FREQUENTLY ASKED QUESTIONS

WHAT IS THE PATIENT’S POLICY ID NUMBER?

The policy ID Number is the Social Security Number of the employee. 

 

WHAT IS THE PATIENT’S GROUP NUMBER?

The Group Number is the three digit number on the patient's ID card right below the Member's Name.   

 

DOES THE MEMBER HAVE FAMILY OR INDIVIDUAL COVERAGE?

All of our active members have family plans.  There is no additional cost to add eligible dependents.  Members who are on retiree plans should contact Customer Service to see if their plan allows them to add dependents.

 

WHO CAN HELP ME WITH QUESTIONS ABOUT CLAIMS, BENEFITS, AND ELIGIBILITY?

Our Customer Service staff is available by phone Monday – Friday from 8 am – 5 pm.  You can also get assistance in person at our Salt Lake City office located at 2621 South 3270 West (North of the Local 222 Union Hall). 

 

WHERE SHOULD CLAIMS BE SUBMITTED TO?

Currently we are not accepting electronic claims.  All claims should be submitted by mail.

All claims for Medical, Dental, Vision and Short Term Disability should be submitted to:

                        GROUP BENEFIT ADMINISTRATORS

                        PO BOX 30749

                        SALT LAKE CITY, UT  84130

 

WHAT IS A PREFERRED PROVIDER?

A preferred provider is a doctor or facility that has signed a contract or agreement with a network.

 

HOW CAN I FIND OUT IF A DOCTOR OR FACILITY IS A PREFERRED PROVIDER?

You can find out if your doctor is a preferred provider by contacting the preferred provider network.

 

HOW CAN I FIND A PREFERRED PROVIDER IN MY AREA?

You can locate a preferred provider in your area by calling the preferred provider network or by visiting their website.

 

WHAT IS HIPAA?

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's health care system will improve the use of electronic data interchange. 

 

WHAT CAN I DO IF I AM UNHAPPY WITH THE WAY A CLAIM WAS PROCESSED, OR IF A CLAIM WAS DENIED?

The patient or an Authorized Representative has a right to appeal the decision to deny benefits or pay at less than 100% to the Board of Trustees following the appeal procedures described below.  If you appeal you will receive a full and fair review of your claim and this decision.

1. You must file your appeal in writing within 180 days of the date you received the Notice of Benefit Determination, and your appeal must set forth the reasons of your appeal.
2. You may submit written comments, documents, records and other information relating to the claim, all of which should be submitted with your appeal in order to be considered. 
3. Upon request, and at no charge, you may obtain reasonable access to, and copies of, all documents, records and information relevant to your claim for benefits. 
4. The review will take into account all comments, documents, records and other information submitted that relates to the claim.  This would include comments, documents, records and other information that either were or were not submitted previously or were or were not considered in the initial benefit decision.  The Board of Trustees was not involved in the initial decision, and its members are not subordinates to the person or persons involved in the initial decision.
5. If your benefit denial or payment at less than 100% was based in whole or in part on a medical judgment, the Board of Trustees will consult with a health care professional with training and experience in the relevant medical field.  This health care professional was not involved in the initial decision, and is not a subordinate of any health care professional who was involved in the initial decision.  If the plan has obtained or will obtain medical experts in connection with your claim, they will be identified, regardless of whether the plan relies on their advice in making any benefit determinations.

Time Period for Appeal Decision

If you appeal, you will be notified of the decision following the review as soon as possible, but no later than five days after the Board of Trustees makes its decision.  The Board of Trustees will make its decision at its next regularly scheduled meeting following the receipt of your appeal.  However, if you file your appeal within the 30-day period prior to that meeting, your appeal may not be decided until the second quarterly Board of Trustees’ meeting following receipt of the appeal.  If special circumstances require additional time for investigation of the facts, you will be notified in writing in advance, of the extension, the special circumstances, any additional information required from you, and the date on which your appeal will be decided.  The extended date for this decision will not be later than the third quarterly Board of Trustees’ meeting following receipt of your appeal, unless such date is suspended based upon your failure to provide information requested in the notice of extension.  You have the right to bring a civil action under ERISA §502(a) if you file an appeal and your request for benefits is denied or paid at less than 100% following review.  Please carefully review the above information.  If you decide to appeal this decision by requesting a review as described above, your appeal must be sent within 180 days to:                                             TRUSTEE APPEALS

P.O. Box 25117

Salt Lake City, UT 84125

Phone: (801) 972-1177 or Toll Free: (800) 657-5377 or FAX (801) 972-3364

If you fail to appeal within 180 days after receipt of the Notice of Benefit Determination, you waive your right to a plan review of this benefit determination.