Each full-time employee must select a medical, dental and vision plan.
Medical: Standard coordination of benefits for double coverage under medical provides the richest benefit of each plan, but does not result in double benefit.
Dental and Vision: Double coverage for dental and vision benefits does provide the full benefit available under each plan, resulting in a double benefit.
Although a full-time employee may not decline BSSP’s medical, dental or vision coverage, BSSP does provide a 25% discount to the monthly medical premiums when each spouse is enrolled as an employee and a spouse in a composite-rate plan, including the composite-rate Waiver Fee plan.
Double-covered households have the following enrollment options:
- One spouse may elect the Waiver Fee plan and receive all the benefits of the other spouse’s medical and prescription benefit.
- The Waiver Fee plan satisfies BSSP and SISC policy that requires all full-time employees participate in a medical plan, but without enrollment as a main subscriber with Anthem.
- The spouse electing the Waiver Fee plan will receive benefits as the dependent on his/her spouse’s plan.
- Each spouse can elect coverage as the main subscriber with one spouse electing the preferred plan for the family and the other spouse electing the MEC 9000:
- Two medical plans will coordinate to the richest benefit of both plans.
- Generally, a lesser plan will not reduce the deductible or out of pocket limits of a richer plan.
- Claims must be submitted to the primary plan before the secondary plan. An employee is primary on his/her own plan; secondary on his/her spouse’s. Generally, children are primary on the parent with the earliest birth date in the calendar year. You can verify under which parent the children are covered by logging into your secure benefits portal at myhealthbenefits.com.
- Each claim will apply to the deductible and out of pocket limits of both plans.
The plan in which you are the main subscriber will always be your primary coverage. The plan in which you are covered as a dependent will be your secondary, regardless of which is the “better” benefit.
For children, in most cases, coverage under the parent with the earliest birth date in the calendar year will be primary and coverage under the parent with the later birth date in the calendar year will be secondary. We encourage enrolling children under both parents.
Unfortunately, no, AmeriBen does not automatically apply your secondary coverage to your account. When you receive the Coordination of Benefits (COB) request asking to verify if there is other group coverage, it is essential for you to respond. Otherwise, AmeriBen will put any claims into a pending status until the COB is received.
The easiest way to update your COB is online via your AmeriBen portal at sisc.myameriben.com. Or, you may call Member Services at (877) 379-4844. You will need to have the group number and Member ID number of the other plan in which you are enrolled.
At the time of any MEDICAL services (doctor’s appointment, lab services, hospitalization, etc.), you will need to inform the provider that you are double covered. First, present the ID card that corresponds with the plan in which you are covered as the main subscriber, and then provide the card that corresponds with the plan in which you are covered as a dependent. You will need to instruct the provider to submit your claim to both of your policies, first to primary and then to secondary.
You will receive an Explanation of Benefits (EOB) from each plan showing what was processed under each plan and what your member responsibility is after each plan has paid its portion.
You will need to contact your provider and ask them to re-bill your services first to your primary and then to your secondary. You may need to contact Member Services at (877) 379-4844 to ensure your claim has been applied to your secondary coverage after receiving the EOB from your primary plan.
At the time of any PHARMACY services (including mail order service), you will only present one ID card. It is recommended to provide the card that corresponds to the better of the two plans in which you are enrolled, regardless if it is your primary or secondary coverage.
Unlike medical services, pharmacy benefits will only process claims under one insurance plan; they do not coordinate between multiple plans. To help identify which card to use for pharmacy benefits, we recommend writing “Rx Only” on the ID card that corresponds with the better prescription benefits.
You may be able to go back to the pharmacy where your prescription was filled and ask them to reprocess your claim under the better prescription benefit of your two plans. Otherwise, you may file a claim with Navitus to seek reimbursement.
Part-time employees may decline coverage when they become eligible to participate or during any open enrollment period.
Full-time employees may opt out of coverage, at no cost, ONLY with proof of enrollment in Medicare, Medi-Cal, Tri-Care of subsidized Covered California benefits.
Full-time employees may, where allowed by their governing collective bargaining agreement, enroll in the Waiver Fee plan at the same cost as the MEC 9000 (or HSA 5000) plan. Under the Waiver Fee plan, the employee and dependents are not eligible for services at the Health and Wellness Centers nor to submit claims for medical and/or prescription services to Anthem and/or Navitus.
The Waiver Fee plan does not reduce benefits available under another BSSP medical/prescription plan.