Open to Everyone.
Open to Everyone.
When you use a network provider, you don’t need to file a claim. Just show your ID card, and your provider files the claim for you. Make sure you carry your ID card with you, since it includes the address your provider will need to submit your claims.
For your convenience, you can view and download a copy here.
Network providers usually file claims for you. However, if you need to submit a claim please use the following address:
Medical claims:
MHBP
PO Box 981106
El Paso, TX 79998
For prescription drug claims:
CVS CAREMARK
Attn: Claims Department
P.O. Box 52136
Phoenix, AZ 85072-2136
For MHBP Dental Plan claims:
MHBP
PO Box 7402
London, KY 40742
For MHBP Vision Plan claims:
VSP
P.O. Box 997105
Sacramento, CA 95899-7105
When you use a network provider, you don’t need to file a claim. Present your ID card at the time of service and your provider will file the claim for you. When you use non-network providers you may have to file your own claim. To file your claim, print this form. Complete the form and mail it to the address on the form. If you have questions, just call us at 800-410-7778.
Follow the Federal Employees Health Benefits program disputed claims process if you disagree with our decision on your claim or request for services, drugs, or supplies, including a request for preauthorization/prior approval. View the appeals/disputed claims process.
Before you're admitted to the hospital as an inpatient, you’ll need to get your stay precertified. Precertification is the process by which we evaluate the medical necessity of your proposed stay and how many days are required to treat your condition. Any stay greater than 23 hours must be precertified, except maternity admission for a routine delivery.
OPM requires all Federal Employee Health Benefits program plans to precertify hospital stays. In most cases, your physician or hospital will take care of precertification. However, you are still responsible for making sure that we are asked to precertify your care. So always check with your physician or hospital that they have contacted us.
Warning: We will reduce our benefits for the inpatient hospital stay by $500 if no one contacts us for precertification.
We will not change the decision we make on medical necessity, unless we are misled by the information given to us. In addition, if the stay is not medically necessary, we will not pay any benefits for the room and board charges.
If you are admitted for services or supplies we don't cover - for example, non-covered cosmetic surgery - we will not pay any benefits.
You, your representative, your doctor, or your hospital must call the Plan at least two working days before admission. The toll-free number is 800-410-7778. Provide the following information:
We will then tell the doctor and hospital the number of days in which the patient is approved to stay in the hospital. Our decision will be sent to you, your doctor, and the hospital.
When there is an emergency admission you, your representative, the doctor, or the hospital must telephone 800-410-7778 within two business days after the day of admission, even if the patient has been discharged from the hospital.
Network physician will take care of obtaining prior approval. If you see a Non-Network physician, you must obtain prior approval. Call us at 1-800-410-7778 as soon as the need for these services is determined.
Note: For a complete list refer to: https://www.aetna.com/health-care-professionals/precertification/precertification-lists.html
Note: Prescription drugs – Some medications and injectables are not covered unless you receive prior authorization. See Section 5(f) Prescription drug benefits. You are required to obtain all specialty drugs used for long term therapy from CVS Caremark. To speak to a CVS Caremark representative, please call 866-623-1441
Yes. The Federal government requires that all members of a fee-for-service plan must precertify their hospital admissions.
You may visit our Find a Provider tool to look up providers who participate in the network. If you prefer, you may send us an e-mail or you may call the number on the back of your ID card and we will help you find a participating provider near you.
While we strive to include correct, complete and current provider information, keep in mind that this information may have changed. Please call your doctor before your appointment to confirm his/her network status.
Paper directories become outdated quickly as new providers join our growing network.
Print a copy of the directory from the Find a Provider tool by selecting the printer icon shown on the page after you have performed your search.
Members have access to providers in our network virtually anywhere in the United States. Whether you are on vacation, business travel or away at college, you and your eligible dependents can find providers who participate in our network.
Yes. While we encourage network doctors to refer their patients to other network doctors, this may not always be possible. You should confirm that the doctor is a member of our network. Likewise, if your doctor refers you to a hospital, please confirm that the hospital is in our network.
If your doctor or dentist does not currently participate in our network, you may submit a physician nomination form or a dentist nomination form to have him/her considered. Fill out the patient section and ask your doctor or dentist to complete the rest. After we receive the form, it can take up to six months for us to complete the review process. If you have questions, please send us an e-mail or call the toll-free number on your ID card for assistance.
For non-life threatening situations, that require immediate attention, go to the nearest participating Urgent Care Center, Convenient Care Clinic or Retail Clinic. For life-threatening emergencies, call 911 or go to your nearest hospital.
To get a new ID card, you may order it online through Aetna Navigator, call us at 800-410-7778, or email us.
Please report your new address in writing to the address below:
MHBP
PO Box 981106
El Paso, TX 79998
USA
Contact your Human Resources department and complete a Standard Form 2809.
Health Savings Accounts (HSAs) are tax-exempt trusts or custodial accounts, similar to an IRA.
The money deposited into an HSA account is 100% tax-free and can be used to pay for qualified medical expenses. Any money that isn't used remains in your account and keeps growing on a tax-favored basis to cover future medical expenses or to supplement retirement.
You do not need to take any action to active your Health Care Savings Account (HSA). Your HSA is administered by Payflex®, a member of the Aetna family.
MHBP will contribute up to $900 for Self Only coverage, or up to $1,800 for Self Plus One and Self and Family coverage per year to your HSA.
Plan contributions are made in monthly installments of $75 for Self Only coverage, or $150 for Self Plus One and Self and Family coverage, for each month you are enrolled in Consumer Option and eligible for an HSA.
