Healthcare,
Simplified.
Fixed Indemnity
Medical Plan
- Includes Inpatient and Outpatient services
- There are NO Deductibles and NO Co-pays on medical services
- Pays you money to cover your health needs
- Keep the difference if a covered event costs less than the amount paid to you
- Plan is supplemental coverage and is not ACA Compliant
- Plan ALLOWS you to receive a subsidy at the Exchange
- Other additional benefits, such as Dental and Vision, may be available
(check your enrollment booklet for personalized plan options)
Enroll or Add Benefits/Insured Members
Within 30 days of your hire date
Within 30 days of your 1st paycheck date
During Employer’s annual 30-day open enrollment period
Within 30 days from the date of a qualifying life event
Otherwise:
Wait until next annual open enrollment
Wait until you have a qualifying life event
Get Covered
Coverage for the Fixed Indemnity Medical Plan and any ancillaries selected begins the Sunday following a payroll deduction and continues as long as you have a deduction from your paycheck.
Review Your Check Stub
Make direct payments to PAI if you miss a payroll deduction to avoid a break in coverage. After six consecutive weeks without a payroll deduction, coverage will be terminated and COBRA information will be sent.
Make a Change
You may cancel or reduce coverage at any time, unless your premiums are deducted pre-tax. To make a change, call 800.269.7783 and enter your PIN CODE, found on PAGE 4 of your enrollment packet, plus the last four digits of your Social Security number (SSN). (For example, “142 + 1234”). If you do not have a PIN CODE, please contact your employer and request a change form.It may take up to three weeks for changes or cancellation to be reflected on your paycheck. Coverage will continue as long as you have a paycheck deduction.
NETWORK INFORMATION
These benefit plans offer you savings for medical care through discounts negotiated with providers and facilities in the First Health Network. Although not required, choosing an in-network provider helps maximize your benefits. When you use an in-network provider, you will automatically receive the network discount and the doctor’s office will file the claim for you. If you use a doctor who is not part of the network, you will not receive the discount, and you may need to file the claim yourself. To find a participating provider or to verify if your current medical provider is in-network, please call or visit the network websites listed below.
DO NOT CONTACT THE ABOVE NETWORKS FOR QUESTIONS REGARDING YOUR MEDICAL BENEFITS. ALL MEDICAL BENEFIT QUESTIONS SHOULD BE DIRECTED TO THE ESSENTIAL STAFFCARE MEMBER SERVICES LINE AT 1-866-798-0803.
QUALIFYING LIFE EVENTS
If you experience a qualifying life event (QLE), and wish to make changes to your health coverage, you have 30 days from the date of the event to submit supporting documentation, along with a change form, to PAI at the address found on the form. In addition, you may request a special enrollment for yourself, your spouse, and/or eligible dependents either (1) within 60 days of termination of coverage under Medicaid or a State Children’s Health Insurance Program (SCHIP) or (2) upon becoming eligible for SCHIP premium assistance under these medical benefits. A qualifying life event is defined as a change in your status due to one of the following events:
Marriage or Divorce
Termination
Loss of Dependent Status
Loss of Prior Coverage
Employer Bankruptcy
Medicare Entitlement
Birth or Adoption of a Child(ren)
Reduction of work hours (under 30)
Death of an Immediate Family Member
FREQUENTLY ASKED QUESTIONS
If you enroll in the Fixed Indemnity Medical Plan, you may still be eligible to receive a subsidy.
The Affordable Care Act (ACA) mandates that each individual has health insurance. If you do not meet that mandate, you are open to being taxed for not having health insurance. The Fixed Indemnity Medical Plan does not satisfy the Individual Mandate, and you may be taxed if you fail to purchase an ACA approved plan.
Oral contraceptives are covered under the prescription benefit with the Fixed Indemnity Medical Plan. Non-oral contraceptives are not covered.
There are no restrictions for pre-existing conditions for the ESC medical plan. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.
If enrolled in the Fixed Indemnity Medical Plan, you are automatically covered by the discount prescription drug program. For generic and brand prescriptions, present your ID card at a participating pharmacy to receive discounts. Generic and brand prescriptions are payable based on the schedule of benefits up to the annual prescription drug maximum. To file a claim for reimbursement, save your receipt and remit to Planned Administrators, Inc. Prescription drug coverage is not provided for drugs administered during a physician office visit or hospital stay.
Yes. Maternity benefits are covered the same as any other condition.
Yes. Eligible dependents include your spouse and your children up to age 26.