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2018 COB/HIPAA Forms
Frequently Asked Questions
Question: Why do I have to fill out this form every year?
Question: Why do my spouse/adult dependent(s) have to fill out the HIPAA form every year?
Question: Do I have to initial the Mental Health and Drug/Alcohol portion of the form?
Question: Do I need to obtain a letter from my spouse's employer stating that he/she does not have insurance?
Question: What if the information on my form is incorrect, can I write the correct information on the form?
Question: : Do my spouse and adult dependent(s) have to sign their own form?
STAY IN-NETWORK! DON'T LET OUT OF POCKET COSTS AFFECT YOU OR YOUR FAMILY MEMBERS!
As you know, Police Officers make it a habit to be aware of their surroundings and to constantly evaluate locations and situations for threats. It is unfortunate that the same mindset should be used when dealing with healthcare providers and facilities.
The best advice we can offer to avoid large out of pocket expenses is to stay in the Blue Cross network. If you refer to the LEHB website, www.lehb.org look at the Blue Cross Blue Shield Summary of Benefits and Coverage, click on "Summary of Benefits 2017" you will see that if you stay In-Network, there is NO deductible and the plan pays 100% of the costs unless otherwise noted.
However, if you go Out of Network, you will be subject to a deductible ($500.00 for Single and $1,000.00 for Family) additionally, the plan will only pay 50% of the In-Network allowable rate. The following simplified example will demonstrate how your costs could be significant. (This example does not include lab fees and other customary charges which can be very significant).
A member's adult dependent goes to an out of network addiction treatment facility. Their charge per day is $2,548.16 times 30 Days for a total cost of $76,444.80.
IBC will pay 50% of the In-Network daily rate. The daily In-Network rate is $454.00, 50% is $227.00 times 30 Days equals $6,810.00 The member will be charged the $500.00 Deductible, leaving $6,310.00
The Out of Network facility charged a total of $76,444.80 IBC would pay $6,310.00. The Out of Network facility could "balance bill" the member $70,134.80
NOTE: Per the Affordable Care Act, the balance-billed portion of your out-of-pocket expenses won't be credited toward your out-of-pocket limit.
Therefore, the member could be responsible for the full balance of $70,134.80
Specific Terminology: Always ask the Provider or the Facility if they are IN the Blue Cross Network. Some Providers/Facilities try to mislead the member by saying "we accept Blue Cross" or "we accept all insurance." That does NOT mean that they are "In Network" or will accept the Blue Cross payment as payment in full. You would be subject to pay the balance.
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