FAQ

How do I add a newborn to my health plan? How do I take an employee off the health plan? How do I add a newly eligible employee to the health plan? How will my terminated employee(s) obtain information about COBRA? How long are the COBRA benefits available to me? When does my child's (dependent's) coverage end? Do I have wellness benefits? Is Chiropractic Care covered? Do I need to Pre-certify for hospitalization? What is my Group Number? What is my Individual Identification Number? What is the prescription mail-order program? How do I use the prescription mail-order program? How can I get a mail-order envelope? What are maintenance medications? What is my co-pay for prescription drugs? How do I know if my prescription is for a generic, preferred or non-preferred medication? How can I save money on my prescription? How do I know how much the co-pay will be for my prescription? How do I refill prescriptions in the mail-order program? What are my payment options in the prescription drug mail-order program? What if I have a question for a pharmacist? How do I access claims, verify coverage, obtain temporary cards and view the Preferred Provider (PPO) network? When applying for coverage, if I have an existing health condition, what additional information will need to be provided?

How do I add a newborn to my health plan? Please inform your employer of any status changes on your health plan, such as adding a newborn or an adopted child, an address change, or a graduating student. Your employer will use a Change Form form to notify our eligibility department. back to top

How do I take an employee off the health plan? Please use the Change Form supplied to you in your welcome packet. back to top

How do I add a newly eligible employee to the health plan? Please use the Enrollment Form supplied to you in your welcome packet. back to top

How will my terminated employee(s) obtain information about COBRA? When you terminate an employee, please complete and return the Change Form. When a completed form is received notifying us of the termination, we will automatically send the COBRA information, instructions and election form to the (terminated) employee's address on record. If the employee then chooses to elect COBRA, they will send the completed forms and remit payment directly to Consociate Dansig. The participating Employer Group is devoid of any COBRA paperwork, invoicing or payment remittances. back to top

How long are the COBRA benefits available to me? For a complete explanation of COBRA benefits, please see the COBRA section of the web site, which details your COBRA rights and instructions for election. back to top

When does my child's (dependent's) coverage end? If you are eligible for coverage, your eligible Dependent(s) may also receive coverage under the Plan, as determined by your employer. Please see the Plan Description section of the web site for more details and for a complete definition of a Dependent. back to top

Do I have wellness benefits? The AGC Health Plan offers a variety of group health plans. To check your plan: • Refer to the schedule of benefits that you received with your Plan booklet, or • View the Plan Description, refer to your group health plan, or • Call customer service at 1-888-242-4357 back to top

Is Chiropractic Care covered? Manipulation therapy is covered 90%, up to a maximum of $500 per calendar year, after deductible. back to top

Do I need to Pre-certify for hospitalization? If you or a covered dependent require emergency or scheduled hospitalization, you or your doctor must call American Health Holding at 1-866-345-3509. Failure to secure pre-admission certification will result in a $500 reduction in benefits normally paid by the Plan. Emergency admissions must be reported within 72 hours. Please refer to the Plan Description and search under Precertification for more details. back to top

What is my Group Number? You can find your Group Number [AGC7448] on the front of your health insurance identification card. back to top

What is my Individual Identification Number? A unique identification number (NOT your Social Security number) is created for each employee and their dependents. This is also the number used for prescriptions. back to top

What is the prescription mail-order program? Your prescription benefit plan includes a mail service benefit. As a result, you can order long-term medications from the Express Scripts Mail Service Pharmacy. When you use Express Scripts Mail Service Pharmacy, you receive a 3 month supply of most drugs. That adds up to big savings over the course of a year, and you can skip the trips to your local pharmacy. Your prescription is filled promptly, and standard shipping is FREE. You can order refills quickly and easily via the Internet or by phone, and you can check your order's status 24 hours a day. back to top

How do I use the prescription mail-order program? Ask your Doctor for a 12 month prescription to be dispensed every 90 days. Send the prescription in to Express Scripts in the mail-order envelope. You should order your refill at least 3 weeks before your current supply runs out. back to top

How can I get a mail-order envelope? First-time mail order pharmacy users can call Consociate Dansig Customer Service at 1-888-242-4357 to receive a mail-order envelope. A mail-in refill envelope is included with your first order. back to top

What are maintenance medications? The Mail Service Pharmacy fills prescriptions for many long-term conditions, such as asthma, diabetes, high cholesterol, hypertension, and arthritis. Medications requiring special packaging or refrigeration can also be ordered. back to top

What is my co-pay for prescription drugs? If your employer is enrolled in the prescription drug program, the co-pays are: Retail - 34 day supply Generic $10 Preferred (formulary) $25 Non-preferred (non-formulary) $40 Specialty Drug $100 Mail Order - 90 day supply Generic $30 Preferred (formulary) $75 Non-preferred (non-formulary) $120 Specialty Drug $300 back to top

How do I know if my prescription is for a generic, preferred or non-preferred medication? A formulary is a list of preferred drugs that the AGC Health Plan uses to administer prescription benefits. These medications were selected to give you the highest standard of quality and the greatest potential value. View 2008 ESI Formulary List You may also visit express-scripts.com and click on formulary lookup under benefits plan to see if your medication is on the formulary list. This search can also provide you generic alternatives available for your prescribed medication. Or you can call Express Scripts at 1-800-451-6245 and press the 0 key twice to reach a Customer Service Representative. back to top

How to I refill prescriptions in the mail-order program? A mail-in refill form is included with your first order. You can also order refills via the Internet or by phone - express-scripts.com or 1-800-451-6245. You should order your refill at least 3 weeks before your current supply runs out. back to top

What are my payment options in the prescription drug mail-order program? American Express, Discover, MasterCard, Visa and debit cards with a MasterCard or Visa logo. You may also enclose a check for your co-pay amount. back to top

What if I have a question for a pharmacist? Express Scripts pharmacists are available 24 hours a day, and they're eager to answer your questions. To contact a pharmacist, call 1-800-235-4357. back to top

How do I access claims, verify coverage, obtain temporary cards and view the Preferred Provider (PPO) network? Please contact Consociate Dansig. back to top

When applying for coverage, if I have an existing health condition, what additional information will need to be provided? If you have an existing health condition, you will be asked to complete a health questionnaire to provide the information required for the application process. back to top

Please call customer service at 1-888-242-4357 if you have additional questions, or email: customerservice@agchealthplan.com