurance Coverage Form with the Trust within 30 days after you begin work. Deferrals apply only to that particular period of work. You cannot cancel a deferral.

To defer coverage for subsequent periods of employment, you must file a new deferral form each time you return to work as a seasonal employee.

Here is an example of an employee who chooses to defer coverage:

  • 7/16: Employee begins employment
  • 9/1: Eligibility begins (the first day of the month following 30 consecutive days in paid status), but coverage is deferred one month
  • 10/1: Deferred coverage begins
  • 11/16: In this example, seasonal leave without pay (SLWOP) begins
  • 11/30: Coverage would normally end on the last day of the month SLWOP begins
  • 12/31: Deferred continues through the last day of the following month

For more information, see the When Coverage Begins section of the Benefits Plan Booklet.

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I am a Seasonal Employee and my term of employment is done. Can I continue my medical coverage through the Trust?

Yes, you have several options to continue your health care coverage, which ends when you are on seasonal leave without pay (SLWOP). The Health Trust strongly encourages you to make arrangements so that you and your family are not left without health care coverage:

  • COBRA (Consolidated Omnibus Budget Reconciliation Act) allows you to continue receiving coverage that is identical to the coverage provided to active employees. Your monthly premium will vary, depending on the type of plan you continue. COBRA enrollment materials with cost information will be mailed to you when your coverage ends.
  • The Low Option Seasonal Plan allows you to continue your coverage that covers only you, not your dependents, for medical coverage only. You will also receive information on this option by mail.
  • There may be other coverage options for you and your family. For more information about health insurance options available through a Health Insurance Marketplace, visit www.healthcare.gov.
  • Private insurance may also be available through carriers, such as Premera Blue Cross and UnitedHealthOne. These plans provide different types of coverage than you have under the ASEA Health Trust Plan, but they could also be a less expensive option.

For more information, see the Continuation Coverage section of the Benefits Plan Booklet.

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HOW TO USE YOUR BENEFITS: Benefits Basics

What benefits does the ASEA Health Trust provide?

The ASEA Health Trust provides the following benefits covered participants including employees and their covered dependents:

  • Medical – covers office visits, immunizations and preventive care, hospitalization and other expenses
  • Dental – covers preventive, restorative, prosthetics, and other expenses
  • Vision - covers eligible expenses for eye exams, lenses, frames and contacts; our vision network is through VSP
  • Telemedicine for Non-Urgent Medical Care – seek treatment with a healthcare provider by phone, online video or mobile app at no cost to you through Teladoc
  • Prescription drug coverage – covers prescription drugs from either a participating retail pharmacy or from a mail-order provider; our pharmacy network is with CVS/caremark
  • Health Care Reimbursement Account (HCRA) – allows you to pay for eligible out-of-pocket health care expenses with tax-free dollars, reducing your taxable income and therefore lowering the amount you must pay in taxes each year
  • Disease Management - available to all participants of the ASEA Health Trust (members, spouses and dependents) who have one of the targeted chronic conditions:
    • Asthma
    • Diabetes
    • A history of heart failure
    • Coronary artery disease
    • Chronic obstructive pulmonary disease (COPD)
    • Musculoskeletal pain including - back pain (neck, upper and lower back), fibromyalgia, headaches (migraine or tension), osteoarthritis, regional musculoskeletal disorders (RMD), rheumatoid arthritis

      Family members (i.e., a parent or spouse) who care for a child age two and older with asthma or diabetes may also participate.
  • Chronic Kidney Disease Management – voluntary, completely confidential program available to all participants (employees, spouses, dependents) – at no cost - who are at risk of develping or who have Chronic Kidney Disease (CKD) or End-Stage Renal Disease (ESRD)
  • Elective or Non-Urgent Surgery Options Outside of Alaska (effective 7/1/2017) – surgery by top-rated surgeons – at no cost to you - in premier facilities across the United States including first-class airfare, lodging and food for you and a care companion
  • Employee Assistance Program (EAP) – confidential counseling service provides you and your covered dependents up to six free counseling sessions per issue or problem, per year.

Please visit Your Benefits page to obtain additional information on all the benefits provided by the Trust

 

All benefits are subject to the Plan provisions, limitations and exclusions.

Your coverage depends on the options you choose. For example, not all of the health plan options offer dental and vision coverage. Also, in order to take advantage of the HCRA, you must enroll each year.

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How does the HRA work under Plan D?

Plan D / Low Option Plan for Employees and Families, offers medical, audio and prescription drug coverage after you satisfy a high deductible. It also provides a $1,000 (per employee) Health Reimbursement Arrangement (HRA). You can be reimbursed from your HRA for eligible expenses, such as prescription medications or a portion of your deductible. No dental or vision benefits are provided in Plan D, but you can use the HRA to pay for dental and vision expenses. If there are unused funds in your HRA at the end of the Plan Year, these funds will be rolled over to the following Plan Year. If you select a different Plan or are no longer eligible for Health Trust benefits, you must forfeit any remaining funds in your HRA.

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Does the Plan cover preventive care?

Yes, the Plan covers preventive care that meets standard guidelines as recommended by the Affordable Care Act. For example, this includes many cancer screening tests, physical exams and associated screenings, labs and X-rays, immunizations and well-baby and well-child exams.

