Using The MultiPlan Network
When you call to make an appointment with your doctor or other health care provider, be sure to identify yourself as a MultiPlan Network participant.
Bring your health benefit plan identification card with you each time you visit the provider.
For your first visit, bring:
notes about your family and personal medical history
a list of all medications you are taking
a list of your past hospitalizations, if any, and the dates of those visits.
Be prepared to discuss your current medical problem or condition.
When any referral is made, remind your doctor that you prefer to go to a MultiPlan Network provider. It is your responsibility to select a MultiPlan Network provider. If you receive services from a non-network provider, you may be billed for the difference between the provider’s charge and the network allowance, even if you were referred to the non-network provider by a MultiPlan Network provider.
To have your physician considered for the MultiPlan Network, please request a Physician Nomination Form from MultiPlan at 800-672-2140.
How Your Medical Coverage Works
During any calendar year (January 1-December 31), before there is any reimbursement for your Medical charges, you must first incur $150 in recognized covered charges. This is called the deductible.
Once the deductible has been met, your Medical Coverage will pay 10070 (9070 for a non-network provider) of the recognized covered charges.
The deductible is applied separately to your health care expenses and to those of each of your covered dependents during each calendar year.
The deductible is based on the date of service or treatment. Services or treatments in 2004 count towards 2004, even if bills are received in 2005.
The following items are covered for recognized covered charges, subject to the annual deductible and the Plan’s limitations as indicated:
When surgery is performed, including maternity procedures, the legally qual-
ified physician’s or surgeon’s charge will be covered up to a fixed schedule of charges for the geographic area in which the surgery is performed. The maxi-
mum payment for all Surgical Benefits is $12,000 for all operations for the
29 The Local 108 Health Expense Benefits Plan