Frequently Asked Health Benefits Questions

Printer-friendly versionPrinter-friendly version

COVERAGE BASICS
 

1. When I am outside Washington state or the United States am I covered by the plan?

Yes, but you must contact the health insurance provider for specific benefits and claim submission procedures at:
Group Health 1-888-901-4636
 Kaiser 1-800-813-2000 
Premera Blue Cross 1-800-722-1471 
Willamette (contact the clinic where the services were provided)

2. Can I add dependents to my plan?

Individual Provider: Dependents are not covered. The Individual Provider benefits do not allow coverage for dependents under this plan. 

Agency Provider: If you are covered by the Health Benefits Trust, you can cover dependents by paying the full premium for them through payroll deduction. Dependents can only be added when they are initially eligible or during the annual open enrollment period. Check with your employer for information.

3. How do I cancel my coverage and the corresponding paycheck deductions?

The request must be made in writing and sent to the Health Benefits Trust via fax or U.S. Mail. Fax to 206-859-2637 or mail to SEIU Healthcare NW Health Benefits Trust PO Box 6, Mukilteo, WA 98275. Requests in writing before the 15th of the month will stop further payroll deductions.

4. If I haven’t received an ID card, who do I call?

Allow up to 10 days after your coverage begins for processing and mailing your ID cards. After you enroll and are eligible you should receive an ID card in the mail. You will need the ID card number to access your benefits. If you do not receive the card by the 10th of the month that your coverage starts, call the MRC at 1-866-371-3200 if you are an Individual Provider or if you are an Agency Provider, talk with your employer. Look for and write down your nearest Urgent Care Center and keep it with your card for reference.

5. Is dental or vision coverage included with this plan?

Yes. Vision coverage is part of your medical plan administered by your medical health insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Premera Blue Cross or Willamette.

6. Is there a pre-existing condition waiting period?

Yes. It is a 3-month waiting period unless you have had prior documented creditable group coverage which can be used as a credit toward the waiting period.

 


 

ELIGIBILITY
 

How do I enroll?7. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month?

No. For the purpose of health care insurance eligibility, hours are only applicable to the month in which they are authorized, not when they are claimed or paid.

8. How do I enroll for coverage?

Individual Provider: Log on to www.myseiubenefits.org to complete enrollment or call the Member Resource Center at 1-866-371-3200.

Agency Provider: Contact your employer to coordinate your enrollment. 

9. How many hours do I have to work for continuing coverage?

After your coverage begins, you must work at least 86 hours each month to have continuous coverage.  The work requirement in each Home Care Aide’s governing Collective Bargaining Agreement (CBA) determines their eligibility for the Trust’s benefits.  Agency Providers should check the CBA for their agency to see if it has a different work requirement than 86 hours.

10. I don’t have enough hours some months resulting in a lapse in coverage, do I have to meet the initial eligibility requirements again?

If you are not covered by the plan for 12 months you need to re-qualify.

11. I work for a Home Care Agency and I’m also an Individual Provider. If I’m currently enrolled in my agency employer’s plan, can I terminate that coverage and enroll in the Health Benefits Trust as an Individual Provider instead of keeping my agency plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. You’ll need to keep your current plan until your coverage as an Individual Provider begins. NOTE: You cannot be covered under both the Health Benefits Trust as an Individual Provider and another employer’s plan.

12. What happens if I work less than 86 hours in a month after I am enrolled in the plan?

You will NOT have coverage the second month following the month you worked less than 86 hours.

Example: If you work only 50 hours in September, no deduction will be taken from your October paycheck and you will not have coverage for the month of November.

However, if you do not work enough hours in a month, you may choose to pay the full monthly (COBRA) premium yourself. The Health Benefits Trust will send you a COBRA notice and election form and if you sign-up for COBRA benefits, you will receive a bill for payment.

13. When can I submit my enrollment form for coverage?

Individual Provider: You should enroll as soon as you have authorization to work as an Individual Provider.

Agency Provider: Contact your employer to coordinate your enrollment. 


 

MISCELLANEOUS
 

14. I am an Individual Provider. What if I report my hours to Social Service Payment System (SSPS) so late that they don’t make the $25 deduction from my check?

