Frequently Asked Questions
Q What is a deductible?
A: A deductible is a set amount that you are responsible for paying prior to your insurance company making payment on a claim. The deductible amount can vary by plan. Please see your Summary Plan Description for specific deductible amounts.
Q: What is a co-pay?
A: A co-pay is a set amount of the charge you are required to pay at the time a service is rendered. Typically, the balance of the charge is covered at 100% up to the plan maximum. Co-pays may vary by plan and type of service. Please see your Summary Plan Description (SPD) for specific co-pay amounts.
Q: What does “co-insurance” mean?
A: Co-insurance is an amount that you are responsible for after deductibles and co-pays have been satisfied. Not all services are subject to co-insurance. Please see your Summary Plan Description (SPD) for specifics on co-insurance amounts and services that this applies to.
Q: What is an outpatient expense?
A: Outpatient expenses are incurred at doctors’ offices, free-standing clinics and hospitals when you are not admitted overnight. For purposes of this document, outpatient expenses include all expenses not specified as Inpatient.
Q: What is an “inpatient” expense?
A: Inpatient expenses are incurred at licensed hospital facilities when you are admitted overnight and charged for at least one day’s room & board.
Q: What doctors can I see?
A: Please call the number on the back of your ID card to find a network doctor in your area, or you may print a personal network directory for your area at www.beechstreet.com.
For enrollees located in Wisconsin, Arkansas, Tennessee and Utah, you can access the USA Network for participating providers at www.usamco.com. Network providers have agreed to discounted, contracted rates for services, which can SAVE YOU MONEY.
You may see any licensed physician; however, if you choose to go to a non-network provider, you may be responsible for a higher deductible and/or co-insurance based on your plan. You will not receive the PPO network discounts from an out of network provider.
Q: What is pre-existing condition and how does it apply to my plan?
A: A pre-existing condition is any injury or illness for which you have received medical advice, treatment or care within a period of up to six months prior to your enrollment date. If a condition is determined to be pre-existing, the employee must wait 12 months before being covered for that condition (may vary by state). This does not apply to pregnancy and to newly born or adopted children under the age of 18 who have been added to the policy within 31 days of birth or adoption. If the employee submits a Certificate of Creditable Coverage from a previous insurer, the pre-existing condition waiting period may be reduced or eliminated.
Q: Will I receive an ID card?
A: Yes. Once your enrollment is processed, an ID card (along with a Confirmation of Coverage letter and SPD) will automatically be generated and mailed to your home address.Please allow up to 3 weeks for delivery. If after 3 weeks you have not received these documents, please contact EssentialCare at 1-866-740-4006.
If you have any additional questions not addressed above, please contact the EssentialCare Customer Service Center at 1-866-740-4006.