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ADMISSION NOTIFICATION
If I am admitted to the hospital, is admission notification
required?
Admission Notification is required within 48 hours of all
NON-EMERGENCY admissions and within 72 hours of all
EMERGENCY admissions. Call SHPS Healthcare Services at
888-TJC83VA (888-852-8382) to satisfy this requirement. A
penalty will apply if this requirement is not satisfied.
BENEFIT
AND CLAIM INQUIRY
How can I verify benefits or inquire about claim status?
You must
contact the Fund Office for verification of
eligibility.
DENTAL
How should a dental claim be filed?
Electronic dental claims are not accepted. Dental claims
must be mailed, faxed or emailed to the Fund Office. For
contact information, please
contact the Fund
Office.
How do I find a dentist that participates in the Dental
Network of America?
You can contact the Dental Network of America by calling
866-522-6758 or by logging on to their website at
www.dnoa.com.
Enter your zip code where prompted and select "Labor" from
the dropdown box.
What if there are no dentists in my area that participate in
the network?
You will not be penalized for seeing a dentist outside the
network. However, by visiting a dentist in the network,
your charges will be discounted, leaving you with no
liability.
DISABILITY
Does the Fund offer Short Term Disability?
The Fund does offer Short Term Disability to eligible
Participants. Be sure to consult your Schedule of Benefits
to be sure that disability is covered under your Plan.
Does the Fund offer Long Term Disability?
The Fund does not offer Long Term Disability.
How often does the Fund mail disability payments?
Provided that the form is received on Wednesday by 4:30,
your disability payment will be mailed out on Thursday of
every week.
My doctor is charging to fill out the disability form. Do I
have any other options to have the form completed without a
charge?
Most
doctor offices have their own forms for disability and will
fill them out free of charge. The Fund does accept the
doctor's form in place of the Fund's form.
ELIGIBILITY
How can eligibility be verified?
You must contact the Fund Office for verification of
eligibility. For contact information, please
contact
the Fund Office.
GENERAL
Who do I notify of a change in address?
You may complete the Change of Address form and mail it to
8814 Fargo Road, Suite 200, Richmond, VA 23229 or fax it to
804-288-3530. Changes cannot be made over the telephone.
How can I change my beneficiary for life insurance?
You may change your beneficiary by completing the
Change of Beneficiary Form
and mail it to 8814 Fargo Road, Suite 200, Richmond, VA
23229 or fax it to 804-288-3530. Changes cannot be made
over the telephone.
How do I add dependents to the Plan?
You can add dependents completing the
Dependent Form
and mail it to 8814 Fargo Road, Suite 200, Richmond, VA
23229 or fax it to 804-288-3530. Changes cannot be made
over the telephone.
How can I remove my ex-spouse from the Plan?
You can remove your ex-spouse from the Plan by submitting a
copy of your finalized divorce decree to 8814 Fargo Road,
Suite 200, Richmond, VA 23229 or fax it to 804-288-3530.
What can I do if I disagree with the Fund's payment of
non-payment of my claim?
If you disagree with the Fund’s decision, you may ask to
have it reviewed. Your written request for review must be
received by the Fund Office within 180 days from the date
you receive an “Adverse Benefit Determination” or denial
notice.
Also, your request must be addressed to the Board of
Trustees in care of the Fund Office and must state the
following:
-
Your name and address
-
The fact that you are appealing a decision of the Fund
Office and the date of the decision
-
The basis of your appeal, i.e., the reason why you feel
that your claim should not be denied
-
The provisions of the Plan on which you base your claim.
Important: If your appeal is not filed within the required
180 day period, you lose your right to a review of the
denial and the decision of the Fund Office will become final
and binding. There is one exception to the written request
rule. If you are appealing an urgent care claim, your appeal
request may be made by phone call, in person or in writing.
An urgent claim is a claim that, if not addressed within 15
days of receipt, could seriously jeopardize the life or
health of the person for whom the appeal relates.
MATERNITY
Is notification of a pregnancy required?
Notification of a pregnancy is required during the first
trimester. Call SHPS Healthcare Services at 888-TJC83VA
(888-852-8382) to satisfy this requirement. A penalty will
apply if this requirement is not satisfied.
Medical
How is a medical claim filed?
All medical claims, both in network and out of network, must
be filed through the local Blue Cross Blue Shield (BCBS)
plan. If you are unsure of the billing address for your
local BCBS plan, please
contact the Fund
Office.
How do I find a doctor or hospital that participates in the
BlueCross BlueShield network?
To find a provider that participates in the BlueCross
BlueShield network, you may call BCBS at 800-810-2583 and
choose option 2, then option 1on the automated system. You
may also log on to
www.bcbs.com
and click on "Find a Doctor or Hospital" on the right hand
side of the page.
I received an Explanation of Benefits for a claim that I
believe is incorrect. What should I do?
You may contact the Fund Office at 804-282-3131 or toll free
at 800-852-0806 to speak with a Claims Coordinator.
What happens if I have a chronic condition but refuse to
participate in the Horse Power Healthy Rewards Program?
If you have a chronic condition and refuse to participate in
the Horse Power Healthy Rewards Program, you will be
penalized with higher co-pays and a reduction in benefits.
By choosing to participate in the program, you will receive
free generic drugs and a $25 gift card for having a physical
in the first year of participation.
pension
How can I change my beneficiary?
You may complete the
Beneficiary Designation Form
and mail it to 8814 Fargo Road, Suite 200, Richmond, VA
23229 or fax it to 804-288-3530. Changes cannot be made
over the telephone.
How can I make changes to my bank account information?
You may complete the
Electronic Funds Transfer Form
and mail it to 8814 Fargo Road, Suite 200, Richmond, VA
23229 or fax it to 804-288-3530. Changes cannot be made
over the telephone.
Does the Fund offer a Medicare Supplement?
The Fund does not offer Medicare Supplement.
Is life insurance covered under the Fund's Retiree Health
Coverage Plan?
The Fund's Retiree Health Coverage Plan does not cover life
insurance.
Prescription
Which card do I use for prescriptions?
Your prescription card should say Prescription Solutions on
the front of it. If you still have a card with the name
General Prescription Program, you may dispose of it as it is
no longer valid. To request a new card, please click
here.
How can I get my prescriptions through the mail?
You can contact the Mail Order Pharmacy through Prescription
Solutions at 800-562-6223 or by completing the
Rx Solutions Mail Order Form
and returning it to Prescription Solutions at P.O. Box
509075, San Diego CA 92150-9075. Be sure to include your
original prescription with the form. You may also find the
information on the website at
www.rxsolutions.com.
VISION
How are vision claims filed?
If the provider participates in the EyeMed network, claims
must be filed with EyeMed. If the provider does not
participate with EyeMed, claims must be mailed, faxed or
emailed to the Fund Office. For contact information, please
contact
the Fund
Office.
Does the retiree health coverage plan cover vision benefits?
No. There is however a discount for retirees covered
through the Fund. If you have not received your discount
card, please contact EyeMed at 800-334-7591. |