For physical exams and preventive services recommended under the Affordable Care Act, the Plan pays 100% for Plans A, B, C and D of the allowed amount with no deductible required. For all other preventive care services, the Plan pays 80% of the allowed amount with no deductible required for Plans A, B, and D; for Plan C, the Plan pays 20%.

Preventive care services are subject to the PPO provisions of the Plan.

For more information, see the Preventive Care section of the Plan Booklet.

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Does the Plan cover chiropractic, massage therapy and acupuncture?

Yes, the Plan covers up to 20 visits per Plan Year for chiropractic, massage therapy and acupuncture services combined.

For more information, see the Chiropractic, Massage Therapy, and Acupuncture Services section of the Plan Booklet.

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What benefits does the State of Alaska offer?

The State of Alaska provides the following benefits for General Government Unit (GGU) employees (ASEA union members). These are provided directly from Alaska State’s Division of Retirement and Benefits.

  • Basic Life Insurance
  • Accidental Death & Dismemberment (AD&D)
  • Travel Accident Insurance
  • Short-Term Disability
  • Long-Term Disability
  • Survivor Benefits
  • Dependent Care Assistance Plan

Details about supplemental benefits are available at http://doa.alaska.gov/drb/ghlb/index.html under Optional Benefits.

The ASEA Health Trust does not control or administer these benefits. You may or may not be eligible for all of the benefits described above, and some of the benefits may require enrollment. Although the above summary is provided by the ASEA Health Trust as a convenience, refer to the information published by the State of Alaska for the most complete and accurate information.

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HOW TO USE YOUR BENEFITS: The Plan’s PPOs (Preferred Provider Organizations)

What health care services are covered by PPOs within the Municipality of Anchorage?

For the following services received within the Municipality of Anchorage, the Plan will provide different benefits depending on whether a PPO facility is used.

Service

PPOs

Inpatient hospital stays

Alaska Regional Hospital

Outpatient X-ray services
(including MRI, CAT scan, mammogram and sonogram)

Alaska Regional Hospital

Outpatient laboratory

Alaska Regional Hospital

Outpatient surgery

Surgery Center of Anchorage (SCoA), also known as Surgicenter of Anchorage

New Frontier Anesthesia

Childbirth services

Geneva Woods Birth Center, Alaska Regional Hospital

Physical therapy services

Chugach Physical Therapy, Ascension Physical Therapy
and Alaska Hand Rehabilitation

Ear, Nose, Throat and Hearing Services

Alaska Center for Ear Nose and Throat (ACENT)

   

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What is the penalty if I don’t use a PPO when one is available?

If you receive health care services from a non-PPO provider within the Municipality of Anchorage, and those services are available from a PPO, the following penalties will apply:

  • The Plan payment will be based on the Plan’s Allowable Expense at the PPO provider
  • The charges will be subject to a lower reimbursement percentage
  • The out-of-pocket limits will be increased

No penalty applies if you receive medical services from a non-PPO facility if those services are not available at a PPO facility.

 

For more information:

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How do I know where my labs and X-rays are being sent?

Ask your doctor where your labs, outpatient testing, and other services will be done. You will pay a PPO penalty for outpatient services provided at a non-PPO hospital if provided within the Municipality of Anchorage.

However, there is no penalty for outpatient services obtained in the doctor’s office, by the doctor’s staff, with the doctor’s equipment. This includes x-rays, lab work, or other outpatient services.

Some doctors maintain separate practices but share resources with other doctors in the same building. The PPO penalty will apply to outpatient services if the doctor or clinic does not own the equipment.

For more information, see the Preferred Provider Provisions section of the Benefits Plan Booklet.

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Where should I get emergency treatment within the Municipality of Anchorage?

The Plan covers emergency care at any facility with no PPO penalty in a medical emergency.

A medical emergency is when your life, any body parts, organs or bodily functions (or those of your unborn child) are at risk if you don’t receive immediate medical care.

If you are admitted as an inpatient to a non-PPO hospital as a result of a medical emergency, you must transfer to a PPO facility when it is medically safe to do so, or your care will be covered at the non-PPO rate, which means you will pay more out-of-pocket.

For more information, see the Emergency Room Visits section of the Benefits Plan Booklet.

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What is the Incentive for Mat-Su Borough Residents to use Alaska Regional Hospital?

Mat-Su Regional Medical Center is a PPO facility in the Mat-Su Borough. In addition, you may choose to use Aetna PPO providers in the Mat-Su Borough.

In many cases, however, treatment is less expensive at Alaska Regional Hospital. The Plan will pay an incentive to participants who live in the Mat-Su Borough and choose to receive treatment at Alaska Regional Hospital instead of Mat-Su Regional Medical Center.

The incentive payment will be 10% of the amount the Plan pays Alaska Regional Hospital, up to $500 for outpatient procedure/surgery services and $1,000 for inpatient hospital services for each treatment episode.

Please see limitations and details in the Preferred Provider Provisions section of the Benefits Plan Booklet.

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I live outside the Municipality of Anchorage; do the PPO provisions still apply?

Yes, the PPO provisions apply to services received within the Municipality of Anchorage, no matter where you reside.

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Do I need to choose a doctor from a PPO network?

