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Answer
I forgot my password to see my online benefits account?
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Please click this link , select password, click the Next button. You will be asked to enter your user name. Click Next, and you will be asked your Security secret question. Click Next, a new password will be created and sent to your email address on record. Check your email for the new password message, copy the password, return to www.mymebs.com. Enter your user name and the password that was emailed to you. Click Next, you will be asked to create a new personal password. Click Next, and your MyMEBS home page will appear. When you log out and need to log back in, use your new personal password.
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| What is a self-funded health care plan? |
| Self-funded or self-insured health care plans pay benefits from a fund established by an employer or organization. Self-funded plans are not insurance plans and therefore do not come under the authority of the Michigan Office of Financial and Insurance Regulation. Self-funded health care plans are created under federal law and come under the authority of the federal government. |
| What is a third-party administrator? |
| A third-party administrator is a person or organization who processes claims and may perform other administrative services in accordance with a service contract. |
| How do I know if my employer-sponsored health care benefit is a self-funded health care plan? |
| The easiest way to find out if your health care is self-funded or insured is to ask your employer. You may also find the answer in the benefit information provided by your employer. Often if the word "plan" is included as part of the name of the coverage, it is a self-funded health care plan. Most large employers provide health care benefits through self-funded health care plans. |
| Does my dentist have to send a description of my treatment plan to the third-party payer before I have any dental work done? |
Third-party payers often request a "predetermination of benefits" on certain treatment plans. Usually this means a dental consultant will review your dentist's treatment plan and determine what benefits your plan will provide. But this predetermination is not a guarantee of payment. You may want to review your benefit prior to receiving treatment, but the final treatment decision should be a matter between you and your dentist, regardless of your benefit.
There may be a provision in your plan that will deny your normal dental benefit, or reduce the level of coverage if you do not submit the treatment plan for prior authorization. |
| What is the definition of an Administrator? |
| Administrator means any person who collects charges or premiums from, or who adjusts or settles claims on behalf of residents in connection with life or health insurance coverage or annuities on behalf of an authorized insurer. |
| What is your prescription drug mail-order plan? |
The Caremark Mail Service Program provides a convenient and cost-effective way for employees to order up to a 90-day supply of maintenance or long-term medication for direct delivery to their home, office or location of their choosing. By using the mail service program, your employees will minimize trips to the pharmacy while saving costs on their prescriptions. Employees can enjoy convenient delivery to their location of choice with standard free shipping. Employees can speak to a registered pharmacist 24 hours a day, ask a Pharmacist a question on Caremark.com, and even order refills online or by phone anytime, day or night. Based on the client’s plan(s), a 90-day supply can generally be dispensed by the mail service pharmacy for the cost of one co-payment.
Employees can make full use of the Caremark Mail Service Program by asking their doctor to write one prescription for up to a 30-day supply for immediate needs of short-term medication to be filled at their local retail pharmacy and a second prescription for their mail service pharmacy program with up to a 90-day supply of medication along with the appropriate number of refills (normally three refills – which is a year’s supply).
Medications are mailed to the employees in anonymous, tamper-proof packaging. Child-resistant caps, order forms and envelopes are included with every delivery. For employees’ convenience, all items in their order will typically arrive in one package. If an item is not available, Caremark will contact the employee to determine if they want the available items shipped, or held until all items are available.
Certain items require special handling and may be shipped by a faster method at no additional cost. In such cases, a customer care representative may contact the employee by phone to schedule a delivery date. The following items require special handling:
• Controlled substances and orders exceeding $1,200 in value will be shipped via two-day delivery service. An adult signature is required for delivery.
• Temperature-sensitive items (such as insulin) – are sent via priority overnight mail or second day delivery, depending on seasonal weather conditions. Ice packs are included with items requiring refrigeration. |
| How do participants activate the Benny Card? |
Participants should call the toll-free number on the activation sticker on the front of the card or visit the website on the back of the card.
Participants can use both cards once the first card is activated – they do not need to activate both. They should wait 48 hours after activation to use their cards. Each card user should sign the card with his or her own name.
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| How does the Benny Card work in participating discount stores and supermarkets? |
a. Bring prescriptions, vision products, over the counters, and other purchases to the register at checkout to let the clerk ring them up.
b. Present the card and swipe it for payment.
c. If the card swipe transaction is approved (e.g., there are sufficient funds in the account and at least some of the products are eligible), the amount of the eligible purchases is deducted from the account balance and no receipt follow up is required. The clerk will then ask for another form of payment for the non-eligible items.
d. If the card swipe transaction is declined, the clerk will ask for another form of payment for the total amount of the purchase.
e. The receipt will identify the eligible items and may also show a subtotal of the eligible purchases.
f. In most cases, the participant will not receive requests for receipts for eligible purchases made in participating discount stores or supermarkets.
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What is a “public employer pooled plan” as that term is used in P.A. 106 of 2007?