You can also make tax-deductible contributions to your HSA. Your contribution may be made in one lump sum at the beginning of the coverage year, or incrementally throughout the course of the coverage year. Your eligible family members may also contribute to the HSA on your behalf.
The maximum annual contributions to your HSA (plan contributions and your contributions combined) are:
These amounts may change in future years.
Please note - you are responsible for keeping track of your contribution totals, which must not exceed the IRS limit. We recommend reviewing IRS Publication 969 for additional information about funding your HSA.
To determine your 17-digit HSA account number, you can reference your account statement or log in to Payflex at payflex.com. You will need to create a username and password to register your HSA. One you’ve registered, go to my profile, then HSA bank information and click view details.
You may access funds in your HSA for qualified medical expenses by using your MHBP Payflex Debit Card.
You have the freedom to spend your HSA on the qualified medical expenses that you consider are most important to you.
You may use the funds in your HSA to pay for qualified medical expenses.
For your convenience, we have included a handy list of some of the most common qualified expenses.
For complete detailed information, refer to “IRS Publication 502 – Medical and Dental Expenses,” Catalog number 15002Q.
When you incur expenses for qualified medical expenses not covered by the MHBP Consumer Option HDHP, such as dental care, you may submit a Withdrawal Form to the address provided on the form.
OPM offers a Limited Expense Health Care Flexible Spending Account (LEX HCFSA) for employees in FEHB high deductible health plans (HDHP) with a health savings account (HSA).
The Limited Expense Health Care Flexible Spending Account (LEX HCFSA) is for eligible dental and vision expenses only.
HSA enrollees are not eligible for general health care flexible spending accounts (HCFSA), according to Section 125 of the Internal Revenue Code. However, you can have both an HSA and a limited purpose HCFSA.
With the LEX HCFSA, HSA enrollees will be able to set aside pre-tax FSA dollars for dental and vision services, just as non-HSA enrollees can.
For further information, visit the OPM website.
If you are not eligible to establish an HSA, the Plan will provide you with a Health Reimbursement Arrangement (HRA).
At the start of the Plan year, the MHBP will credit your HRA with up to $900 for Self Only coverage or $1,800 for Self Plus One or Self and Family. These amounts may be prorated for mid-year enrollments.
Please note – enrollee contributions to an HRA are not permitted.
These funds can be used to pay for any of your health-related expenses, such as office visits, deductibles and prescription drugs.
When you or a health care provider submit a claim to the Plan for qualified medical expenses, funds will automatically be withdrawn from your HRA and sent to you or your provider as payment.
Likewise, when you purchase prescription drugs from a retail pharmacy, funds will automatically be withdrawn from your HRA at the time of purchase to cover out-of-pocket expenses such as deductibles and copayments.
Once your HRA has a zero balance, you will be required to pay for covered medical and/or pharmacy related services until you reach your deductible.
Remember, you will save money – and the funds in your HRA will go further – when you receive care from network providers and use generic medications.
When you incur expenses for services not covered by MHBP Consumer Option, such as orthodontia and Medicare premiums, you may submit a Reimbursement Request to the address provided on the form.
Health Savings Accounts (HSAs) are tax-exempt trusts or custodial accounts, similar to an IRA.
The money deposited into an HSA account is 100% tax-free and can be used to pay for qualified medical expenses. Any money that isn't used remains in your account and keeps growing on a tax-favored basis to cover future medical expenses or to supplement retirement.
HSAs encourage savings for future expenses, such as medical, out-of-pocket and long-term care expenses.
Please note - you are responsible for keeping track of your contribution totals, which must not exceed the IRS limit.
The Internal Revenue Service has defined qualified medical expenses in a very broad way, to include "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body." Based on that definition, qualified medical expenses include many services from acupuncture to dental procedures to weight-loss programs. Prescription medications are included as well. However, expenses that are merely beneficial to general health, such as vitamins or vacations, do not qualify. In general, health insurance premiums do not qualify either.
Consumer Option provides traditional style benefits after you meet your deductible. The difference is that the deductible is higher than most traditional plans and you get a health savings account that offers tax advantages. The deductible applies all services except Network Preventive care. For care that's related to an illness or injury, you can use funds from your HSA to pay for that care.
You should not use your HSA Visa debit card at the doctor’s office. To ensure that you receive the Network discount, tell your doctor's office to bill MHBP first. We will apply the appropriate discount. When you get the bill, you can simply fill in your debit card number as a form of payment and the funds will be taken out of your HSA to pay for the covered medical expense. Once you reach your deductible and are eligible for traditional plan benefits, you can simply pay your copayment at a Network doctor using your debit card.
An FSA is a "use-it-or-lose-it" account. You fund it with a specified amount of money, tax-free, and if you don’t use that money by the end of the year, you lose it. In addition, you cannot earn interest on the money in an FSA. The money in an HSA, on the other hand, is yours to keep, year after year, to spend as you wish on qualified medical expenses (or even for other expenses, with tax and penalties). You can earn tax-free interest on money in your HSA.
Your HSA is like any other investment account in this way; you name a beneficiary, and any money remaining in your account goes to that person should you pass away.
If you enroll in Medicare, you can no longer make contributions to your HSA; however, you can continue to withdraw money tax free for qualified medical expenses. And when you’re 65, you can even withdraw money for non-medical expenses and pay only your current income tax rate.
No. You are not eligible for an HSA if you are covered by TRICARE, Medicare or by another traditional health plan, such as a spouse’s employer-sponsored coverage.
You can have an HSA, but the total amount you can contribute each year will depend on the IRS Defined Limits. The total amount that can be collectively (by MHBP and you) contributed each year must not exceed the statutory limit--$3,400 Self Only coverage and $6,750 for Self Plus One or Self and Family coverage.
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