Plan Coverage Questions
- You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays health care expenses without regard to fault. This is called “double coverage”. When you have double coverage, one plan normally pays its benefits in full as the primary payor and the other plan pays a reduced benefit as the secondary payor. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners’ (NAIC) guidelines. For more information on NAIC rules regarding the coordinating of benefits, visit https://content.naic.org/sites/default/files/inline-files/MDL-120.pdf.
For complete details about how we coordinate with other health plans and a Primary Payor Chart, see Section 9. of the official plan brochure under Coordinating Benefits with Medicare and Other Coverage.
Claims Questions
- 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. It includes the address your provider will need to submit your claims.
If you use an out-of-network provider, you may have to submit a claim. You can view and download a copy here. Be sure to write your MHBP ID number on your itemized bill and include it with the claim form.
- 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 79998Prescription drug claims:
CVS Caremark
PO Box 52136
Phoenix, AZ 85072-2136MHBP Dental Plan claims:
Aetna
PO Box 14094
Lexington, KY 40512-4094MHBP Vision Plan claims:
VSP
PO Box 385018
Birmingham, AL 35238-5018 - 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 1-800-410-7778 (TTY: 711).
- 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.
Precertification Questions
-
Precertification is the process of collecting information prior to inpatient admissions and performance of selected ambulatory procedures and services. The process permits advance eligibility verification, determination of coverage, and communication with the physician and/or you. It also allows MHBP to coordinate your transition from the inpatient setting to the next level of care (discharge planning), or to register you for specialized programs like Care Management Program or our prenatal program. In some instances, precertification is used to inform physicians, members and other healthcare providers about cost-effective programs and alternative therapies and treatments.
Certain health care services, such as hospitalization or outpatient surgery, require precertification to ensure coverage for those services. When you get services that require precertification through a participating provider, this provider should precertify those services prior to treatment.
Note: This plan pays non-network benefits and you may self-refer for covered services. So, it’s your responsibility to contact MHBP to precertify those services which require precertification. You must get precertification for certain types of care rendered by non-network providers to avoid a reduction in benefits paid for that care.
If you are admitted for services or supplies we don’t cover – for example, non-covered cosmetic surgery – we will not pay any benefits.
-
In most cases, your network provider will take care of getting precertification. You’re still responsible for ensuring that your care is precertified. This means you should always ask your provider whether or not they’ve contacted us and that we’ve approved the admission. If you see an out-of-network provider or you’re admitted to an out-of-network hospital you must get prior approval or precertification by calling 1-800-410-7778 (TTY: 711).
We will let the provider know the number of days in which the patient is approved to stay in the hospital. Our decision will be sent to you and the provider.
- When there is an emergency admission you, your representative, or your provider must call 1-800-410-7778 (TTY: 711) within two business days after the day of admission, even if the patient has been discharged from the hospital.
-
A prior approval is a pre-service claim. It requires approval from us in advance of obtaining medical care or services.
Some services require prior approval or precertification before we will consider them for benefits. Your network doctor will take care of getting prior approval. If you see a non-network doctor, you must get prior approval. Call us at 1-800-410-7778 (TTY: 711) as soon as the need for these services is determined.
For a current list, refer to: https://www.aetna.com/health-care-professionals/precertification.html
- Yes. The Office of Personnel Management requires that all fee-for-service plan members must precertify their hospital admissions.
Network Provider Questions
- 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 email via the Aetna® member website or just 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 provider before your appointment to confirm their network status.
- Paper directories quickly become outdated as new providers join our expanding network.
You can print a copy of the directory from the Find a Provider tool. Just select the printer icon shown on the page after you’ve completed your search.
- Members have access to providers in our network 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 providers to refer their patients to other network providers, this may not always be possible. You should confirm that the provider is a member of our network. Likewise, if your provider refers you to a hospital, please confirm that the hospital is in our network.
-
Your relationship with your provider is important. We understand the importance of having confidence in your health care provider. You’ve built a trusting relationship and you want to keep it. Yet you can save by using an in-network provider. That’s why we make it easy for providers to join our network.
To find out if your provider already participates in our network, search our directory of health care professionals or call 1-800-410-7778 (TTY: 711)
If your provider is not part of our network, then have them visit https://extaz-oci.aetna.com/pocui/join-the-aetna-network and choose the appropriate channel to get started. We’ve streamlined the process to ensure the provider has a smooth transition once they’re officially participating in our network.
- 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.
ID Card Questions
- To get a new MHBP ID card, you may order it online through the Aetna Member Website, call us at 1-800-410-7778 (TTY: 711).
Contact Information
- Please report your new address in writing to the address below:
MHBP
PO Box 981106
El Paso, TX 79998 - Contact your Human Resources department and complete a Standard Form 2809.
Consumer Option Questions
- HSAs are tax-exempt trusts or custodial accounts, similar to an IRA.
The money deposited into an HSA account is 100% tax-free. You can use it to pay for qualified medical expenses. Any money that remains in your account stays there. It keeps growing on a tax-favored basis to cover future medical expenses or to supplement retirement.
- You don’t need to take any action to activate your HSA. Payflex® administers your HSA.
-
MHBP will contribute up to $1,200 for Self Only coverage, or up to $2,400 for Self Plus One and Self and Family coverage per year to your HSA.
MHBP makes plan contributions in monthly installments of $100 for Self Only coverage or $200 for Self Plus One and Self and Family coverage. This occurs each month you’re 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 you can make it 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:
- For 2023, $4,150 for Self Only, or $8,300 for Self Plus One and Self and Family.