You will need to notify the Health Benefits Trust and mail in a check or money order for $25 payable to SEIU Healthcare NW Benefits Trust, PO Box 6, Mukilteo, WA 98275. You will also need to send a copy of your paycheck stub (aka Remittance Advice) and invoice showing you claimed at least 86 hours for that month.

It is very important to report your hours to SSPS in a timely manner to avoid having to make a payment by mail. Your health insurance provider may not be able to verify your eligibility and your coverage will be considered lapsed until we receive your check and supporting documentation.

15. Can I be covered by another plan at the same time that I’m enrolled in the Health Benefits Trust Plan and use it as secondary coverage?

As in Individual Provider or Agency Provider, participants may not have  other coverage. This includes Basic Health Plan, another employer’s coverage or another family member’s coverage. The only exception is that you may retain Medicare or Medicaid coverage while enrolled in the Health Benefits Trust Plan.

16. How do I notify you that my address has changed?

A request for an address change must be made to either your DSHS case worker or to Social Service Payment System (SSPS) directly if you are an Individual Provider. If you are an Agency Provider, contact your employer to make this change.

Is dental or vision coverage included?17. I currently have coverage, but not through the Health Benefits Trust plan. Can I enroll in the Health Benefits Trust plan if my other current coverage terminates?

Yes.

18. I want to change my dental insurance provider, how can I do this?

Typically, this is only allowed during the annual open enrollment period that takes place in July of each year and has an August 1 effective date. If you are an Agency Provider, please contact your employer about open enrollment or other location change options available. If you are an Individual Provider, please call the Member Resource Center toll-free at 1-866-371-3200 about options for changing dental insurance providers.

19. If I cancel my insurance, can I enroll again later?

Yes, but if you have voluntarily cancelled your coverage, you will have to meet the initial eligibility requirements again in order to regain coverage. If you are an Agency provider, you cannot enroll again until the next annual open enrollment.

20. If I have coverage through my spouse, can I cancel that coverage and sign up for the Health Benefits Trust plan?

Yes, but please keep in mind the initial eligibility requirements when determining your cancellation date. 

21. What benefit plans are offered by the Health Benefits Trust?

Currently, three insurance providers provide fully insured medical and/or dental coverage and one insurance provider provides self-insured dental coverage. Providers currently include: Group Health Options, Kaiser Permanente, Premera Blue Cross Self-insured Dental, and Willamette Dental Group. Trust enrollees are automatically enrolled in the Group Health coverage unless they reside in the Kaiser Permanente service area (southwest Washington and Portland, OR areas).  Trust enrollees have a choice of dental insurance providers.

22. What if I am currently on COBRA through another plan? Can I cancel COBRA and enroll?

Yes. There is a place on the enrollment application to indicate the current plan termination date. 

23. What if I have Washington’s Basic Health Plan (BHP) coverage? Can I enroll in this plan?

Only if you cancel your BHP coverage. You cannot have both. There is a place on the Health Benefit Trust’s enrollment application to indicate the termination date of the current coverage. 

24. When will my coverage be effective?

Individual Providers: Log on to www.myseiubenefits.org and use the eligibility calculator to estimate when your coverage will begin or call the Member Resource Center at 1-866-371-3200.

Agency Providers: please contact your Human Resources department to coordinate your enrollment. 

25. Why do you need prior coverage information?

HIPAA Law allows prior group coverage to be used as a credit toward the required pre-existing condition waiting period.

 

 

Group Health Options 1-888-901-4636 www.ghc.org

Kaiser Permanente 1-800-813-2000 www.kp.org

Premera Blue Cross (Dental) 1-800-722-1471 www.premera.com

Willamette Dental 1-800-359-6019 www.willamettedental.com

 


 

Group Health Options Specific Questions

 

26. What if I don’t want to see any doctors who practice with Group Health Medical Centers?

Each time you seek health care services, you can choose to use your in-network providers, or not. Your highest level of benefits ($0 deductible) will be found using in-network providers:  Group Health Physicians for the POS (Options) plan and First Choice Health Network / Beech Street Network of Providers for the PPO (Options PPO) plan.  

