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Frequently Asked Questions


Below are some of the questions that are frequently asked by our members, as well as information on more general topics.


If you have any questions not addressed in this space please do not hesitate to Willis of Colorado.


Q. When does my PPO deductible start and end?

A. The deductible is on a calendar year basis, from January 1 to December 31.


Q. Do I have a separate co-payment for lab charges on the PPO plans?

A. Yes, the same amount as the office visit co-payment when the lab work is being done by a different provider.


Q. Do emergency room charges apply toward the PPO deductible?

A. Yes, even if your doctor directs you toward the emergency room.


Q. On the PPO plans will x-rays be covered under my office visit co-pays?

A. No, x-rays are always subject to the deductible.


Q. Do I have to get a refund on the EPO to see a specialist?

A. No, but you must see a contracted provided.


Q. When do my annual dental benefits re-set?

A. January 1st of each year.


Topics


  • EPO
  • Maternity
  • Newborn
  • Pre-existing Conditions
  • COBRA
  • Deductible
  • Deductible Carry Over
  • PPO Wellness Benefits

  • EPO


    Must see contracted provider.

    Maternity


    PPO - at a contracted provider, there is one office visit co-payment if plan has co-pay. Then charges are paid at the end of the pregnancy, billed on a global basis, subject to the plan deductible and coinsurance.


    EPO - office visit co-pay for 1st prenatal visit, then hospital co-pay at the time of delivery.


    Newborn


    A newborn is covered for the first 30 days, in the absence of other coverage. If the child is added to the CEBT plan, premiums will be due from the date of birth. The deductible is waived if the mom and newborn are discharged from the hospital at the same time. If the baby is not discharged with mom, then the plan deductible would be applied.


    An employee has 30 days from the date of birth to add the newborn to the CEBT plan. If the child is added to another plan we will need an Other Insurance form completed and proof from other carrier.


    Pre-existing Conditions


    Any NEWLY covered employee and/or dependent whose medical coverage becomes effective and who has undergone treatment, incurred expenses, or received a diagnosis for any condition within three (3) months prior to the effective date of medical coverage will be limited to an amount not to exceed $1,000.00 during the first twelve (12) months of coverage.


    If this plan is replacing another plan covering your group the pre-existing limitation may not apply. If you are a new employee enrolling in the CEBT Plan and have current qualified coverage the pre-existing limitation may not apply. Please check with the plan administrator for details. The plan follows all HIPAA guidelines.


    COBRA


    An employee who loses their coverage, unless due to gross misconduct, can continue on COBRA for up to 18 months at their own cost. Dependents that lose their coverage due to death of the employee, divorce or reaching the maximum age limitations can continue on COBRA for up to 36 months at their own cost.


    Deductible


    The following are some, but not all examples of charges that would apply toward the PPO plan deductible.


    1. X-rays, MRI's, CT Scans, PET Scans, etc.

    2. Hospital charges (in or out patient)

    3. Emergency room charges and related providers

    4. Charges from any non-contracted provided. These charges would be subject to Reasonable & Customary guidelines based on the geographic location of the provider.

    5. Durable medical equipment.

    6. Prosthetic devices and orthopedic appliances.


    Deductible Carry Over


    Covered charges incurred each calendar year on or after October 1st for which benefits are not payable because the deductible has not been met, will apply toward the next calendar years deductible. This does not apply to the High Deductible Plans.


    PPO Wellness Benefits


    Routine services - Pap/pelvic exams will be paid at 100% after the PPO office visit co-payment. For non PPO providers, we will pay 100% of the first $300 charges are subject to R & C


      - Child wellness 0 through 12 years of age: in-network benefits - 100%, subject to member's co-pay with no visit maximum; out-of-network benefits 100% up to $300, thereafter deductible is waived, paid at 60%.

    - Adult wellness: in-network benefits - 100% up to $300; subject to member's co-pay; out-of-network benefits - 100% up to $300; then any charges exceeding this amount will be the responsibility of the member.

    - If any of the covered items are submitted because of a diagnosis or ailment, they will not be covered by the wellness benefit. They could, however, be covered by other provisions of the plan. The plan language would determine this in all cases. For PPO members, an office visit co-pay will be required for covered items.

    COVERED UNDER WELLNESS (co-pay required) NOT COVERED UNDER WELLNESS
    Routine Vision Exams
    Routine Physicals (including sports)
    Routine Pap/Pelvic
    Routine Cholesterol Screening
    Routine CBC and other Blood Work
    Routine Urinalysis
    Routine Blood Stool Testing
    Routine Chest X-rays
    Immunizations
    Flu Shots
    Hepatitis B Shots
    Routine Sigmoidoscopy
    Routine Prostate Exam
    Routine Heart Imaging
    Routine Bone Density Screening
    Office Charges for Above Routine Services
    Hearing Exams
    Family Planning
    Health Club Dues
    Athletic Equipment
    Employment Physicals including DOT Physicals

    *Updated 7/01/2010


    If you have questions or problems that this site could not answer please contact us via email or phone.


    CEBT is administered by Willis of Colorado / 303-773-1373 / 800-332-1168 / Fax: 303-773-1685 / Email
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