Frequently Asked Questions
I am confused about how my benefits are coordinated with Medicare.
Coordination Where Medicare Benefits are “Primary.” When Medicare benefits are primary to any benefits under the Plan, Medicare benefits are paid first, and payment of Plan benefits, if any, occurs second based on what Medicare has paid and other rules. For example, Medicare is primary to Plan benefits if you are eligible for Medicare benefits based on age or disability and your coverage under the Plan is not based on current employment (as in the case of coverage for Retired Participants and their Dependents and certain “COBRA” coverage). Coordination Where Medicare Benefits are “Secondary.” Medicare benefits are sometimes “secondary” to those under the Plan, meaning that Plan benefits are paid first and Medicare benefits, if any, are paid second. Further Discussion of Coordination of Plan Benefits with Medicare. For the full explanation of the rules on coordination of Plan benefits with Medicare, see your TEAMStar Retiree booklet (if receiving benefits through TEAMStar) or Section 15.10 through 15.12 of the SPD.
What is the name of our insurance company?
Your medical and dental benefit coverage is provided through the Alaska Teamster-Employer Welfare Trust, which is a multi-employer employee benefit plan governed by a federal law called ERISA, the Employee Retirement Income Security Act. Medical and dental benefits (other than Retiree benefits obtained through TEAMStar) are not paid by an insurance company; they are paid directly by the Plan.
Will the Plan cover 100% of all my bills?
The Board of Trustees has designed a comprehensive program of Health Plan benefits for you and your eligible dependents. However, not all services you receive are covered by the Plan. For covered services, you will be responsible for deductibles, co-payments and co-insurance amounts. The Plan will not pay charges above the “Usual, Customary and Reasonable” rate for medical services or supplies. A charge that does not meet all three of those requirements – by being “usual,” “customary,” and “reasonable” – will be adjusted by the Plan or eliminated. A charge is “usual” if it is no more than the charge that the medical provider most frequently makes to its patients for that service or supply. A charge is “customary” if it is equal to or less than the 85th percentile rate established for the geographic area by the Plan’s third party service, which analyzes appropriate health care charges, and does not exceed Medicare’s allowed amount for end-stage renal disease charges. A charge is “reasonable” if the service or supply is justified by the circumstances, and is not performed too frequently or at an unreasonable time.
Will the Plan cover my dependents automatically or must I pay for that coverage?
An Active Employee who has met the initial eligibility requirements will be automatically enrolled in Employee-Only coverage. Enrollment of a spouse and/or children under the Employee-Plus or Family coverage levels requires a timely and properly-completed enrollment form. Otherwise, the Eligible Employee will remain enrolled in Employee-Only coverage until a change at the Plan’s next Open Enrollment or (if available) a change at Special Enrollment. Enrollment forms are available online and from the Trust Customer Service Office.
I understood that my plan would not charge for a routine physical examination. However, the explanation of benefits I received shows that you applied part of the charges to my deductible and only paid 70% of the balance.
This happens when your physician has indicated on the billing statement that your examination was for a specific symptom or complaint. The billing statement must reflect that the primary purpose for your visit was for preventive care. The Plan and Trust cannot change the physician’s billing statement; you will need to contact your physician.
The doctor’s office needs my group number and identification number to file my claim.
The group and ID numbers for your medical, dental and prescription drug benefits are now on your ID card. Please refer to your medical/dental card for your medical and dental ID numbers.
Is it important that I advise the eye doctor I have VSP coverage?
Yes. Your benefit coverage is determined based on the preferred provider agreement with VSP. If you do not advise the doctor’s office at the time the appointment is made, you may end up paying more out of pocket.
What is the difference between getting prescriptions filled through a mail order facility versus a retail outlet?
Retail outlets are for prescription medications which require immediate use. Mail order is for long-term maintenance prescriptions; up to a 90-day supply through the Preferred Participating Mail Order Pharmacy program for direct delivery to your home.
Is there an annual dental deductible?
Yes, there is a $75.00 annual deductible on basic and major dental work (waived for Diagnostic, Preventive, and Orthodontics only).
Is payment for Class III – Dental Services made on the preparation date or the seat date?
Payment is made on the preparation date for Class III – Dental Services.
What is the annual medical deductible?
The annual medical deductible for Eligible Employees and their Dependents is $1,000.00 per active member and $3,000.00 per family. For Retired Participants and their Dependents with Medicare, see the TEAMStar Retiree Booklet.
Where should claims be sent?
Alaska Teamster-Employer Welfare Trust
520 E. 34th Avenue, Ste. 107
Anchorage, AK 99503-4116
I went to the emergency room and the bill wasn’t paid at 100% – why not?
Benefits are extended for Hospital outpatient emergency room care when required for Emergency treatment of an Illness or Injury.
No benefits will be extended for emergency room care that is not related to an Emergency and/or could have been provided in a Physician’s office, an outpatient clinic or urgent care center.
Is it important to take my pharmacy card with me when I get my prescriptions filled?
Yes. Pharmacists at any of the in-network pharmacies need the information off your prescription card to ensure you get the proper benefit coverage under the Plan.