No. The Plan does not require the use of a PPO network for doctors. The Plan pays the same level of benefits for services received from any licensed physician, inside or outside the Municipality of Anchorage.

However, for health care services that can’t be performed by a PPO provider within the Municipality of Anchorage/Mat-Su Borough or at a Coalition Health Center, you can save money by using a doctor in the Aetna network. If you choose a PPO provider, Plan benefits will be determined based on the PPO provider’s contract amount (rather than UCR) and there will not be any amount in excess of UCR. For more information, see the Preferred Provider Contracts section of the Benefits Plan Booklet.

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What is the Coalition Health Center?

The Coalition Health Centers provide primary and preventive care to Trust participants.  The deductible is waived for services obtained at the Coalition Health Centers. There is no copay. 

Coalition Health Center Locations
Anchorage:   Fairbanks:
Age 5 and up
Alaska Regional Hospital
2741 DeBarr Rd.,
Building C,
Suite C210
(970) 264-1370
  Age 2 and up
Ridgeview Business Park
575 Riverstone Way,
Unit 1
(907) 450-3300

Coalition Health Center Hours:
Monday – Friday
7:30a.m. – 6:30p.m. (By appointment)
8:30a.m. – 4:30p.m. (Walk-ins welcome for acute care)
Appointments are required for wellness and preventive care services. Whenever possible, please schedule an appointment for other services.

Click here to visit the coalitionhealthcenter.com.

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What is the Geneva Woods Birth Center?

The Geneva Woods Birth Center in Anchorage is a nationally accredited center that offers birthing alternatives, such as hydrotherapy, that are not available in most hospital settings. Talk with your doctor about this option. For more information, please visit the center’s website at www.midwivesatgenevawoods.net or call 907-561-5152.

When you receive care at this center, you will receive Plan reimbursement at the PPO level.

For more information, see the Preferred Provider Contracts section of the Benefits Plan Booklet.

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What is the Aetna PPO?

Aetna contracts with a nationwide group of doctors, hospitals and other providers that have agreed to provide services at a discounted rate for PPO members. The Plan pays the same benefit percentage, whether or not you choose an Aetna provider.

If you choose an Aetna PPO provider (except for hospital services and physical therapy within the Municipality of Anchorage), Plan benefits will be determined based on the PPO provider contract amount, (rather than UCR) and there will not be any amount in excess of UCR. Here are some money-saving tips:

  • Outside of Alaska (in the U.S.): If you are traveling out-of-state for health care services, or need care while traveling, check to see if an Aetna provider is available. To locate an Aetna provider or facility, go to aetna.com. Click Log In/Register and follow the prompts. You can also search for providers on Aetna’s public website at aetna.com/docfind. Select the “Aetna Choice POS II (Open Access)” network.
  • Within Alaska: Check to see if Aetna providers are available near your home for regular health care services at www.aetna.com.
  • Within the Municipality of Anchorage: Consider an Aetna provider for services that can’t be performed by a PPO provider within the Municipality of Anchorage/Mat-Su Borough.

For more information, see the Preferred Provider Contracts section of the Benefits Plan Booklet.

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How do I find a Aetna provider?

To locate an Aetna provider or facility, go to aetna.com. Click Log In/Register and follow the prompts. You can also search for providers on Aetna’s public website at aetna.com/docfind. Select the “Aetna Choice POS II (Open Access)” network. When you call to make an appointment with an Aetna provider, you must identify yourself in advance as an Aetna participant in order to receive the discounted rate.

 

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Is there a PPO for vision services?

Yes. VSP is the provider network for routine vision care. When you choose a VSP provider you receive exams, basic lenses, polycarbonate lenses and UV coating all covered in full. There are no PPO penalties if you do not use a VSP provider and the Plan pays up to the maximum benefit amount for routine vision services received from any vision provider. If you are being treated for a medical condition of the eye, use a provider in the Aetna network to avoid possible balance billing of charges.

To locate a VSP Provider, go to www.vsp.com or call 800-877-7195 (toll-free).

For more information, see the Vision Benefits section of the Benefits Plan Booklet.

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Is there a PPO for transplant services?

Yes. The Plan works with Specialized Networks for transplants and related services. Please contact the ASEA Health Trust Administrator for more information prior to seeking transplant services.

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HOW TO USE YOUR BENEFITS: Prescription Drugs

Is there a network for prescription drugs?

Yes. The Plan uses the CVS/caremark Network. You receive a discounted rate for prescription drugs that are in the CVS/caremark advance formulary when you choose a participating pharmacy, which keeps your costs down. Just show your Health Plan ID card, pay your copay, and the pharmacy files a claim for you.

If you use a non-participating pharmacy, you pay the full cost of the prescription and file the claim yourself. The Plan reimburses the benefit percentage based on the Allowable Expense (which is the participating pharmacy discounted rate), and you pay the difference.

If you purchase a brand-name prescription when a generic equivalent is available (even if your doctor’s prescription does not allow a subsitution), the plan pays 80% of the generic equivalent.

Effective 7/1/2018:

  • Prescriptions for non-specialty drugs that cost more than $1,500 will be reviewed by a CVS/caremark pharmacist prior to allowing benefits for the medication. This may include dosage, quantity, days’ supply and/or billable amounts.
  • Artificial saliva products and select skin or topical barriers are excluded from coverage.
  • Diabetic Test Strip quantities are limited. You will initially be allowed up to 200 strips per month or up to 300 strips per month following prior authorization.

