Frequently Asked Questions

  1. Can I add dependents to my plan?
    Answer:

    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.

  2. 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?
    Answer:

    Participants may not have comprehensive health care benefits or insurance through other individual, family, employment-based, military or veterans cover- age or insurance.

  3. Can I use authorized, unclaimed hours from a previous month to satisfy my hour requirement in a subsequent month?
    Answer:

    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.

  4. Do I have out-of-network coverage under Kaiser Permanente?
    Answer:

    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

  5. How do I cancel my coverage and the corresponding paycheck deductions?
    Answer:

    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 received before the 15th of the month will stop further payroll deductions.

  6. How do I enroll for coverage?
    Answer:

    Individual Provider: Log on to www.myseiubenefits.org to complete enroll- ment or call the Member Resource Center at 1-866-371-3200. Agency Provider: Contact your employer to coordinate your enrollment. 

    Agency Provider: Contact your employer to coordinate your enrollment.

  7. How do I look for a provider available to me through Group Health?
    Answer:

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

    On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory”; then click on “Doctors and Other Providers”; then under “*Health plan provider network:” choose “Options PPO” or “Options POS” or “Options Select” (for the HMO plan)

     

    For PPO Plan (all others): On right hand side of www.ghc.org, under “Find a Doctor or Medical Facility” click on “Provider & Facility Directory,” click on “Doctors and Other Providers”; then under “*Health plan provider network:” 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
  8. How do I notify you that my address has changed?
    Answer:

    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 Pro-vider. If you are an Agency Provider, contact your employer to make this change.

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

    After your coverage begins, you must work at least 86 hours each month to have continuous coverage.

  10. 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?
    Answer:

    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.

  11. 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?
    Answer:

    Yes.

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

    If you are not covered by the plan for 12 months in a row, you will need to re- qualify for the initial eligibility requirements.

  13. I want to change my dental insurance provider, how can I do this?
    Answer:

    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.

  14. 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 pla
    Answer:

    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.

  15. If I cancel my insurance, can I enroll again later?
    Answer:

    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.

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

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

  17. If I haven’t received an ID card, who do I call?
    Answer:

    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 re- ceive 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.

  18. Is dental or vision coverage included with this plan?
    Answer:

    Yes. Vision coverage is part of your medical plan administered by your medi- cal health insurance provider – Group Health or Kaiser. You have the choice of dental coverage either through Delta Dental or Willamette.

  19. Is there a pre-existing condition waiting period?
    Answer:

    No.

  20. Kaiser Permanente Membership Services
    Answer:

    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
  21. Register for kaiser Online Access where you Can:
    Answer:
      li>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 a monthly e-newsletter

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

  22. What benefit plans are offered by the Health Benefits Trust?
    Answer:

    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, Kaiser Permanente, Delta Dental Self-insured Dental, and Willamette Dental Group. Trust enrollees are automati- cally 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.

  23. what does Group Health HMO vs. POS vs. PPO mean?
    Answer:

    If you live within 30 miles of a Group Health facility or contracted provider, and your coverage begins 8/1/2012 or later, you will automatically be enrolled in the HMO plan. If you are already enrolled, then your coverage is through the POS Plan.

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

    In the POS and PPO Plans, you have the choice of in-network or out-of-network providers each time you seek service.

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

    For all Grandfathered Agency Providers - (this means you were an Agency Provider and must have had health care coverage by the Trust in the month of September 2011).

    Your coverage will terminate the first day of the following month. Example: If you work less than 86 hours in May, your health care coverage will end that month and you will NOT have coverage starting June 1st.

    For all Individual Providers and all Non-Grandfathered Agency Providers Your coverage will continue for one month and end the first of day of the second month.

    Example: If you work less than 86 hours in May, you WILL have health care coverage in June, but you will NOT have coverage starting July 1st.

    If you lose coverage, you may choose to pay the full monthly (COBRA) premium out of pocket. In this case, the Health Benefits Trust will send you a COBRA notice and election form explaining your coverage option and the cost.

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

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

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

    If you are a new enrollee in the Health Benefits Trust effective 8/1/2012 or later, and you live within 30 miles of a Group Health Medical Center or contracted provider, your health care coverage is only for using Group Health Medical Centers or con- tracted providers. There is no out-of-network coverage.

    For all other enrollees, 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 (Op- tions) 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 ex- ample, you will have a $500 deductible.

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

    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.

  28. What is Kaiser Permanente’s Service area?
    Answer:

    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

  29. When can I submit my enrollment form for coverage?
    Answer:

    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.

  30. When I am outside washington state or the United States am I covered by the plan?
    Answer:

     

    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

    Delta Dental 1-800-554-1907

    Willamette (contact the clinic where the services were provided)

  31. When will my coverage be effective?
    Answer:

    Individual Providers: Call the Member Resource Center at 1-866-371-3200 to determine.
    Agency Providers: Please contact your Human Resources department to coordi- nate your enrollment.

  32. Why do you need prior coverage information?
    Answer:

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