Member FAQ
General | Benefits |
Medical Management | Claims
How can I contact BPA?
Who can I put on this plan?
What if my dependents have other
coverage?
Can I provide coverage for my child
who is a full-time student in college?
What documentation will I need
to show full-time student status??
How can I get a copy of my Plan Benefit
Booklet?
What if my health care provider requests
a copy of my eligibility and benefit information?
How long will it take to receive my ID
card?
How do I add someone to my policy?
What is precertification for inpatient
hospital care?
How do I file a claim?
Who should I call if I don’t understand
how a claim was processed?
I received an Explanation of Benefits
form; why was the benefit check not mailed the same day?
How are claims for pre-existing
conditions handled?
What is a Certificate of Creditable Coverage
form and how does it affect coverage for pre-existing conditions?
How can I verify all claims paid for my
family for the year?
What if I have expenses for an accident
or illness that may be payable by Worker's Compensation, car insurance or a party
I intend to sue?
How can I get a copy of my Explanation of
Benefits (EOB)?
What is a Prescription Benefit Manager (PBM)?
If my pharmacist has a problem processing
my prescription, what should we do?
What is a preferred provider, and how does
using one affect my benefits?
How can I have a provider added to the
PPO?
How can I correct information that
BPA has on file, such as the spelling of my name, my address or date of birth?
How can I obtain a copy of my ID card?
If I elect COBRA coverage, how can I find
out my rate and verify receipt of my payment?
How can I get a Certificate of Creditable
Coverage (COCC) for my next benefit plan?
General
How can I contact BPA??
Benefits
Who can I put on this plan?
What if my dependents have other
coverage? Download Form
Most health and dental plans contain a coordination of benefits provision.
This means that if one person is covered by two benefit plans, both companies share
responsibility for covering the person's health care expenses. This avoids the duplicate
payment of benefits and helps hold premium costs down.
BPA periodically requests updated information regarding other coverage you and your
family members have. Examples of other coverage are:
- Medicare, either due to age or disability,
- Group coverage through the employment of
another family member,
- Association group coverage through an organization
you or a family member belong to,
- Student health insurance covering dependent
children, or
- Coverage mandated by a divorce decree, requiring
a divorced spouse to carry coverage on certain dependent children
The information can be mailed or faxed to our Customer Service. The information
should include:
- The name, address, phone number and policy
number of the other insurance company or plan;
- In the case of group or employer coverage,
the name of the group or employer
- The name and birth date of the person who
is listed on the coverage as the primary member or policyholder
- The effective date of the coverage
- The type of coverage, such as medical or
dental
- The names of the family members covered under
the plan
Information returned to BPA by mail can be returned to the address indicated
in the letter you received, or to:
Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128
The number for information returned by fax is 715-838-8507. When faxing
information to BPA, it is important that you keep a copy of the fax machine's confirmation
record which shows the date, time and phone number you faxed the information from.
Our Service Center staff will need this information if you call later to confirm
receipt.
Can I provide coverage for my child
who is a full-time student in college?
What documentation will I need
to show full-time student status? Download Form
Unmarried dependent children are usually not covered under your plan once
they reach an age specified by your policy; usually age 19. Coverage may, however,
be continued if the dependent is a full-time student at a high school, accredited
college, university or trade school. Coverage then ceases at an age specified by
your plan, such as age 25.
If your dependent is required to be a full-time student, coverage will
be continuous over any scheduled academic breaks such as winter and summer breaks,
as long as the dependent was enrolled and attending each academic session before
and after the break. We may request dependent eligibility information from you periodically,
or when a claim for the dependent is received. You must submit proof of the dependent's
full-time student status to us when requested.
Acceptable written proof may include a Registrar's letter or other documentation
provided by the school which verifies the quarters enrolled in, and the student's
full time attendance. Note, A student's report card or schedule are not sufficient
forms of proof.
If you received a letter or Explanation of Benefits form from BPA requesting
proof of a dependent's full-time student status, please attach your documentation
to the form and return it to BPA as soon as possible by fax or by mail. We are unable
to take this information over the phone. Information returned by mail should be
addressed to:
Benefit Plan Administrators
PO Box 1128
Eau Claire, WI 54702-1128
If the student status information request was made by an Explanation of
Benefits form for a claim, or in the form of a letter from our eligibility department,
the number for information returned by fax is: (715) 838-8507.
