The company benefits marketplace is unpredictable and complicated.

Making good company benefit decisions requires specialized knowledge that only comes with years of experience

At Tailored Benefits we want to take the confusion out of your company benefit solutions, so we'd like to share our knowledge with you.

Here are some answers to some Frequently Asked Questions about Company Benefit Program Planning and Administration, and a useful Glossary of Health Insurance Terms

			I have ordered new insurance cards. How long will it take me to receive the cards?
			It will take approximately 7 to 10 business days for you to receive your new identification cards. If you have not received them by this time, please contact your customer service representative.

			I have just enrolled on my employer's group insurance. Will I be subject to a waiting period for pre-existing conditions?
			If you had prior coverage within the past 63 days, then the amount of time you were covered under the prior carrier will count toward the pre-existing condition time limit for this plan. If you did not have prior coverage, then you will be subject to pre-existing limitations. The pre-existing limitations vary, so please contact your customer service representative for the details of your plan.
			I am having problems getting my claims paid. Who can help me?
			WE CAN!!! Just call your Tailored Benefits customer service representative and we will help you to resolve any claims issues.
			What is my deductible?
			A deductible is a specified dollar amount of covered services that must be incurred by you before your plan will provide benefits for all or part of the remaining covered services. Deductibles vary by plan; please refer to your benefit booklet or call your customer service representative to determine the dollar amount of your deductible.

			Do I need a referral to go to a doctor other than my primary care doctor?
			This varies according to your plan. Please contact your customer service representative before you seek care, for the details of your plan.
			What do I do if I need a prescription filled before I receive my identification card?
			You will need to pay the full price for the prescription and send the receipt from the pharmacy to us. We will file the prescription for you with your insurance carrier and you will be reimbursed all but the member responsibility.
			I went to the pharmacy to get a prescription and I had to pay more than my copay, why?
			This could be for a variety of reasons. Please contact your customer service representative and we can contact the pharmacy and insurance company to assist you in finding out why you paid more than your copay.
			Do I have coverage for routine physical exams?

			This varies according to your plan. Please contact your customer service representative for details on your plan benefits.
			What are the procedures I need to follow if I go to the emergency room?
			If your plan requires you to elect a primary care physician, then you will need to contact that primary care physician before going to the emergency room. If it is after hours or on the weekend, then you must contact your primary care physician as soon as possible, usually within 24 hours, or on the next business day. Please remember that if this is not an emergency medical condition, all services will be denied.
			What doctors and hospitals can I go to with my plan?
			When you enrolled on the plan, you should have received a provider directory. If you did not or it is more than 6 months old, please see your employee benefits coordinator for a new directory. You can also contact your customer service representative if you need a directory or need to know right away if a provider is on your plan.
			I just got married. I have a newborn. How do I add them to my plan?

			You need to see your employee benefits coordinator for an enrollment change form. You must complete this form within 30 days of the event for the effective date of coverage to be the date of the event. If you do not, then your new dependents may not be able to enroll until your group's open enrollment and may be subject to pre-existing condition limitations.
			What is the difference between my deductible and my out-of-pocket?
			Your deductible is a specified dollar amount that must be incurred by you before your plan begins paying benefits. Your out-of-pocket is a specified dollar amount that you must pay after your deductible has been met. The out-of-pocket limit is met on charges that you pay a portion and the insurance company pays a portion, in other words, you share the cost of the charge with the insurance company. Once the out-of-pocket limit is reached, your share of the cost will decrease to an amount specified by your plan - usually with there being no member responsibility and the insurance company paying the entire cost of the covered charges.
			I was covered on my employers group insurance plan. I left employment and continued the coverage on COBRA. How long can I stay on COBRA?
			COBRA is a federal law. Depending upon the reason you left employment, the length of time you can continue COBRA will vary. Please contact your customer service representative to help you determine the length of time you may continue.

			I left employment and had money in my 401K plan. How do I get my money and what can I do with the money?
			CONTACT US!!!! We will send you the appropriate forms to complete. Not only can we help, we can help guide you with the taxes and penalties that may apply if you get your money.* We can also help you with options to rollover your money so you will avoid taxes and penalties.

*You should discuss any legal, tax, insurance or financial matters with the appropriate professional.