For more information, see the Prescription Drug Benefits section of the Benefits Plan Booklet.

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What is the CVS/caremark advance formulary?

The advance formulary is a list of generic and brand name prescription drugs that are evaluated by a committee of experts and chosen for their safety and effectiveness. Drugs that are not in the formulary are excluded from coverage.

For more information or to find out if your prescription medication is in the advance formulary, contact CVS/caremark at 1-866-818-6911 (toll free).

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How do I find a participating pharmacy?

Here’s how to find a participating CVS/caremark pharmacy:

  • If you are NOT currently logged in to the secure section of this ASEA website: You must first login, then navigate to Your Account > Your Claims > Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.
  • If you are currently logged in to the secure section of this ASEA website: Click to visit the Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.
  • Call CVS/caremark  at 866-818-6911 (toll-free) and request a list

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How do I use the mail-order program?

To start buying maintenance medications that you take regularly via mail-order, complete the Prescription Mail Service Order Form. Follow the instructions to submit the form along with your prescription.

You’ll save money with the mail order program’s discounted prices, and enjoy online reordering services and free home delivery.

For more information, see the Prescription Drug Benefits section of the Benefits Plan Booklet.

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How do I refill mail-order prescriptions?

  • If you are NOT currently logged in to the secure section of this ASEA website: You must first login, then navigate to Your Account > Your Claims > Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.
  • If you are currently logged in to the secure section of this ASEA website: Click to visit the Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.

Since you are already logged into the secure portion of the ASEA Health Trust website, you may access your CVS/caremark information directly from here and do not need to log into the CVS/caremark website. From the CVS/caremark link you can request a refill, check order status and much more.

For assistance with prescription refills, CVS/caremark Customer Care representatives are available 24 hours a day, 7 days a week at 866-818-6911 (toll-free).

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How do I see my prescription claims?

  • If you are NOT currently logged in to the secure section of this ASEA website: You must first login, then navigate to Your Account > Your Claims > Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.
  • If you are currently logged in to the secure section of this ASEA website: Click to visit the Prescription Drug Claims page and click on the "Caremark Single Sign-On" link.

Since you are already logged into the secure portion of the ASEA Health Trust website, you may access your information, including prescription claims information and status directly and do not need to log into the CVS/caremark website.

For more information on your prescription claims, CVS/caremark Customer Care representatives are available 24 hours a day, 7 days a week at 866-818-6911 (toll-free).

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What is the Prescription Savings Guide report?

CVS/caremark, the ASEA Health Trust’s Prescription Benefit Manager, periodically sends personalized Prescription Savings Guide reports to participants who have used prescription drug benefits and have savings opportunities. The report helps you track and manage your prescription costs and identify ways to save money on prescriptions.

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HOW TO USE YOUR BENEFITS: Travel Benefits

Are travel expenses covered?

Yes, the Plan pays travel benefits when you must travel to obtain medically necessary services under certain conditions:

  • Medical treatment that is not available locally when you need treatment
  • Diagnostic testing that is not available locally
  • Second surgical opinions that cannot be obtained locally
  • Surgery in other locations when it is available less expensively in another location
  • Emergency conditions that require immediate transfer to a hospital with special facilities for treating the condition

For more information, see the Travel section of the Benefits Plan Booklet.

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Do I need to obtain preauthorization for travel benefits?

Yes. You and your doctor must complete the Travel Preauthorization Form, and submit it to the ASEA Health Trust Administrator before you travel. If you do not obtain preauthorization, the Plan will not pay travel benefits (except for emergency ambulance transportation).

For more information, see the Preauthorization of Travel Benefits section of the Benefits Plan Booklet.

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If I have to travel with my child, are my expenses covered?

Travel for the following individuals may be covered:

  • The eligible Plan participant who is the patient that requires travel
  • A parent or legal guardian if the patient is a child under 18 years of age
  • A companion when the patient is an incapacitated adult
  • A physician or a registered nurse, in some cases when determined to be medically necessary

For more information, see the Travel section of the Benefits Plan Booklet.

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What expenses are covered?

The Plan may reimburse a portion of your travel, food and lodging. The amount depends on whether your travel is for a medically necessary treatment or a diagnostic service.

For more information, see the Travel section of the Benefits Plan Booklet.

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HOW TO USE YOUR BENEFITS: Precertification

What is precertification?

Precertification helps you get the appropriate medical care by reviewing whether a proposed treatment or procedure is medically necessary. An objective, independent Utilization Review provider, Aetna, makes this determination.

Precertification does not guarantee eligibility, benefits or that all charges will be covered, nor does it consider whether you are seeking treatment at a PPO or non-PPO facility. (In other words, precertification does not waive the PPO provisions of the Plan, and does not provide coverage for services excluded or limited by the Plan.)

For more information, see the Precertification Requirements section of the Benefits Plan Booklet.

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What services are required to be precertified by the Plan?

Precertification is required for hospitalizations and certain outpatient procedures (click here for a current list). Call the ASEA Health Trust Administrator at 866-553-8206 (toll-free) if you are unsure if precertification is required for your services.

For more information, see the Precertification Requirements section of the Benefits Plan Booklet.