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A group of public employers may join together to provide medical, optical, and/or dental benefits to its employees on a self-insured basis. Such a “pooled plan” must provide coverage to at least 250 employees. A pooled plan must accept any public employer that applies to become a member and agrees to make the required payments, remain in the pool for three years, and satisfies other reasonable provision of the pooled plan. A pooled plan does not constitute doing the business of insurance and is not subject to Michigan’s insurance laws except as provided in the Public Employees Health Benefit Act. © 2009 Legislative Council, State of Michigan
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What groups or businesses are entitled to receive claims utilization and cost information?
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a. Public employers. Section 15(2) of P.A. 106 of 2007; MCL 124.85(2)
b. A carrier or administrator selected by an employer or employer group to provide benefits or administrative services. Section 15(5) of P.A. 106 of 2007; MCL 124.85(5)
c. The employee representative of employees covered under the medical benefit plan. Section 15(5) of P.A. 106 of 2007; MCL 124.85(5)
d. Any carrier or administrator who requests the opportunity to submit a proposal to provide benefits or administrative services for the medical benefit plan at the time of the request for bids. Section 15(6) of P.A. 106 of 2007; MCL 124.85(6) |
What are FSAs?
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Link to PDF download reference What are FSAs?
Flexible Spending Accounts or (FSAs) are employer sponsored benefit plan arrangements that
allow employees to pay for certain healthcare or dependent care expenses on a pre-tax basis.
Basic FSA facts include:
• The employer determines the maximum contribution.
• An employer may contribute to the account.
• Contributions are made pre-tax.
• Reimbursements are excluded from income.
• No limit on amount of reimbursement employees may receive under a healthcare FSA
• Dependent care FSA has expense limit of $5,000 annually ($2,500 for married taxpayer filing
separately).
What are the advantages of a FSA?
FSAs offer significant tax advantages. For employees any amount they contribute is exempt
from federal income, state income, or FICA taxes. Employers are exempt from paying FICA
taxes on the salary contributions and FUTA taxes because the employee's salary is slightly
reduced.
• Employers are able to offer a low-cost benefit that meets essential needs of their employees
such as childcare.
• Most employers generate significant FICA tax savings on contributions made to a FSA plan to
the point of providing the plan arrangements at no cost to the employer.
• No other type of a cost-sharing plan can provide the same level of dependent care tax
savings.
How do FSAs work?
• FSAs operate by the employer setting a maximum amount available in the FSA fund.
• The IRS Uniform Coverage Rule requires that the full amount of funds be available from the
start of the plan. This structure is similar to an insurance plan rather than a mere
reimbursement account.
• Employees make their "benefit elections" prior to the beginning of each plan year (before
benefits become available).
• The employer may also contribute to the account as long as it is specified to the employee in
the written plan document. The amounts employees may elect to contribute should be also
detailed in the plan document.
• Once the elections are made they may not be changed unless there is a "change of status".
• During the plan year, employees submit written proof of expenses for reimbursement.
• Employees must use their total amount set aside for their FSA account within the plan year or
within an employer's discretionary 2 1/2 month extension otherwise the balance is forfeited to
the employer.
Reference: MEBS edited FAQ content provided by Blue Cross® Blue Shield® of Michigan, a nonprofit corporation and independent licensee of the Blue Cross Blue Shield Association.
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Why should I use the Caremark Mail Service Program for my prescriptions?
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| The Caremark Mail Service Program provides a convenient and cost-effective way for you to order up to a 90-day supply of maintenance or long-term medication for direct delivery to your home, office or location of your choosing. By using your mail service program, you minimize trips to the pharmacy while saving costs on your prescriptions. With most benefit plans, up to a 90-day supply is dispensed by the mail service pharmacy for the cost of one co-payment. |
How can I receive the maximum benefit from the Caremark Mail Service program?
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| So that you can make full use of the Caremark Mail Service Program, ask your doctor to write one prescription for up to a 30-day supply for immediate needs for your short-term medication to be filled at your local retail pharmacy and a second prescription for your mail service pharmacy program with up to a 90-day supply of medication along with the appropriate number of refills (normally three refills - which is a year's worth). In your Welcome Package you received a Participant Profile/Order Form. Please complete the form, attach your new 90-day supply prescription and mail it to Caremark along with the appropriate co-payment in the self-addressed envelope or return it to the address listed in your booklet. |
How do I receive additional Mail Service order forms? Is the order form necessary every time I order? Do I need to complete all information on the form?
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You can print order forms from Caremark.com. Simply log in to Caremark.com with your username/login ID and password, click on the "Prescriptions & Coverage" tab, then select Print Forms from the menu on
the left side of your screen. You can also contact Customer Care at customerservice@caremark.com, contact them via your toll-free number or contact your benefits office.
When ordering refills via Caremark.com, you will not need to fill out an order form for each refill order. Once we have your account and billing information, you can place refill orders by simply logging in to Caremark.com with your username/login ID and password, clicking on the "Prescriptions & Coverage" tab, selecting Refill Prescriptions and choosing the prescriptions that you want to refill.
You also will receive a computer-generated Participant Profile/Order Form and pre-addressed envelope with each Caremark prescription mailed to you. The form will be filled in with your preprinted information, so you will not need to complete the form every time you submit a mail service prescription. If your address, doctor or health condition information changes, please note them on the Participant Profile/Order Form and be sure to make the same changes to your account on Caremark.com.
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