Benefits Administration

Frequently Asked Questions

 

What is the last date to file Capital Blue Cross claims for the CMM Plan, PPO 80, and PPO 100? 

Claims must be filed within twelve (12) months of the date of service for any of these Capital Blue Cross medical plans.

What are the steps for completing an enrollment in any medical plan? 

Step 1:  Elect the coverage on your flexible benefits enrollment form or complete the annual online open enrollment process.

Step 2:  Complete a Medical Enrollment/Change Application form and forward it to Human Resources. If the medical plan you select requires that you choose a primary care physician, your application must include that information or it will not be complete. Your enrollment (and provider choice, if required) is then communicated to the plan by Human Resources.

You must complete Step 2 for coverage to be accessible. It is your responsibility to complete both steps of the enrollment process. Your failure to do so does not constitute a Qualifying Life Event and will not permit you to dis-enroll from a plan you have initially selected before the next open enrollment period (the following November).

If I select the HMO, can I change my primary care physician? 

Yes. You can change your Keystone HMO primary care physician by calling Keystone Member Services at 800-216-9741. The change is normally effective the first of the month following the request. Please keep this in mind when scheduling appointments.

How often can I change from one health insurance coverage plan to another? 

You can change to another plan ONLY during the Open Enrollment period, typically held from mid-November to mid-December. If you are dissatisfied with your current coverage, please contact Human Resources. It is important to tell us about any problems you encounter.

I am getting married soon. Can I add my new spouse and/or stepchild(ren) to my coverage or do I have to wait until there is an open enrollment period? 

You have thirty (30) days from the date of marriage to add your spouse and/or stepchild(ren) to your health and/or dental coverage, purchase dependent life insurance, and/or increase your supplemental life insurance. After 30 days, you must wait for the next open enrollment period. If your spouse has access to health insurance through his or her employer, keep the spousal surcharge in mind when considering adding your spouse to your medical plan. See page 9 in the Flexible Benefits Enrollment and Reference Guide for additional information. To enroll your new spouse and stepchild(ren) you must contact Human Resources, provide a copy of your marriage documentation, and complete the appropriate documents.

How do I enroll my domestic partner and his/her dependent children in the plan? 

The process for adding a domestic partner and his/her dependent children to your benefits program is similar to the process of adding any new dependent(s), with one exception. You and your partner will first need to affidavits to document and provide evidence that you are involved in a committed relationship. The affidavits and other domestic partner forms are available in the benefits section of the forms page. The completed affidavits are filed and retained in Human Resources.

Once the affidavits are done, you can complete a Personal Information Change Form. On this form you’ll provide the names, dates of birth, and Social Security numbers of your dependents.

To include these dependents in the annual online open enrollment process, all you need to do is indicate your coverage choices on the available screens. For example, if you want life insurance for your partner, you’ll need to elect Dependent Life Insurance and identify the level of insurance you want to purchase. For medical plans, you’ll select your plan choice and then indicate the level of family coverage you need. You’ll also have to complete a medical coverage enrollment form for the carrier you select — including primary care physicians if you elect Keystone Health Plan coverage.

At any other time during the benefit plan year, you will have 30 days from the beginning of the partnership to add your partner and his or her dependent child(ren) to your health and/or dental coverage. After 30 days, you must wait for the next open enrollment period.

Keep the spousal/partner surcharge in mind when adding your spouse/partner to your medical plan. See page 9 in the Flexible Benefits Enrollment and Reference Guide for additional information. You must contact Human Resources and complete the appropriate affidavits.

Also, if you elect medical coverage for a domestic partner and/or the child(ren) of that partner, you will incure a tax liability equal to the value of the benefits provided unless your partner and his/her child(ren) are tax qualified dependents pursuant to section 152 of the Internal Revenue Code.

Please see Tax Information On Health Benefits for Domestic Partners on the HR Website. You are also urged to consult with your personal tax advisor or attorney.

 

I am expecting a baby soon. Can I add the baby to my coverage? 

 

You have thirty (30) days from the date of birth or adoption placement to add a child (under age 19) to your medical and/or dental coverage. You must contact Human Resources, provide proof of birth or adoption placement, and complete the appropriate documents.

Can my grandchild or niece/nephew be covered under my health plan? 

The child must meet certain qualifications to be covered under your health plan. If the child:

  • Is under age 26
  • Doesn't have medical coverage from his or her own employer
  • Is living in a parent-child relationship with you and economically dependent upon you
  • You have legal guardianship of or formally adopted the child,

he or she may be covered under your health plan. The natural parent cannot be living in the same household as the child. If disabled, special rules apply. The dependent must be enrolled within thirty (30) days from the date of legal custody or during open enrollment. You must contact Human Resources, provide proof of custody, and complete the required documents. 

 

Can my dependent parents be covered by my medical plan? 

 

No. Even if totally dependent on the employee, parents are not eligible for coverage. 

Can I submit claims to my Health Care Spending Account for my dependent parents? 

Yes, you can submit claims for any person who is financially dependent on you and that you claim as a dependent on your income tax return. You can also submit claimes for your adult child(ren) under 26 years of age, regardless of whether they are covered by your medical insurance.

My child just turned age 24 and has no health insurance plan. Can he or she stay covered on my medical plan?

Children of employees may be covered up to age 26 if they do not have access to health insurance through an employer. This access includes Lehigh's medical and vision plans only. All other past restrictions --- including marital and full-time student status, and financial dependence --- no longer apply. If disabled, special rules apply. Please contact Human Resources for information

I am helping my 25-year old pay for major dental work. Can I be reimbursed through my Flexible Spending Account (FSA)?