You will pay more out of pocket costs by using an out-of-network provider.  For example, you will have a $500 deductible.

27. What does Group Health Options POS vs. PPO mean?

If you live within 30 miles of a Group Health facility or contracted provider, you will automatically be enrolled in the POS plan.  

If you live beyond 30 miles, you will automatically be enrolled in the PPO plan.  

In both plans, you have the choice of in-network or out-of-network providers each time you seek service.

28. How do I look for a provider available to me through Group Health Options?

For POS Plan (within 30 miles of Group Health facilities):  

On left hand column of www.ghc.org, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and choose “Options.”

For PPO Plan (all others):

On left hand column of GHC website, click on “Doctors & Healthcare Services”; then click on “Provider Directory”; then click on “Select a health plan provider network” and choose “Options PPO.”

Or call Group Health Customer Service toll free: 1-888-901-4636 

• Finding a provider

• Specific benefit questions

• Complex medical care case management

• Inpatient care case management

29. How do I look up my Group Health Medical Centers providers?

On the left hand side of the www.ghc.org website, click “Pharmacy Services.”

 

Group Health Options 
Point of Service POS Plan (POS)

You will be automatically enrolled in this plan if you live within 30 miles of a Group Health Medical Center facility or contracted provider.  

Group Health Options, PPO Plan

You will be automatically enrolled in this plan if you live farther than 30 miles from a Group Health Medical Center facility or contracted provider.  

You can choose to access coverage in- or out-of-network each time you seek service. You do not have to see the physicians who practice at Group Health Medical Centers locations, although use of these providers will give you the most cost savings.

The First Choice Health Network has an extensive panel of preferred providers in WA, OR, ID, AK and MT.  Beech Street providers are located in all other states. 

“Options” 

Options is the POS plans giving you in-network access to Group Health Medical Centers care, and care from contracted providers. Out-of-network care is provided by First Choice Health Network Providers.

“Options PPO” Network

In-network care is provided by First Choice Health Network and Beech Street providers. Out-of-network care is provided by any other licensed provider.

 

Link to look up both Options and Options PPO Providers.

http://myseiu.be/imSCSp

Pharmacy  www.ghc.org/pharmacy/index.jhtml

POS Plan

PPO Plan

In-network: Any Group Health Medical Centers or contracted community pharmacy.;   

Out-of-network:  Med Impact Pharmacies 

In-network: Group Health Medical Centers and MedImpact pharmacies. 

Out-of-network:  All other pharmacies

 

Options and Options PPO Providers http://myseiu.be/imSCSp

Pharmacy www.ghc.org/pharmacy/index.jhtml


 

Kaiser Permanente Specific Questions

30. What is Kaiser Permanente’s Service area?

If you live in any of the following counties/zip codes, your medical coverage will be provided by Kaiser Permanente’s HMO plan.

Washington counties:  Clark, Cowlitz, Lewis 98591  98593  98596, Skamania 98639  98648, Wahkiakum 98612 98647

Oregon counties:  Multnomah, Polk, Washington, Yamhill

31. Do I have out-of-network coverage under Kaiser Permanente?

No (with the exception of emergency services).  To access your comprehensive coverage, you must use a Kaiser Permanente provider/facility.

www.kp.org

Link to find Kaiser Permanente Providers

http://myseiu.be/mTdBBa 

32. Kaiser Permanente Membership Services

Or call Kaiser Permanente Membership Services toll free: 
1-800-813-2000 

• Choose a primary care provider

• Specific benefit questions

• Complex medical care case management

• Inpatient care case management

• Speak to an advice nurse

• Ask about Kaiser Permanente facilities across the country

33. Register for Kaiser Online Access

E-mail your doctor’s office

View select test results

Order prescription refills (and have them mailed to you, with free shipping)

Request or cancel routine appointments

Review recent past office visits

See a list of your recent immunizations and allergies

Act for a family member (e-mail your child’s doctor, and more)

Receive our monthly e-newsletter

Register at https://members.kaiserpermanente.org/redirects/register/