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How do I request precertification?

When precertification is required, the hospital or your doctor is responsible for calling the Aetna precertification phone number for providers on your ID card.

  • If you use an Aetna network provider, your provider is responsible for obtaining necessary precertification for you. Because precertification is the provider’s responsibility, if your provider fails to precertify required services, the provider’s reimbursement will be limited and the provider cannot bill you for those services.
  • If you use a non-preferred provider, your provider may precertify for certain services on your behalf. If the provider fails to precertify those services, Aetna will review the medical necessity of those services when the claim is filed. If the service is not medically necessary and is not approved, no benefits will be paid. If the service is medically necessary, benefits will be paid according to the Plan and you will be responsible for the following penalties:
    • $400 penalty for failure to precertify inpatient hospital admissions.
    • $200 penalty for failure to precertify a skilled nursing facility admission.

For travel preauthorization, you and your doctor must complete the Travel Preauthorization Form and submit it to the ASEA Health Trust Administrator before you travel.

For more information, see the Precertification Requirements section of the Benefits Plan Booklet.

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What can I do if a procedure is not precertified?

If your provider requested precertification of a procedure or a hospital stay, and the service is not certified, your provider may first appeal to the Utilization Review provider. If the denial of certification is upheld, you have the right to appeal the non-certification to the Board of Trustees.

For more information, see the Precertification Requirements section of the Benefits Plan Booklet.

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What is the penalty if I receive a service but did not request precertification beforehand?

  • If you use an Aetna network provider, your provider is responsible for obtaining necessary precertification for you. Because precertification is the provider’s responsibility, if your provider fails to precertify required services, the provider’s reimbursement will be limited and the provider cannot bill you for those services.
  • If you use a non-preferred provider, your provider may precertify for certain services on your behalf. If the provider fails to precertify those services, Aetna will review the medical necessity of those services when the claim is filed. If the service is not medically necessary and is not approved, no benefits will be paid. If the service is medically necessary, benefits will be paid according to the Plan and you will be responsible for the following penalties:
    • $400 penalty for failure to precertify inpatient hospital admissions.
    • $200 penalty for failure to precertify a skilled nursing facility admission.

For more information, including details about penalties see the Precertification Requirements section of the Benefits Plan Booklet.

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HOW TO USE YOUR BENEFITS: Multiple Surgery Rule

If I have more than one surgical procedure during the same operation, what does the Plan pay?

The Plan has a “multiple surgery rule” (also called the “second surgery rule”). When two or more surgical procedures are performed during the same operation, the Plan allows 100% of the UCR charge for the primary procedure and 50% of the UCR charge for all other procedures.

Note that many doctors will bill the entire charge for each of the procedures, but write off the billed charges above the amount allowed for the second surgery. Some doctors may charge you for the difference between their billed charge and the Plan’s payment. You should talk to your doctor about this before you have surgery.

For more information, see the Allowable Expense for Multiple Surgical Procedures section of the Benefits Plan Booklet.

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HOW TO MANAGE YOUR BENEFITS: Payment and Claims

What are UCR charges?

UCR charges (sometimes called U&C) are the Usual, Customary and Reasonable charges for a particular service in a specific area. It is the prevailing rate charged in the geographic area where the service is provided, or the provider’s usual charge, whichever is less.

The ASEA Health Trust utilizes a database provided by an independent third party which determines UCR charges by collecting claims data submitted for each procedure, defined by the procedure code, in a specific geographic area. The geographic area is determined by where the procedure is performed.  Some types of procedures, such as surgery, are based on claims data statewide or from a larger area to ensure sufficient information to establish UCR.  A multiplier may be applied to reflect differences in the cost of services in a particular region.  The ASEA Health Trust uses the 90th percentile to determine the UCR. Plan payment is based on UCR charges for covered services. Charges or fees in excess of the UCR are your responsibility to pay.

For more information, see the Usual, Customary, and Reasonable (UCR) Charges section of the Benefits Plan Booklet.

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How can I find out in advance if my doctor’s charge will be over the UCR?

When you schedule a procedure, ask the provider for the CPT procedure code and what he or she charges.

You can submit a Medical Pretreatment Estimate form to the ASEA Health Trust Administrator or call the Administrator with this information. The Administrator will let you know if the provider's charge is within the UCR charge. This way, you will know in advance about any financial responsibility you will have for charges over UCR.

If you choose a PPO provider, Plan benefits will be determined based on the provider’s PPO contract amount (rather than UCR) and there will not be any amount in excess of UCR. For multiple surgical procedures, the PPO discounted amount may be reduced by 50% for the second (and third) procedure.

For more information, see the Allowable Expenses section of the Benefits Plan Booklet.

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How can I make sure my provider submitted a claim?

It is your responsibility to make sure claims are submitted for services you receive.

  • At your appointment, ask whether your provider will bill the ASEA Health Trust Administrator.
  • Make sure your provider has your correct ID number and billing address (on your Health Plan ID card).
  • Watch for an Explanation of Benefits (EOB) statement in the mail showing payment.
  • Check with the ASEA Health Trust Administrator if you haven’t received an EOB within six to eight weeks of your visit.
  • If necessary, follow-up with your provider to make sure they send their bill soon after you receive care.
  • Check the status of your claims online by logging in to the secure section of this website.
  • If the ASEA Health Trust Administrator asks the provider for additional information, encourage your provider to submit the information in a timely manner. Your claim will be delayed and cannot be processed without the information.

