Medical: Health & Wellness Plan FAQ's

Does this Plan cover non-traditional providers?

Our plan does not cover any "alternative care" with non-traditional providers like Functional, Holistic, Integrative, Homeopathic, or Complimentary.  

Does this Plan cover homeopathic treatments?

Our plan does not cover homeopathic treatments.  

Does this cover alternative / experimental treatments?

No, our plan does not cover alternative or experimental treatments.  

• Any time a physician mentions "study" or "research study" there is a good chance this is experimental and not covered by our plan.  
• Any time a treatment has a registered name such as BoTox or BioTE, there is a good change this is alternative treatment and not covered by our plan.  
• To know for sure if something is covered, reach out to Denise for a determination...before you get the treatment!

Does this Plan limit visits for physical or occupational therapies?

Physical and Occupational Therapies are limited in that the therapy must be ordered by a physician, but there are no limits on number of visits. Sessions are covered fully by CHM if they are part of an incident with an incident total over $1,000 for up to 45 sessions.   If you have more the 45 sessions, you can use your EBC/HRA to be reimbursed. If the therapy sessions are not part of an incident with an incident total of over $1,000, then the sessions are covered by the Austin Stone Component of the Health and Wellness Plan (HRA - Out of Pocket - HealthFund).

Learn more about CHM's coverage for therapy on their Guidelines.

Does this mean we can have ALL THE BABIES for free?

Yes - IF eligible bills are submitted to CHM within 6-months of service date. Check out the Maternity coverage details in the Maternity Page.  Keep in mind that immunizations are covered under your EBC HRA, not CHM, regardless of cost. CHM claims must be submitted within 6 months of date of service - or they are not covered by our plan - so do not wait.

With short wait times and lower copays, my family tends to prefer urgent care centers.  With the new plan, are these facilities better/worse than ER visits?

We always want you to seek the medical care you need!  There is no "better or worse" issue with urgent care centers versus ERs with our Plan.  You are covered for both!  If the total, prediscount cost of your services is less than $1,000, your expenses will be covered by your HRA.  If the total, prediscount cost is over $1,000, then your expenses will likely be a CHM-eligible claim.

Where does Dental coverage fit into our Plan?

Dental coverage will continue to be provided through our MetLife Dental Plan. If you have charges that are NOT covered through our dental insurance, there is a limited amount of coverage available through our HRA for dental costs.

I'm asked to provide my health insurance information on forms for my kids (e.g. school, sports, field trips).  What should I put on the forms?

You will put "The Austin Stone Health and Wellness Plan" and use your own phone number for contact information.  If you have a specific form you have questions about, please ask Denise!

Will this change anything when we file taxes?

No, nothing will change.  If an employee incurs medical costs and is reimbursed by the employer, the reimbursement is excluded from the employee's gross income and not taxed under both federal and state tax law.

Will we get 2 EBC cards per family?

You should have already received one EBC Credit card in the mail.  If you need a 2nd card, simply log onto www.ebcflex.com and request another card for your spouse.

Is the $1000 incident total amount before or after the discount?  

CHM looks at PRE-DISCOUNT amounts.

For example: a procedure is $1,600 before the cash discount, but you receive a 50% discount and the amount you pay is only $800. The incident total before the discount met the $1000 CHM qualifying amount. So even though you paid $800, CHM still considers this a qualifying incident. Always ask for a discount!

Do you have to wait until the incident is complete to submit to CHM?

No!  But, you do need to have at least $1,000 (pre-discount amount) in Itemized bills to create your claim. 

Is it possible for an incident to last longer than 6 months and if so, how should that be handled?

Medical bills must be submitted to CHM within six months of the date of service.  You can, and should, begin the bill submitting process as soon as you can so that CHM can begin the sharing process.  Technically, a CHM incident can go on forever...if you do not have a 90 day break in service (meaning you go 90 days without treatment of any kind).  So, if you consistently receive care every 89 days, then the incident continues on.

With over $1,000 expenses, do we pay cash and then submit for reimbursement? Or is there a way for CHM to pay the expenses as they arise?

Remember, do not use your EBC Benefits Card to pay for these expenses!

Ask the provider to place you on a payment plan.  Pay the the minimum amount required at the time of service.

If they do not offer a payment plan:

1. Contact CHM, if it is a large amount ($2,000+) and you have to pay it upfront. CHM will direct you on next steps.
2. Pay in full on personal card ONLY if you receive a 30% or more discount.
3. If you have to pay up front and floating the amount represents a financial hardship, please contact Denise (denise@austinstone.org) to discuss a medical advance.

What about CHM non-eligible expenses over $1,000?  What are those expenses?

CHM has Guidelines they use to define what they do cover.  Their list is extensive!  

Some expenses that are not covered by CHM are chiropractic care, cosmetic surgery, immunizations, mental health care, and infertility testing.  If you have a question about a specific expense, contact Denise!

Does CHM have any pre-existing conditions clauses?

Normally, yes, so you may see comments about this on their website.  BUT, because we came into the program as a large group, CHM has waived our pre-existing conditions and will cover claims for costs associated with them. When you completed your CHM member application, you had the opportunity to disclose pre-existing conditions so that they could be covered by CHM.