When faxing information to BPA, it is important that you keep a copy of
the fax machine's confirmation record which shows the date, time and phone number
you faxed the information from. Our Customer Service staff will need this information
if you call later to confirm receipt.
How can I get a copy of my Plan
Benefit Booklet?
You should have received one when you joined the
plan, but you can also view your plan benefits on the BPA website after logging in by
clicking on this link.
What if my health care provider
requests a copy of my eligibility and benefit information?
How long will it take to receive
my ID card?
How do I add someone to my policy?
Medical Management
What is precertification for inpatient hospital
care?
Claims
How do I file a claim?
Who should I call if I don’t understand
how a claim was processed?
I received an Explanation of Benefits
form; why was the benefit check not mailed the same day?
A recent change in the law governing self insured employer groups, requires
BPA to send you a claim determination notice within 30 days of receiving your claim
for benefits. This applies to claims received at BPA on or after July 1st, 2002.
For some self-insured employer groups, this means you may occasionally
receive a claim determination notice, (or Explanation of Benefits form as it is
called), before the check for benefits is actually released. This happens because
the timing and frequency of check cycles for each group will vary depending on the
funding options chosen by the group. If the benefit check has been released, the
check number will be shown on the Explanation of Benefits.
Benefit checks are usually released no later than four weeks from the date
the Explanation of Benefits form was mailed. If after more than four weeks, you
receive a "balance due" statement from your provider, call the provider to see if
all benefit payments received in the office have been credited to your account.
In most cases, we find that the provider has the payment but has yet to credit your
account. If payment has still not been received by the provider, please call our
Customer Service at 1-800-236-7789.
How are claims for pre-existing
conditions handled?
Your medical plan may contain a waiting period
for expenses incurred in connection with a pre-existing condition. In general, a
pre-existing condition is any illness or injury for which medical advice, diagnosis,
care or treatment was recommended or received within a specified time period prior
to your coverage enrollment date. Specific details on this time period and the waiting
period for coverage can be found in your health plan benefits booklet or certificate
of coverage.
If you submit medical claims for a condition which
may be pre-existing, additional information may be required from you and your provider
of service. You may be asked for a list of physicians that have treated you in the
past for the condition, or your provider may see a request from BPA for your medical
records on the Explanation of Benefits form for the claim you submitted. It is your
responsibility to make sure this information is submitted to BPA since your claim
will remain in a denied status until the requested information is returned.
The requested information can be returned to BPA
in several ways. If you were asked for a list of physicians that treated you prior
to you're your enrollment, you can supply the information at the bottom of the Explanation
of Benefits form you received and return it by mail or fax. Your provider can return
requested medical records attached to a copy of BPA's request by fax or mail. When
all of the requested information has been received, your claim will be re-opened
and a coverage determination made.
Information returned by mail should be addressed to:
Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128
The number for information returned by fax is 715-838-8507.
When faxing information to BPA, it is important that you keep a copy of the fax
machine's confirmation record which shows the date, time and phone number you faxed
the information from. Our Customer Service staff will need this information if you
call later to confirm receipt.
What is a Certificate of Creditable
Coverage form and how does it affect coverage for pre-existing conditions?
The Health Insurance Portability and Accountability Act of 1996, placed
limits on the extent to which your group coverage can exclude or limit coverage
for pre-existing conditions. It excludes coverage for the treatment of conditions
which existed within 6 months prior to your enrollment date. This exclusion complies
with state and federal laws and will not exceed a period of 12 months from your
enrollment date or 18 months from your enrollment date if you are a late enrollee.
Pre-existing conditions do not include pregnancy, pre- or post-natal care, or any
complications with pregnancy. Refer to your certificate for more detailed information
regarding the pre-existing condition limitation.
For example, if you were covered by "creditable" health insurance for 12
straight months, with no lapse in coverage of 63 days or more, prior to your enrollment
date with BPA (not a late enrollment), the pre-existing conditions exclusion of
your coverage will not apply to you.