Your provider may turn your bills over to collections if claims are not submitted properly and on time.

For more information, see the How to File a Claim section of the Benefits Plan Booklet.

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What is the normal time for processing claims?

Claims for covered services that are submitted on time and with complete information are paid within 11 to 15 working days from date of receipt.

For more information, see the How to File a Claim section of the Benefits Plan Booklet.

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HOW TO MANAGE YOUR BENEFITS: Coordination of Benefits (COB)

How does the State of Alaska’s health coverage coordinate with the ASEA Health Trust Plan coverage?

The State of Alaska Plan encompasses health insurance, disability insurance, life insurance, day care spending account, etc. Under the authority of 2 AAC 39.920, the State of Alaska Plan will pay 30% of covered charges for you and/or your dependents if your family is eligible for coverage by a State employee health trust, and that coverage:

  • Has been waived
  • Pays less than 70% of covered expenses
  • Has an individual out-of-pocket maximum, including deductible, of more than $3,500

This applies to anyone covered by the State of Alaska Plan as the secondary plan under the standard Coordination of Benefits (COB) rules, where the ASEA Health Trust Plan would normally pay first if you hadn’t reduced or waived coverage. When you select coverage under a State employee health trust, the State’s regulation encourages you to ensure you are electing a plan that covers at least yourself and any dependents for which you have primary responsibility, and that coverage provides full family coverage. Failure to do so will result in the State of Alaska Plan reducing coverage for you and/or your dependents in the coming year.

For more information, see the Coordination of Benefits section of the Benefits Plan Booklet.

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Can I be covered by both the Trust and by Medicaid?

Yes, if your family has ASEA Health Trust coverage and one of your covered family members is also covered by Medicaid or Denali KidCare, you are able to receive benefits under both plans.

Both plans will pay a portion of the covered benefits through a process called Coordination of Benefits (COB). In this case, the ASEA Health Trust Plan is the primary plan (it pays benefits first), and Medicaid is secondary (it usually pays a portion that the primary plan did not pay). Your combined coverage may be up to 100% of the total covered amount.

The plans coordinate the benefits for you; all you have to do is make sure that the health care providers have complete coverage information and submit all claims to both plans. Claims cannot be processed by the secondary plan until the primary plan has processed the claims.

For more information, see the Coordination of Benefits section of the Benefits Plan Booklet.

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My spouse and I both have medical coverage, from different employers. Which plan pays for my medical expenses?

You need to know how your other health coverage and the ASEA Health Trust Plan work together to pay covered expenses. In most cases, both plans use standard Coordination of Benefit (COB) rules. As the employee, the Trust Plan usually is primary for you (it pays your claim first). Your other plan is secondary (it pays second). For your spouse, his or her employer plan is primary, and the ASEA Health Trust Plan is secondary. Claims cannot be processed by the secondary plan until the primary plan has processed the claims.

For your children, the plan of the parent with the birthday earliest in the year is primary, and the other parent’s plan is secondary. If you are separated or divorced, the custodial parent’s plan usually is primary unless otherwise ordered by the court.

Once the primary plan pays benefits, the secondary plan reimburses covered expenses as allowed under its provisions. Benefits from your primary and secondary plans may combine to pay up to—but no more than—100% of covered expenses.

Effective July 1, 2018, when the ASEA Health Plan is the secondary plan, the Health Plan’s allowable expense will be limited to the expense that is allowed by the primary plan. In the event that the primary plan’s allowed expense has been reduced because you did not follow its plan rules and procedures (for example, you did not obtain a required precertification or did not use the plan’s in-network provider), the ASEA Health Plan will not pay the amount of the reduction.

For more information, see the Coordination of Benefits section of the Benefits Plan Booklet.

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HOW TO MANAGE YOUR BENEFITS: Appeals

What can I do if the ASEA Health Trust Plan denies payment of a claim?

You may appeal the claim payment decision, if you have reason to believe it should be covered by the ASEA Health Trust Plan. For example, you may have additional information or there may be special circumstances that you think should be taken into account. 

First, understand why the claim was denied. The Explanation of Benefits (EOB) will state the reason. Call the ASEA Health Trust Administrator or the Prescription Benefits Manager (CVS Caremark) to discuss the reason for the denial. Ask questions to be sure you clearly understand why it was not approved.

Second, you may request that the decision be reconsidered by submitting an appeal. A request for appeal must be submitted within 180 days of the date of the denial. The Plan provisions include a detailed appeals process that you must follow exactly if you choose to request an appeal.

Enrollment or eligibility appeals must be submitted in writing to the Board of Trustees, in care of the ASEA Health Trust Administrator within 45 calendar days after the first payroll to which the enrollment applies. After consideration of the appeal, the Board of Trustees will advise you in writing of their decision no later than 30 days after the meeting in which the appeal is decided.

For more information, see the If a Claim is Denied section of the Benefits Plan Booklet.

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What can I do if a preauthorization request is denied?

You may appeal the preauthorization decision if you have reason to believe it should not have been denied. For example, you may have additional information or there may be special circumstances that you think should be taken into account.