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 to see it. You’ll need to create a username and password to register your HSA. One you’ve registered, go to my profile, then select “HSA bank information” and select “view details.”
- You may access funds in your HSA for qualified medical expenses by using your MHBP Payflex Debit Card.
-
OPM offers a Limited Expense FSA (LEX HCFSA) for employees in FEHB high deductible health plans with an HSA.
The 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.
There may be fees associated with a health savings account (HSA). These are the same types of fees you may pay for checking account transactions. Please see the HSA fee schedule in your HSA enrollment materials for more information. This material is for informational purposes only and is not an offer of coverage. It does not contain legal or tax advice. You should contact your legal counsel if you have any questions or if you need additional information. Information is believed to be accurate as of the production date; however, it is subject to change. PayFlex cannot and shall not provide any payment or service in violation of any United States (US) economic or trade sanctions. For more information about PayFlex, visit payflex.com.
-
If you’re not eligible to establish an HSA, the plan will provide you with an HRA.
At the start of the plan year, the MHBP will credit your HRA with up to $1,200 for Self Only coverage or $2,400 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.
You can use these funds 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’ll 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) Questions
- 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. You can use it to pay for qualified medical expenses. Any money that remains in your account stays there. It 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.
- Accounts are owned by the individual, not the plan or employer.
- Accounts are completely portable, regardless of the individual’s employer, employment status, area of residence, age, marital status or future medical coverage.
- There is no requirement to use unspent balances within a specific timeframe, unlike a Flexible Spending Account (FSA).
- Accounts grow through interest and investment earnings.
- All contributions are made to your account pretax.
-
- MHBP will contribute up to $1,200 for Self Only coverage, or up to $2,400 for Self Plus One or Self and Family coverage per year to your HSA.
- Plan contributions are made in monthly increments of $100 for Self Only coverage, or $200 for Self Plus One or Self and Family coverage for each month you are eligible for an HSA.
- You may make an additional contribution to your HSA, up to the IRS limits.
- You may make a contribution in one lump sum at the beginning of the coverage year, or in increments throughout the course of the coverage year. Your eligible family members may also contribute to the account on your behalf.
- For 2023, you have the option to make additional tax-free contributions to your HSA, so long as total contributions don’t exceed the limit established by law. The limit is $3,850 for a Self Only enrollment or $7,750 for a Self Plus One or Self and Family enrollment. These limits include our contribution amount of $1,200 for Self Only coverage and $2,400 for Self Plus One or Self and Family. These limits 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.
-
- You can choose to use your HSA funds to pay for qualified medical expenses such as office visits, lab work and prescription drugs while you’re meeting your annual deductible. Expenses you incur for services covered under your health plan will count toward your annual deductible.
- You may also choose to use your HSA funds for qualified services not covered by the health plan. These include dental care, weight loss programs and eyeglasses. However, expenses that your health plan doesn’t cover won’t count toward your annual deductible.
- If you prefer, you can choose to save any or all of your HSA funds, and pay for your medical expenses out of pocket throughout the year, until you meet your annual deductible.
- Once you’ve met your deductible, additional health care expenses are covered under the terms of your medical plan. You can choose to use your HSA funds to pay for fixed expenses, such as copayments.
- If you don’t use all of your HSA dollars, the remaining amount will carry over into the next year. Please check the Official Plan Brochure for more information about your HSA.
-
To be eligible for an HSA, you must meet certain requirements:
- Only people covered by a high-deductible health plan (HDHP).
- You can’t have Medicare or TRICARE.
- You can’t be claimed as a dependent on another person’s tax return.
- You or your spouse can’t have a regular flexible spending account (FSA)or regular health reimbursement arrangement (HRA)* in the same year.
- You can’t have received certain Veterans Administration (VA) health benefits in the previous three months.
- You can’t be covered under any other health plan that pays for out-of-pocket health care expenses before you meet your plan deductible. However, the legislation provides exemptions for certain types of “permitted” (generally limited) health coverage such as that provided under state workers’ compensations laws, property insurance, insurance for a specified illness, and hospital indemnity insurance. An HRA or FSA limited to these types of benefits may still be offered alongside an HSA. In most cases, members would use the FSA for dental.
- If you’ve enrolled in the MHBP Consumer Option and you don’t qualify for an HSA, the plan will open an HRA for you.
-
- HSAs are “above the line” deductions, meaning the deduction is always available and is not dependent on earnings, tax-filings status, employment status or whether or not you itemize tax deductions. Interest earnings inside the HSA account are not taxed.
- Distributions taken from an HSA are tax free if they are taken for qualified medical expenses incurred by the person covered under the HDHP, their spouse or their dependents.
- You can use it to pay for other health insurance except:
- COBRA premiums for the continuation of health care benefits
- Health coverage while receiving unemployment compensation
- Medicare premiums and out-of-pocket expenses
- Long-term care insurance
- Members between the ages of 55 and 65 can make additional pretax “catch-up” contributions of $1,000 each year.
- If you make your maximum annual contribution early in the coverage year, and then you leave your employer before that coverage year has ended, you will be responsible to pay the taxes on any amount that exceeds the coverage.
- 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 (HSA) that offers tax advantages. The deductible applies to 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. Then 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 tax-free money. If you don’t use that money by the end of the year, you lose it. In addition, you can’t earn interest on the money in an FSA. The money in an HSA, on the other hand, is yours to keep, year after year. You can spend it 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. 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–$3,850 Self Only coverage and $7750 for Self Plus One or Self and Family coverage.
Have Questions? Call 1-800-410-7778 (TTY: 711)
24 hours a day, 7 days a week, except major holidays