HEALTH & WELFARE
FAQs
Find Answers to Frequently Asked Questions about Claims and Eligibility
• What is a deductible?
• What is an out of pocket limit?
• How do I find out if my provider is in the Alaska UFCW PPO network?
• How do I file a claim?
• How do I add a new dependent?
• My Explanation of Benefits shows a patient balance, but my dentist told me they would write it off. Who do I contact?
• Does my plan have a dental preferred provider network?
• How do I preauthorize a hospitalization?
Q: What is a deductible?
A: A deductible is the amount of covered charges that you must pay before the plan pays benefits.
Q: What is an out of pocket limit?
A: An out of pocket limit is the amount of covered expenses for which each covered individual must pay a portion of before the plan begins to pay covered expenses at 100% for the remainder of the policy year. For example, if the individual PPO max is $4,500, an individual would be responsible for 20% of allowable expenses until they have paid $4,500. The plan would then pay at 100% for the remainder of the year.
Q: How do I find out if my provider is in the Alaska UFCW PPO network?
A: In the Municipality of Anchorage, the Coalition hospitals are Alaska Regional Hospital and Mat-Su Regional Medical Center. Elsewhere, PPO providers (hospitals, physicians, etc.) are those in the Aetna Choice® POS II (Open Access) network. To find a PPO provider, click on the following link, select the provider type and location you are looking for and then select the Aetna Choice® POS II (Open Access) network. www.health.aetna.com/login
The Trust also contracts with the following providers, who are part of the Pacific Health Coalition: Surgery Center of Anchorage, Alaska Surgery Center and Alpine Surgery Center. The Trust offers contracted Surgery Benefit Management Services through Bridgehealth/Transcarent.
Q: How do I file a claim?
A: If you visit a preferred provider, your provider will file the claim on your behalf. It is very important that your health care provider has a copy of your current identification card to ensure that he or she files the claim properly.
If you visit non-preferred providers, they will likely require you to pay the full cash price for service at the time of your appointment. You will need to request an itemized billing to submit in this case. The claims submission address can be found on the back of your identification card.
Q: How do I add a new dependent?
A: You should complete a new enrollment form listing the dependents your wish to enroll and authorize a wage deduction for employee/child(ren) or employee/spouse and/or family coverage. You are required to provide supporting documentation such as a marriage certificate or birth certificate to enroll your spouse/children. Dependents may be added at open enrollment (if eligible), or when you reach the required coverage level for employee/child(ren) coverage, or employee/spouse and/or family coverage, or if you have a change in your marital status, or adopted or given birth to a child.
Q: My Explanation of Benefits shows a patient balance, but my dentist told me they would write it off. Who do I contact?
A: Zenith American Solutions, Inc. is not aware of agreements between you and your dentist. When benefits are processed, they are based on billed charges. Please contact your dentist, and ask him or her what your account reflects as patient balance.
Q: Does my plan have a dental preferred provider network?
A: Your plan does not have a dental preferred provider network. You can choose any licensed dentist of your choice.
Q: How do I preauthorize a hospitalization?
A: You can have your provider contact Aetna to preauthorize a hospitalization. Aetna can be reached at 888-632-3862 and their contact information is listed on the back of your identification card.