If you had less than 12 months of prior creditable coverage,
the waiting period for coverage of a pre-existing condition will be shortened by
the number of days you were covered under the prior qualifying health plan. For
example, if you had:
the 12 month waiting period would be reduced to 9 months, due to your three
months of prior qualifying health coverage.
Most prior health coverage qualifies for this credit. It includes prior
coverage under any of the following: A group health plan; Non group or individual
health insurance; Part A or B of Medicare; Medicaid; The Active Military Health
Program or CHAMPUS; a medical program of the Indian Health Service, or of a tribal
organization; a State sponsored health benefits risk sharing pool; the Federal Employees
Health Plan; a public health plan as defined by government regulations; and The
Peace Corps Health Program.
If you had prior creditable coverage but had a claim rejected by BPA due
to a pre-existing conditions limitation or investigation, we may not have a record
of your prior coverage. In order to receive credit for the time you were covered,
you need to request a "Certificate of Creditable Coverage" form from your prior
benefits carrier. Your prior carrier is required to give you this information if
you ask for it. After receiving this form, you should attach a copy of it to the
claim determination or letter you received from BPA, then return it to us by fax
or mail.
The fax number information can be sent to is (715) 838-8507. When faxing
information, it is important that you keep a copy of the fax machine's confirmation
record which shows the date, time and phone number you faxed the information from.
Our Customer Service staff will need this information if you call later to confirm
receipt. The address for mailing this information is:
Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128
How can I verify all claims paid
for my family for the year?
Please use the "My Claims" section
of the website or contact our Customer Service Department for assistance.
What if I have expenses for an
accident or illness that may be payable by Worker's Compensation, car insurance,
or another third party?
If we receive a claim that could be the result of an accidental injury
or that may be the responsibility of a third party, you may receive a letter from
BPA requesting additional details. We ask that you please respond as soon as possible
to the inquiry by fax or by mail to avoid a denial of benefits. We are unable to
take this information over the phone. This information is important for several
reasons.
Your plan may include special benefit provisions for accidental injuries
or your health plan may not cover medical expenses resulting from a work injury.
In the case of motor vehicle accidents, we may need to coordinate our benefit payments
with your automobile or motorcycle No Fault medical coverage.
In addition, your health plan may have a right to recover payment made
on your medical bills if they were incurred for an injury or condition caused by
another party. This right falls under the subrogation and reimbursement provision
of your coverage. If we pay benefits as a result of that injury or illness, we have
the right on behalf of the plan, independently of you, to proceed against the party
responsible for your injury or illness, to recover the benefits the plan has paid.
Under certain circumstances, the plan may also be entitled to be reimbursed for
the benefits it has paid from a settlement or a judgment you receive from the party
responsible for your illness or injury.
Information returned to BPA by mail can be returned to the address indicated in
the letter you received, or to:
Benefit Plan Administrators
P.O. Box 1128
Eau Claire, WI 54702-1128
The number for information returned by fax is 715-838-8507. When faxing
information to BPA, it is important that you keep a copy of the fax machine's confirmation
record which shows the date, time and phone number you faxed the information from.
Our Customer Service staff will need this information if you call later to confirm
receipt.
How can I get a copy of my Explanation
of Benefits (EOB)?
Prescription Drug Coverage
What is a Prescription Benefit
Manager (PBM)?
If my pharmacist has a problem
processing my prescription, what should we do?
PPO
What is a preferred provider, and
how does using one affect my benefits?
Miscellaneous
How can I correct information that
BPA has on file, such as the spelling of my name, my address or date of birth?
You, or your Human Resources department may
call a BPA Customer Service Representative at 800-236-7789. You can also go to the "Online Customer Service" page of the
website and look for the link containing this question. An electronic form
will display where you can enter your correct information and submit it electronically
to BPA.
How can I obtain a copy of my ID
card?
Go to the "Online Customer Service" page of the website and look for
the link that contains this question. An electronic form will display where you
can enter your information and submit it electronically to BPA. If you are
unable to access the website, please call BPA's Customer Service at 800-236-7789.
If I elect COBRA coverage, how
can I find out my rate and verify receipt of my payment?
How can I get a Certificate of
Creditable Coverage for my next benefit plan?
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