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Patient First Update:

Effective immediately, Patient First is accepting new patients insured under all Anthem plans.  A media statement announcing this has been issued by Patient First. For a short period of time they were only seeing existing patients with Anthem Health Insurance.

As of June 1, 2016, they have begun to accept new patients with all Anthem Health Insurance policies.



 
PLANS 

 

There are three medical plans for employees to choose from.  All three plans are through Anthem Blue Cross/Blue Shield.  The plans are: KeyCare 15 PPO, HealthKeepers HMO 20 and Lumenos.

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  • The PPO option offers coverage through network providers and permits you elect to receive care from a doctor or health provider out of network coverage. The out of pocket expenses are higher for some services due to coinsurance.  A coinsurance is a percentage of the entire bill that the employee is responsible for after the services are rendered.
  • The HMO option coverage is offered through network providers resulting in lower out of pocket costs. With the HMO coverage, out of pocket expenses are lower due to co-payments.  A co-payment is a flat, pre-determined amount of money that is expected at the time of service.  Employees electing the HMO coverage will need to choose a primary care physician for any dependents covered under the plan.  The HMO plan that is offered does allow covered members to go to a specialist without needing a referral.
  • Lumenos is a low premium/ high deductible health insurance option. Once the plan year deductible is met, most expenses are paid at 80%, and you are responsible for the other 20%. Preventative care, such as well visits, are covered at 100% and not subject to the deductible if you see an in-network provider. The in-network providers are the same as those in the HealthKeepers network. Prescription coverage for the Lumenos plan is provided by Anthem, and prescriptions are applied towards the deductible. The Lumenos plan comes with a $500 Health Savings Account (HSA) for individual, $750 for employee & spouse, Employee & Child and $1000 for family to use towards meeting the deductible. 

There are four levels of coverage that an employee can choose from based on their family’s needs:

  • employee only
  • employee & one child
  • employee & spouse
  • family coverage 

The premiums are based on an employee’s employment status.  If an employee changes from full time to part time, the premiums will need to be adjusted accordingly.  Employees must work 20 hours per week and be a permanent employee to qualify for health insurance. If you experience a change in employment status, contact the Human Resources Department.

Health insurance premiums are paid one month in advance.  If an employee separates from service and works half of the month, their coverage will end the last day of the following month.  If an employee separates from service and has not worked more than half the month, their coverage will end at the end of the month of separation.

 



 

Find your Primary Care Physician (PCP) number here or by visiting: 

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PRESCRIPTIONS  

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Your prescription coverage is through Optum Rx.  This plan will provide coverage for your prescriptions only.  All medical services are through your Anthem plan.  You will receive a separate card for the prescription coverage.

  • There is not a separate premium for the prescription coverage.  The premium you pay for your medical coverage includes that cost of the prescription coverage.
  • Employees can contact the insurance company for your group number and identification number.  Below is the contact information:  

  • Optum Rx – 1-888-543-1369

 


ENROLLMENT

 

  • Employees must enroll in insurance within 60 days from the date of hire. If employees miss the 60-day enrollment period, changes can only be made during the annual Open Enrollment period (held during the spring). Any changes made during Open Enrollment will go into effect July 1st.
  • Enrollment takes place through the Fauquier ePortal.  Once an employee has logged into their account, you will need to select the benefits option.  The next screen will allow you to choose which medical and dental plan you would like to select in addition to the level of coverage.  Any dependents that you wish to have on your policy will need to be entered, for each plan (medical and/or dental).   If you are selecting the HMO medical plan you will need to provide the primary care physician ID number.  This information can be found on Anthem’s website:  www.anthem.com.
  • Anthem PPO plans – 1-800-451-1527
  • Anthem HMO plans – 1-800-421-1880
  • Anthem Dental plans – 1-888-315-2049
  • Insurance premiums are paid one month in advance.  Therefore, coverage would begin the first of the month following when elections are submitted.  As an example:  If an employee is hired on October 5th and the elections are submitted on November 5th, coverage would begin December 1st


INSURANCE CARDS

 

  • Employees will received insurance cards approximately 2-3 weeks after their election has been made.  Based on the elections you can receive up to three cards.  Anthem (medical coverage), Optum Rx (prescription coverage) and Anthem Dental (dental coverage).   Cards will be mailed to the home address that is on file.  You can verify your address is correct by logging into your Fauquier ePortal account.
  • Contact the insurance company to request a new card and verify your mailing address on file.  You can also request or print a new card on the carrier’s website.  You will need to create an account prior to gaining access to your insurance cards.  The websites for each plan is listed below:


LIFE EVENTS

 

Employees that need to make a change to their coverage due to a qualifying life event will need to log into their Fauquier ePortal Account.  Under the benefits tab you will see the option to report/view life event.  Once you have submitted this request, employees must send in the documentation that is required showing the effective date of the life event.  Examples include: the proof of birth letter from the hospital, marriage license, or a letter from former employer that states when coverage has ended.  Once the Human Resources Department receives this documentation, your life event will be approved.  The next step is for employees to make their new selections under the benefits tab in their Fauquier ePortal account.

  • Employees will be able to add their unborn children to their policy after the birth of the child.  Employees that need to make a change to their coverage due to a qualifying life event will need to log into their Fauquier ePortal account.  Under the benefits tab you will see the option to report/view life event.  The proof of birth letter that the hospital provides is required as documentation of the life event.  Once the HR department has received this documentation, your life event will be approved.  The next step is for employees to make their new selections under the benefits tab in their Fauquier ePortal account.
  • Losing your coverage is a qualifying life event that will allow you to make a change in the middle of the plan year.  Employees that need to make a change to their coverage due to a qualifying life event will need to log into their Fauquier ePortal account.  Under the benefits tab you will see the option to report/view life event.  We will need documentation to show when the coverage ends.  A letter from the former employer stating when the coverage ended would met this qualification.  Once the HR department has received this documentation, your life event will be approved.  The next step is for employees to make their new selections under the benefits tab in their Fauquier ePortal account.
  • Getting married is a qualifying life event that will allow you to make a change in the middle of the plan year.  Employees that need to make a change to their coverage due to a qualifying life event will need to log into their Fauquier ePortal account.  Under the benefits tab you will see the option to report/view life event.  We will need documentation to show when the coverage ends.  A copy of your marriage license would met this qualification.  Once the HR department has received this documentation, your life event will be approved.  The next step is for employees to make their new selections under the benefits tab in their Fauquier ePortal account.


Consolidated Omnibus Budget Reconciliation Act (COBRA)

 

Federal law allows you to continue health, and dental coverage for up to 18 months following termination.  To continue any other supplemental coverage, contact the insurance company directly within 31 days from your termination date to complete the appropriate forms.


OTHER

 

Please review your paycheck to ensure premiums have been deducted for the coverage. If not, please contact the Human Resources Department for guidance on how to make your elections.  If your paycheck is in order, please the Human Resources Department and speak with someone in the benefits department.  

Children may remain on the insurance plan without having to provide proof of dependency until age 26. The child may stay on the insurance coverage through the month in which they turn 26 years of age.