Yes, you can. As a result of The Affordable Care Act, qualifying medical expenses incurred by your adult child (under 26 years old) are eligible for reimbursement through your FSA. The same documentation requirements apply.

 

I am considering using the mail order drug program for my routine, maintenance medication. What is the cost? 

 

The cost of a three-month supply of prescription drugs through Express Scripts is 10 percent of the average wholesale price (AWP) for generic drugs up to a maximum cost of $75 and 20 percent of the AWP for brand names up to a maximum cost of $150. Remember that your final cost may be lower than at your local pharmacy because the mail program buys drugs in larger quantities. You share in the savings larger quantity purchases may produce. Check prescription prices with Express Scripts using the telephone number on your ID card.

How are diabetic supplies covered by university-sponsored medical plans? 

The Express Scripts drug card program covers insulin, diabetic tablets, syringes, and diabetic supplies. All university medical plans provide coverage for diabetic supplies (glucose monitors, lancets, test strips, insulin pumps, infusion pumps, injection aids), orthotics, and self-management education programs.

  • The CMM fee-for-service plan covers these latter supplies without referral under the standard deductible/copayment benefit.
  • PPO 80 subjects Durable Medical Equipment (DME) supplies to deductible and copayment as well.
  • PPO 100 covers 100 percent of the cost of the latter supplies only with a prescription and only at a DME provider.
  • Keystone Health Plan Central (KHP) offers two different levels of coverage — 100 percent at a DME provider (with a referral and prescription) or 50 percent at a pharmacy (with a prescription and KHP ID card). Insulin is covered only at 50 percent, regardless of purchase location.

How does my medical plan work outside the United States?

All four of Lehigh's medical coverage plans are administered by Capital BlueCross, which is a member of the BlueCross-BlueShield Association. That affiliation makes the Bluecard Worldwide program available to employees and dependents covered under any Lehigh medical plan. BlueCard Worldwide provides access to an international network of traditional inpatient, outpatient, and professional healthcare providers, as well as participating hospitals around the world.

If you plan to travel outside the United States, you can find information about the program and its services --- including the process for locationg a doctor or hospital --- by visiting: http://www.bcbs.com/already-a-member/coverage-home-and-away.html, or by calling 800-810-BLUE. Outside the United States, call the service collect at 804-673-1177.

If you are enrolled in the CMM Plan, PPO 80, or PPO 100 medial plan --- and receive services or supplies from BlueCard Worldwide providers or facilities --- those charges will be processed as in-network, meaning that you will be responsible only for any co-insurance, deductible, or co-payment imposed by your medical plan. You would be asked to pay only your portion of plan charges at the time of service, and the provider would file a claim with the medical plan on your behalf. Balance billing would not apply.

If you are enrolled in the Keystone HMO --- and receive services or supplies from BlueCard Worldwide providers or facilities --- the plan will cover urgent or emergency care you receive, just as it does when you receive such care in the U.S., but outside of Keystone's twenty-one-county service area. Payment and billing would work just as they do here. You should always contact your primary care physician (PCP) as soon as you reasonably can after receiving out-of-area services or supplies. This will allow your PCP to continue to manage your care, in part, by keeping in touch with the plan about treatment you've received and authorization for further services or supplies. Your PCP's telephone number is printed on the front of your member ID card. Remember that routine medical care is not covered outside of the Keystone plan service area.

Doctors to whom BlueCard Worldwide would refer you meet program quality of care standards, such as speaking English and being acquainted with U.S. treatment practices and standards. That added knowledge could be useful since only medical treatments and supplies approved by the FDA are covered by American medical plans.

Is there any other assistance available to me if I need medical services outside the United States?

If you are traveling on university business outside the U.S., you can use the International SOS program travel services assistance plan. If you become injured or ill while traveling within covered areas, the program will provide medical, personal, travel, and security assistance services to you and accompanying family members. International SOS is not medical insurance, but it is another source of support while on university business outside the U.S. You can learn more about the program --- and other university travel insurance issues --- from the International Programs office (610-758-3351) or the Risk Management office (610-758-3899).

Can I continue my health benefits if I resign? 

Yes. COBRA continuation coverage provides you the option of continuing your medical and/or dental plan for up to eighteen (18) months. You would be responsible for paying the entire premium amount to Ceridian (Lehigh’s COBRA administrator) plus a two (2) percent administrative fee. The provisions of COBRA also apply to dependents who lose coverage. Contact Human Resources for further information. You can also contact Ceridian directly at 800-877-7994. 

If I am disabled on a long-term basis, will I continue to receive income? 

If you experience an eligible disability for a period exceeding six (6) months, you may receive 66-2/3 percent of your pre-disability LTD Base Salary. This benefit is offset by any Worker’s Compensation or Social Security disability benefits, and is provided under a group long-term disability policy with Lincoln Financial.

What is the difference between pre-tax and post-tax long-term disability (LTD) plans? 

If you purchase LTD coverage on a pre-tax basis, this means you pay federal income tax on the benefit if you become disabled but you pay no federal income tax on the premium. If you choose the post-tax option, you pay federal income tax on the premium but no federal income tax on the benefit (or income) if you become disabled. It is necessary to pay for the benefit on a “post-tax” basis for a period of 36 months to make the benefit 100 percent free of federal taxation. If you have paide the premium on a post-tax basis for less than 36 months, you will receive a pro-rated tax savings.

2007 Human Resources, Lehigh University, 428 Brodhead Ave., Bethlehem, PA 18015
Tel (610) 758-3900 Fax (610) 758-6226