First, understand why your preauthorization request was denied. The treatment may not have been considered medically necessary for your condition. Call the Utilization Review Provider, Qualis, at 800-783-8606 (toll-free) to discuss the reason for the denial. Ask questions to be sure you clearly understand why it was denied.

Second, you may request that the decision be reconsidered by submitting an appeal to Qualis. A request for an appeal must be submitted within 60 days of the date of the denial. Plan provisions include a detailed appeals process that you must follow exactly if you choose to request an appeal.

For more information, see the If a Claim is Denied section of the Benefits Plan Booklet.

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ADDITIONAL BENEFITS: Disease Management

Who can participate in the Disease Management program?

The Disease Management program is available to all participants of the ASEA Health Trust (members, spouses and dependents) who have one of the targeted chronic conditions:

  • Asthma
  • Diabetes
  • A history of heart failure
  • Coronary artery disease
  • Chronic obstructive pulmonary disease (COPD)
  • Musculoskeletal pain including - back pain (neck, upper and lower back), fibromyalgia, headaches (migraine or tension), osteoarthritis, regional musculoskeletal disorders (RMD), rheumatoid arthritis

Family members (i.e., a parent or spouse) who care for a child age two and older with asthma or diabetes may also participate.

For more information, see Your Benefits > Disease Management.

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How do I enroll in the Disease Management Program?

Optum (formerly Alere), the ASEA Health Trust’s Disease Management program provider, periodically reviews the Health Trust’s claims to identify plan participants who have these conditions. If this applies to you or a family member, Optum will send you an introductory letter, and then a specialist will call to answer your questions and invite you to participate.

To learn more, contact Optum toll-free at 855-738-1768 or visit https://asea.optum.com/mve/.

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Is the Disease Management program confidential?

Yes. Optum (formerly Alere) fully complies with Federal privacy regulations. The ASEA Health Trust will only receive general information and statistics about how the program is meeting members’ needs.

Optum will send your doctor information about the program and recommended treatment guidelines for your condition. If it is beneficial to speak with your doctor, an Optum specialist will only do so with your permission.

For more information, see Your Benefits > Disease Management.

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Am I required to participate in the Disease Management program?

No. The program is completely voluntary.

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How much does it cost to participate in the Disease Management program?

There is no cost to you to participate; the ASEA Health Trust pays for the program.

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Is there a penalty if I do not participate in the Disease Management program?

No. Your ASEA Health Trust benefit coverage is the same whether you participate or not.

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ADDITIONAL BENEFITS: Chronic Kidney Disease Management (CKD)

What is the Chronic Kidney Disease Program and who is Renalogic?

Did you know that 1 in 3 adults is at risk of developing chronic kidney disease (CKD)? It’s considered a “silent disease” because most people aren’t aware that they have it until it’s too late. Fortunately, kidney disease is preventable and reversible, if treated early enough. So, the ASEA Health Trust has partnered with Renalogic to help educate you and your dependents about how to prevent CKD and end-stage renal disease (ESRD). If you’ve already been diagnosed with CKD or ESRD, this program can help you manage your disease and improve your overall health.

For more information, see Your Benefits>Chronic Kidney Disease Management

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Who can participate in the Chronic Kidney Disease Management Program?

This program is available to all participants of the ASEA Health Trust (employees, spouses and dependents).

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How do I participate in the CKD Program?

Reanlogic Nurse Coaches, who specialize in kidney heatlh, will reach out to members who have been diagnosed or are at high risk for CKD or ESRD. You will also be receiving, or may have received, literature or information from Renalogic.

But, if you would like to learn more, please go to www.renalogic.com/afscmelocal52 and fill out the form or call 844-841-5065 to speak with the Nurse Coach.

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Is the CKD program confidential?

Yes. Renalogic complies with all Federal privacy regulations. The ASEA Health Trust will only receive general information and statistics about how the program is meeting members’ needs.

For more information, see Your Benefits>Chronic Kidney Disease Management

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Am I required to participate in the CKD Program?

No. The program is completely voluntary.

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How much does it cost to participate in the CKD program?

There is no cost to you to participate; the ASEA Health Trust pays for the program on your behalf.

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Is there a penalty if I do not particpate in the CKD program?

No. You ASEA Health Trust benefit coverage will remain the same whether or not you participate.

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ADDITIONAL BENEFITS: Employee Assistance Program

How many free counseling sessions do we have through the EAP?

The Employee Assistance Program (EAP) counseling service provides you and your covered dependents up to six free counseling sessions per issue or problem, per year. The EAP is free to you and your dependents and is 100% confidential. The EAP is provided through LifeWorks.

  • Online: Go to www.LifeWorks.com (user ID=asea; password=eap; these are case sensitive)
  • By phone: Call 24 hours a day, 7 days a week, to talk with a professional counselor:
    • Toll-free: 877-234-5151
    • TTY/TDD: 800-999-3004
    • En Espanol: 888-732-9020

For more information, see Your Benefits > Employee Assistance Program (EAP).

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ADDITIONAL BENEFITS: Health Care Reimbursement Account (HCRA)

What is the Health Care Reimbursement Account (HRCA)?

