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a complete Understanding Health Benefit Plan - …

A complete Understanding your Health Benefit plan WELCOME. DEAR plan MEMBER: Welcome to Employee benefits Administration & Management Corp. (EBA&M). EBA&M has been selected to provide administrative services to your employer's Health Benefit plan . We are dedicated to providing the highest quality service in claims administration and management of employer sponsored Benefit plans. Included in this packet you will find your identification cards. The group number is listed on the front of your identification card. These cards are important as they identify your group number and vital EBA&M contact information. You must alert your providers of the change to EBA&M.

Claims/Customer Service • 800-249-8440 WELCOME DEAR PLAN MEMBER: Welcome to Employee Benefits Administration & Management Corp. …

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1 A complete Understanding your Health Benefit plan WELCOME. DEAR plan MEMBER: Welcome to Employee benefits Administration & Management Corp. (EBA&M). EBA&M has been selected to provide administrative services to your employer's Health Benefit plan . We are dedicated to providing the highest quality service in claims administration and management of employer sponsored Benefit plans. Included in this packet you will find your identification cards. The group number is listed on the front of your identification card. These cards are important as they identify your group number and vital EBA&M contact information. You must alert your providers of the change to EBA&M.

2 Please present your EBA&M identification card each time you visit your provider. When submitting claims to EBA&M, please provide the group number and the employee's identification number on all original itemized bills. EBA&M will accept photocopies when this plan is the secondary payor. You will be contacted in writing if additional or updated information is required to provide full benefits under the plan ( , spouse's insurance, dependent status, etc.) EBA&M may be unable to pay claims until the complete information is received from you or your healthcare provider. Please submit all claims, along with any other requested information, to the address on the back of your identification card.

3 EBA&M is committed to providing you with superior quality service. If you have questions please call the following number: Claims/Customer Service 800-249-8440. EBA&M's professional staff is pleased to have the opportunity to serve you. We look forward to assisting you in receiving the benefits to which you are entitled and helping you to become a wise healthcare consumer. 1 Claims/Customer Service 800-249-8440. TAKE YOUR LINK TO CARE . WITH YOU EVERYWHERE. Your Health plan ID card is your direct link to healthcare. Remember to carry your ID card and show it to physicians, other providers and pharmacists whenever you need care or prescriptions.

4 Please encourage your healthcare providers and pharmacists to make a copy of the front and back of this ID card, as it contains information necessary for the accurate submission and processing of claims. What information is included on your EBA&M ID Card? 3. 1 Eligibility Information: Employee (The enrolled member's name); Group Number/Location Number (Your employer's assigned 2. 1. number with EBA Identification Number (enrolled member's ID number). 2 Preferred Provider Network 4. (EPO or PPO) logos: Identifies the name(s) and logo(s) of EPO or PPOs 5. your employer contracts with to ensure the best discounts for NOTE: ID Card formats vary, healthcare services.)

5 So yours may look different. 3 Pharmacy Information: Rx vendor information. 4 Member Customer Service Contact Information: Claims Questions (EBA&M Online website and Client Service Center phone number); Rx Claims (Rx Customer Service phone number); Inpatient Hospital Stays (Pre-Certification). 5 Provider Customer Service Contact Information: Hospital Pre-Certification (if applicable); Provider Questions (EBA&M Client Service Center); Claims Submittal (mailing address). Claims/Customer Service: 800-249-8440. Claims/Customer Service 800-249-8440 2. benefits . INFORMATION ONLINE. WE'VE MADE ACCESSING YOUR. benefits INFORMATION EASY!

6 How do I access this information? From the Internet, go to and click on plan Participants.. Click on the EBA&M ONLINE button to get to the User ID and Password screen. Input your User ID and Password. If you don't have one yet, click on Register. Click the drag-down menu arrow in the User Type menu and choose Employee or Dependent, then input your 5 digit Group Number. Once you do that, Employees will be asked for their Social Security Number or Member ID, while dependents will be asked for their name, date of birth and gender. You will now be asked for your address, phone number and email address. KEY FEATURES. Claims Inquiry: You can check the status of your claims 24 hours a day, 7 days a week.

7 Coverage Inquiry: Although you should always refer to the actual Summary plan Document for detailed plan benefits , you may access a summary of your benefits here. You can also verify your eligibility at any time. Links: The Links section offers you web-links to all of the various vendors associated with your plan , the PPO Network, the Utilization Review company, or the Prescription Drug plan . Frequently Asked Questions (FAQ): Here you will find a list of answers to the questions that we receive most frequently from our clients. Reimbursement plan Accounts: You can check the status of your FSA or HRA claims and balances 24 hours a day, 7 days a week.

8 3 Claims/Customer Service 800-249-8440. STRATEGIES TO HELP YOU CONTROL. YOUR HEALTHCARE COSTS. EBA& providing real solutions for healthcare cost control Employee benefits Administration & Management Corporation, (EBA&M). takes the responsibility to control healthcare costs for our members seriously. EBA&M utilizes an experienced team of claims examiners, along with sophisticated software programs, to identify specific areas where extra cost savings should occur for our members. Some estimates project $750. Recently, we have enhanced this billion annual fraud, waste and process to include a special fraud and abuse or $.30 of every Health billing abuse detection care dollar spent.

9 Analysis allows us to examine our Institute of Medicine members' medical claims for accuracy to ensure fair and consistent reimbursement to all providers. EBA&M has worked with the providers to help them understand what can be billed to you. If you are billed more than your liability of deductible, copay, coinsurance or non-covered services, please contact them to clarify the balance owed. If they continue to bill you for more than your liability, contact our Client Services at the toll free number (listed on the back of your Health plan ID card). EBA&M will work with the provider to help them further understand our coding and reimbursement policies.

10 Just as you would review a restaurant tab for accuracy, EBA&M. reviews claims of services billed ala carte to ensure they are bundled appropriately, based upon generally accepted coding and reimburse- ment guidelines. These coding rules were created by the American Medical Association in conjunction with multiple specialty societies, CMS (Medicare) and representatives from multiple healthcare insurers. A study of 40,000 hospital bills found that 97% had billing Estimated errors represent $15 billion each year. -Equifax Claims/Customer Service 800-249-8440 4. STRATEGIES TO HELP YOU CONTROL. YOUR HEALTHCARE COSTS. HEALTHCARE PROVIDERS.


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