Frequently Asked Questions
Q – HOW AND WHEN CAN I ENROLL IN BENEFITS?
A – As a new employee, you are eligible on the first day of your employment. If you are not a new employee, you must enroll in benefits during open enrollment on January 1. Some exceptions are if your current health insurance plan’s contract ends mid-year or your church is newly accepted into the Covenant family. Enroll in benefits by requesting an application from Covenant Benefits.
Q – I RECEIVE HEALTH INSURANCE THROUGH MY SPOUSE’S EMPLOYER. CAN I APPLY FOR LIFE AND LONG-TERM DISABILITY BENEFITS ONLY? AND CAN WE ENROLL IN COVENANT BENEFITS HEALTH INSURANCE IF MY SPOUSE LOSES HIS COVERAGE?
A – If you are working full-time (averaging 30 or more hours per week), you may waive health insurance if you receive health insurance through your spouse’s employer (or your own secondary employer) and enroll in life and long-term disability benefits only (and dental and vision, if you choose).
In order to enroll in health insurance when your spouse loses their employee benefits, you must be enrolled in life and long-term disability through Covenant Benefits. If you are working part-time (averaging 20 and 29 hours per week), you are not eligible for life and long-term disability benefits and may enroll in health insurance at any time in the year if your spouse loses his/her coverage.
Q – WHAT IS A DEDUCTIBLE AND HOW DO MY MEDICAL BENEFITS WORK?
A – The deductible is the amount you must pay before your insurance starts paying your eligible medical bills. The coinsurance, or out-of-pocket, is the percentage of your eligible medical bills which Highmark Blue Cross Blue Shield pays after you have paid the deductible. The maximum out-of-pocket is the limit of what you will pay for in-network medical and prescription costs, including your deductible, copays, and coinsurance. After you have paid the maximum out-of-pocket, all covered in-network medical and prescription expenses will be covered 100%.
Q – WHY SHOULD I GO TO AN IN-NETWORK DOCTOR OR HOSPITAL?
A – You receive a higher level of benefits from in-network providers, which saves you money. Also, in-network providers are given a maximum amount they are allowed to charge you and any extra money they request is denied. Out-of-network doctors do not have a maximum amount they are allowed to charge, and often bill you for the extra amount the insurance company will not pay (this is called above the Usual, Customary, and Reasonable Allowance).
Another convenience is that in-network doctors file your claims for you and send your bill later, while out-of-network doctors require you to pay the full amount and file a claim for reimbursement yourself.
Q – I RECEIVED A BILL FROM MY DOCTOR THAT DOESN’T SEEM RIGHT. WHAT SHOULD I DO?
A – If you think you have been charged an incorrect amount for a doctor’s visit or procedure, call the insurance company to make sure the claim has been received and processed (See Contacts page). If you are unable to resolve the issue with the insurance company, contact Covenant Benefits. We will guide you or act as your liaison to make sure your claim has been paid correctly, and you are being charged the correct amount.
Q – I JUST HAD A BABY. DO I HAVE TO DO ANYTHING TO ADD THEM TO MY ACCOUNT?
A – Yes. Please have your employer add the baby to your policy through the online portal within 60 days of your baby’s birth or adoption. Legal documentation (I.e. birth certificate, marriage certificate, court order) may be requested when dependents are added to your policy.