Question 1

What is a Qualifying Life Event?

Accepted Answer

A Qualifying Life Event (QLE) is a specific life change that allows you to make changes to your health insurance and other benefits outside of the annual Open Enrollment period. These changes are permitted because the event significantly impacts your coverage needs.

Common QLEs include:

• Marriage, divorce, or legal separation
 • Birth or adoption of a child
 • Death of a dependent
 • Loss or gain of other coverage (e.g., through a spouse's job)
 • A significant change in employment status (e.g., starting or leaving a job, changing from full-time to part-time, or retiring)
 • A change in residence that affects your coverage area (e.g., moving to a different state)
When a QLE occurs, you have a limited window of 30 days from the date of the event to make adjustments to your benefits. This could include enrolling in, changing, or canceling coverage. It's essential to act quickly and provide any necessary documentation to avoid missing this opportunity.
For more information or to report a QLE, contact your Lacher Healthcare Advocate.

Question 2

What services and screenings are covered as preventive care?

Accepted Answer

Preventive screenings can help you take better control of your health. They are an important foundation of early detection and prevention of disease.

Preventive care services are NOT subject to a copayment or deductible when using in-network providers and must be billed to insurance with proper preventive coding.

Click here (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_6fdcc551840a45419b32b0d1be1fd0be.pdf)for a list of common preventive care services covered by our medical plans.

Please note: Coverage for these services is subject to certain conditions, age and time limits.

Question 3

Why did I get billed for my preventive care visit?

Accepted Answer

While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health. When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed. However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.

Here’s how to be sure your preventive care visit is free for you:

1. Mention prevention upfront – When scheduling your appointment, confirm that you are scheduling a preventive care visit.
2. Know what to discuss with your doctor during the visit – During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.
3. Ask your doctor – If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.

For more information about preventive care, contact your Lacher Healthcare Advocate.

Question 4

When can I make changes to my benefit elections?

Accepted Answer

You can make changes to your benefit elections during your healthcare and benefits open enrollment OR if you have a qualifying life event (QLE).

A QLE is a change in your situation, like a marriage, divorce, or having a baby, for example, which allows you to make changes to your health insurance. Take a look a this document (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_1f3a5f76afda4c099b4cda248f4d49b3.pdf)for more information.

You have 30 days to submit your changes online through our benefits enrollment system.(https://hiltz.ease.com/) (https://www.dfebenefits.com/enroll)

Here's an overview (https://www.healthcare.gov/glossary/qualifying-life-event/)of qualifying life events from Healthcare.gov.

If you have a QLE, contact our Lacher Healthcare Advocate.

Question 5

How do I change my plan or enroll my dependents?

Accepted Answer

You can make plan changes and enroll dependents during open enrollment, or if you have a qualifying life event,(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_1f3a5f76afda4c099b4cda248f4d49b3.pdf) by visiting Ease.(https://hiltz.ease.com/)

Question 6

Where should I go for medical care?

Accepted Answer

Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_7164da5c27ba449badeef0713e6733be.pdf)to learn about your choices when it comes to where you should receive care.

High Level Overview:

Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:
 • PPO Plan - Choice 1 provider: $20 copay; Choice 2 provider: $40 copay
 • QDHDP Plan - Choice 1 provider: $0 after deductible; Choice 2 provider: 20% after deductible

Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:
 • PPO Plan - Choice 1 or 2 provider: $250 copay, waived if admitted
 • QDHDP Plan - $250 copay after Choice 1 deductible, waived if admitted

Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. Cost to you:
 • PPO Plan - Choice 1 or 2 provider: $75 copay
 • QDHDP Plan - $75 copay after Choice 1 deductible

Telemedicine with Capital BlueCross- Consider using telemedicine for non-life threatening conditions, and when you need 24/7 care. Cost to you:
 • PPO Plan - Choice 1 or 2 provider: $5 copay (non-specialist) / $40 copay (specialist)
 • QDHDP Plan - Choice 1 or 2 provider: $0 after deductible

Question 7

I think a provider is billing me an incorrect amount for a service, what should I do?

Accepted Answer

First, make sure you compare the bill you received with the EOB from the insurance. If you need to locate an EOB you can find one by logging into your account at https://www.capbluecross.com.(https://www.capbluecross.com) 
 
If the bill does not match the EOB, please contact your Lacher Healthcare Advocate for further assistance.

Frequently Asked Questions