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What is a calendar-year deductible?
A calendar year deductible is a fixed dollar amount that you are required to pay each calendar year before any payment of eligible expenses is made. The deductible starts over on January 1st, every year. |
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What is coinsurance?
Coinsurance is the percentage of the eligible expenses that is paid by you. |
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What is a co-payment?
A co-payment is a fixed dollar amount that you pay for a particular service each time the service is provided. The co-payment amount is not applied to your deductible or out-of-pocket maximum. |
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What is an out-of-pocket maximum?
The out-of-pocket maximum is the maximum dollar amount you must pay in deductible and coinsurance costs every calendar year. Once you reach the maximum, all your additional eligible expenses will be paid in full for the remainder of the calendar year. You will still be responsible for payment of applicable co-payments, as they do not apply toward your out-of-pocket maximum.
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How will I know whether or not the deductible
and/or
maximum out-of-pocket expense on my plan has been met?
Each time you receive services, Antem will send you an Explanation of Benefits (EOB). This EOB will indicate how much of your deductible and/or maximum out-of-pocket expense you have met. You can also call ASA’s Service Center at 1-800-539-9370 or Aetna’s Customer Service Center at the number printed on your identification card to obtain this information.mation.
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How is preventive care covered?
Anthem has a comprehensive preventive care benefit and does not impose an annual limit on the benefit. Physical health examinations, well child examinations, immunizations, routine screenings, routine mammograms, pap smears, prostate exams and routine colonoscopies are covered in full.
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Do you provide coverage for work-related injuries?
Yes, coverage is provided for work-related injuries. However, coverage is not provided if benefits are provided or payable under Workers’ Compensation.
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If I receive a denial for certain services, what can I do?
Call ASA’s Customer Service Center at 1-888-863-5713. A representative will review your situation and guide you through the appropriate steps..
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