A Health Care Reimbursement Account (HCRA) is like a checking account: you “deposit” payroll deductions from your pre-tax income and then use that money to pay for eligible health care expenses. Because you set aside this money before taxes are withheld from your paycheck, you can reduce your taxes and increase your take home pay. HCRA elections do not rollover. You must enroll in HCRA during Open Enrollment each Plan Year. 

For more information, see Your Benefits > Health Care Reimbursement Account (HCRA).

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How much can I set aside?

You must contribute at least $20 a month, and you can contribute up to $2,650 each Plan Year (effective 7/1/2018). Use the HCRA Planning Worksheet to determine how much you should set aside to pay for reimbursable expenses .

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Can I still deduct out-of-pocket medical expenses on my income tax if I enroll in the HCRA?

An income tax deduction is not available for expenses reimbursed through the HCRA. Instead of the HCRA, you may be able to take a tax deduction for eligible medical expenses on your Federal income tax return. The deduction, however, is available only for expenses that total more than 7.5% of your adjusted gross income. For help determining which approach may be best for you, consult your tax advisor.

For more information, see Your Benefits > Health Care Reimbursement Account (HCRA).

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What are some of the expenses eligible for reimbursement with the HCRA?

You can use your HCRA for most medically necessary expenses that are not reimbursed or covered by any health plan. Examples include:

  • Annual deductibles
  • Copays
  • Coinsurance
  • Non-PPO penalties
  • Over-the-counter medications with a doctor's prescription
  • Over-the-counter items in these eligible categories: bandages and wraps, birth control, braces and supports, catheters, contact lens supplies, denture adhesive, diagnostic tests and monitors, first-aid supplies, insulin and diabetes supplies, ostomy products, reading glasses, wheelchairs, walkers and canes
  • Transportation expenses to and from your health care provider
  • Chiropractic, acupuncture and alternative health care
  • Prescription copays and coinsurance
  • Orthodontia
  • Vision exams, eyeglasses and contacts
  • And many others

For a complete list, see Internal Revenue Service (IRS) Publication 502, Medical and Dental Expenses.

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Why do I lose the money left in my HCRA account if I don't spend it?

The IRS requires you to forfeit any money left in your account each year, after all eligible expenses have been paid. This is often called the “use it or lose it” rule. All forfeited money belongs to ASEA/AFSCME Local 52 Health Benefits Trust.

For more information, see Your Benefits > Health Care Reimbursement Account (HCRA).

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ADDITIONAL BENEFITS: Telemedicine For Non-urgent Medical Care

What is Teladoc?

Participants of the ASEA Health Trust (employees, covered spouses and dependents) can access a board-certified physician and receive treatment for non-urgent care and minor illnesses (sinus problems, bronchitis, allergies, cold or flu symptoms) by phone, online video or mobile app 24 hours per day, 7 days per week at no cost through Teladoc.

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How do I access a Teladoc provider?

When you have a minor illness (such as sinus problems, bronchitis, allergies, cold and flu symptoms, or respiratory or ear infection), you can contact Teladoc any time (24 hours/day, 7 days/week) to request a visit by a one of their board-certified physicians:

You will receive a response from a Teladoc healthcare provider by phone, online video or mobile app (whichever you specify) within approximately 10 minutes . They will assess your issue, diagnose your condition, recommend treatment and prescribe medication, if appropriate.

For more information, see Your Benefits > Teladoc - Telemedicine Non-Urgent Care.

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ADDITIONAL BENEFITS: Elective or Non-Urgent Surgical Care Outside Of Alaska

What is BridgeHealth?

You can have elective or non-urgent surgery (such as a total hip or knee replacement, coronary artery bypass graft or spinal fusion) performed by top rated surgeons in premier facilities across the United States - at NO COST to you - through BridgeHealth. The Health Trust is able to offer this benefit because the cost for these procedures can be much lower outside of the state of Alaska.

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What expenses are covered if I choose BridgeHealth for my surgical care?

If you choose BridgeHealth, the Health Trust:

  • Covers ALL surgical costs during the episode of care; there is no deductible or coinsurance
    • There may be other costs incurred that may be covered by your medical benefits but may be subject to your deductible or coinsurance (i.e., medical clearance exam, durable medical equipment, additional imaging, follow-up care with a local provider)
  • Pays for your travel expenses, including FIRST-CLASS airfare, lodging and food, up to benefit limitations
  • Pays the travel expenses for a companion (whom you choose) to go with you as your caregiver

To learn more, contact BridgeHealth at 844-249-8108 or visit bridgehealth.com.

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How do I use BridgeHealth?

If your doctor recommends surgery, contact BridgeHealth to ask if it is a covered procedure.

  • Phone: 800-249-8108
  • Online: Register for an account on bridgehealth.com, click “Register here” and use ASEAL for “Company Code”.

You will work with a dedicated Care Coordinator who will guide you every step of the way:

  • Assist you by explaining your benefits
  • Help you understand your treatment options
  • Make your travel arrangements
  • Set up your pre-operative visit, surgery and post-operative visits with a BridgeHealth surgeon

NOTE: Plan limitations and exclusions will apply with respect to surgical procedures covered by the Plan. If the ASEA Health Trust Plan is your secondary health plan, BridgeHealth may not be available to you. Contact BridgeHealth for more information.

For more information, see Your Benefits > BridgeHealth – Option for Elective or Non-Urgent Surgery Outside of Alaska.

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