Health Insurance FAQ
We welcome your questions on all aspects of our schools and our teaching positions. This page contains answers to those questions most often asked. If you don't find the answer to your question here, please send us an email.
- Is the policy year the same as a calendar year?
- How does the insurance company keep up with how much of my annual deductible I and/or my family members have met?
- How can I determine how much my prescription will be?
- Do I have to use a generic medication?
- Can I have my prescription filled for more than 30 days?
- Is a yearly physical check up covered?
- Do I have a co-payment when I go to the doctor?
- Do I have to get preauthorization before having tests or surgery?
- Can I purchase extended health coverage when I leave NICS/OASIS?
- How do I get a replacement ID card?
- Do we need to notify someone when we learn we are expecting a child?
- How do I enroll in the NICS/OASIS health insurance program?
- Can I use a doctor or clinic that is not in the network?
- Can I receive teatment outside the area where I serve and will the transportation be covered?
- Who is a legal dependant?
Is the policy year the same as a calendar year?
No, the policy year begins on July 1 and ends June 30.
How does the insurance company keep up with how much of my annual deductible I and/or my family members have met?
Our insurance company tracks the annual deductible that has been satisfied for you and each member of your family that is enrolled in the NICS/OASIS health insurance program. Once you register in the Aetna Navigator program (see Navigator Registration instructions) you will receive notification by email there is new activity on your account. You may then log in to Navigator and view the Explanation of Benefits (EOB) for charges related to any recent medical treatment or prescriptions filled. The EOB also shows how much you (and each family member) have met of the annual deductible. Network providers in the U.S. file the claim with Aetna for you. For services outside the U.S. you are responsible to submit the claim for your medical treatment in order to have it applied to your annual deductible.
How can I determine how much my prescription will be?
If you know the name and strength of your prescription you can go to the Prescription Program and follow the instructions at the end of the third paragraph just above the formulary table.
Do I have to use a generic medication ?
Your prescription will ALWAYS be filled with a generic medicine when available UNLESS the generic medicine will not work for you and your doctor writes the prescription accordingly. In this case your prescription will be filled with the name brand medicine placing it in Tier 2 or 3 with a higher co-payment.
Can I have my prescription filled for more than 30 days?
There is a special program in place allowing our members to fill a prescription for up to 365 days; for details go to the Prescription Program.
Is a yearly physical check up covered?
Each school’s plan is slightly different due to local medical and pharmacy rates and other factors and may not include the “Wellness benefit”. To learn if your school’s plan includes the “wellness benefit” check with your school administrator.
Do I have a co-payment when I go to the doctor?
The co-payment is only applicable to medical treatment / doctor visits in the U.S. You are required to pay 10% (network provider) or 20% (non-network provider) at the time of the visit if you have met your annual deductible. If you have not met your deductible you will be responsible for the full amount up to the amount of your deductible plus the appropriate co-payment. There is no co-payment for treatment outside the U.S. once you meet your annual deductible.
Do I have to get preauthorization before having tests or surgery?
There are certain treatments that require preauthorization such as “scheduled” in-patient tests or surgery, out-patient surgery, home health care, durable medical supplies, and / or treatment of chronic conditions where the total of treatment may exceed $5,000. To determine if your test / treatment requires preauthorization call Aetna customer service 24 hours a day at 800-231-7729 (in U.S.) or collect at 813-775-0190 (outside U.S.) *Members must contact customer service within 48 hours of emergency admission.
Can I purchase extended health coverage when I leave NICS / OASIS?
The NICS / OASIS health insurance plan includes a benefit called “bridge” coverage, which provides full coverage for up to 3 months as you transition to your next position. For complete details click on the Continuance Coverage.
How do I get a replacement ID card?
To obtain a new insurance card(s) log in to Aetna Navigator and click on the ID Card link on the left under related shortcuts; then click on Order Medical ID Card(s). From this same page you may also print a temporary ID card(s).
Do we need to notify someone when we learn we are expecting a child?
-
Notify NICS / OASIS health insurance coordinator (Allan English) via email at allanenglish@nics.org as soon as you learn you are expecting. Once the baby is born email date of birth, full legal name, and gender within 31 days of birth to ensure coverage.
-
The NICS / OASIS health insurance company does not require pre-authorization or notification pertaining to impending maternity claims. Proceed with pre-natal visits and delivery, and submit the claims periodically with the filing deadline in mind (90 days from date of service). Aetna providers in the U.S. normally submit the claim for our members.
Please note:
-
Note: Maternity claims are still subject to all other requirements and restrictions of the underlying policy. They are reviewed for eligibility of the member, usual and customary fees, medical necessity of all related tests and procedures, network providers, as well as the policy limits on maternity.
Once the baby is born email the date of birth, full legal name, and gender to the NICS / OASIS health insurance coordinator (Allan English) at allanenglish@nics.org to have the baby enrolled (added to the family enrollment). This must be done before the baby is 32 days old, as coverage under the mother (as a part of the maternity process) terminates after 31 days.
How do I enroll in the NICS / OASIS health insurance program?
You will need to follow the Aetna Navigator Registration menu item.
Can I use a doctor or clinic that is not in the network?
You may use any physician or clinic you choose but if they are not in the Aetna network you will have to pay a 20% co-payment for your treatment or visit to a provider in the U.S., instead of the usual 10%.
* Please note: for services rendered by a non-participating provider in the U.S. you will be responsible to pay the 20% co-payment up to an out of pocket maximum of $2000 (separate from deductible).
Can I receive treatment outside the area where I serve and will the transportation be covered?
Aetna will arrange treatment for you (and pay for transportation costs) whenever there is an urgent need for a higher level of care than is currently available in your area if any of the following conditions exist.
-
The quality of medical care is unacceptable in your area.
-
The procedure or test is unavailable at the facilities in your area.
-
There are no qualified physicians or technicians in your area to perform the procedure or test needed.
Treatment (and related travel) outside your area must be pre-approved and arranged by IHAT (International Health Advisory Team). This is a team of medical professionals available 24 hours a day, 7 days a week, EVERY day of the year. If you feel you need to get treatment or tests outside the area where you serve, you must call the customer service phone number listed on your insurance ID card (800-231-7729 or collect 813-775-0190) and ask for the emergency nurse on duty. This person, a member of IHAT, will evaluate your situation and assist you in getting the best possible care for your illness. If this requires travel to another location the IHAT team member will make the necessary arrangements, approvals, and any related referrals.
Who is a legal dependent?
A legal dependent is defined as follows:
* Your wife or husband
* Unmarried children who are under 19 years of age.
* Any other unmarried child under age 25 who goes to school on a regular basis (12 hours per semester) and depends solely on you for support.
* Your children include:
- Your biological children.
- Your adopted children.
- Your stepchildren.
- Any other child you support who lives with you in a parent-child relationship.