ERACPeople - Medical Questions

Medical Questions and Answers

Can an employee join the EPO and his spouse/dependent join a PPO plan (or vice versa)?
No, all family members must belong to the same plan.

What if an employee selects EPO coverage and then changes his mind?
Employees are committed to their enrollment choices for the entire plan year (Jan. 1 - Dec. 31) and may only change from one plan to another during open enrollment which takes place each year in the fall. Changes made during open enrollment become effective January 1.

With the EPO Plan, can each family member choose a different PCP (Primary Care Physician)?
Yes, each member may choose a separate PCP, or if they wish, they may all see the same family practitioner.

Can I change PCP's (Primary Care Physician) during the plan year?
Yes, you can change your Primary Care Physician (PCP) anytime throughout the year. Simply call UnitedHealthcare customer service at 800-520-0746 and ask them to make the change or register on www.myuhc.com and select a new PCP online. Since PCP information does not appear on your medical ID cards, new ID cards will not be issued when changing from one PCP to another.

Do I need a referral from my EPO Primary Care Physician (PCP) to see a specialist?
No, PCP referrals are not required to see an EPO specialist in the EPO. However, for EPO benefits to be paid, you must receive care from EPO network providers. (Note: This is different from the PPO plan where there are in-network and out-of-network options.)

How do I get a new medical ID card?
Call UnitedHealthcare at 800-520-0746 or request additional ID cards via www.myuhc.com.

Is chiropractic care covered?
Yes, chiropractic care is covered under the UnitedHealthcare medical plans up to 20 visits per calendar year.

If an active employee is in the PPO, can they, upon termination, switch to the EPO when they elect COBRA?
No, they must wait until the next open enrollment period to change plans.

Does getting married or having a baby allow me to switch coverage from EPO to PPO or vice versa?
No, these life-changing events do not allow you to switch coverage. Depending on the life-changing event you may be allowed to either add or drop coverage for yourself or eligible dependent(s) only within the plan you are currently enrolled.

Example I: Employee enrolled in the EPO has a baby. Employee can add new dependent to the EPO. This event does not allow employee to switch coverage to the PPO300 or PPO600 plan.
Example II: Employee and spouse enrolled in the PPO300 get divorced. Employee must drop coverage for the ex-spouse. The divorce does not allow employee to switch coverage to the PPO600 or EPO plan.

A specialist I want to see is not in the EPO. Can I switch to the PPO300 or PPO600 in order to change providers?
No, your enrollment elections must remain unchanged until the next open enrollment. For example, if you are enrolled in the EPO, all specialists must be in the EPO network. You may change to another Primary Care Physician or specialist within the EPO network — but you may not make a midyear switch to the PPO300 or PPO600. If you decide to see a specialist that is not an EPO network provider, you will be responsible for paying the entire cost of any care you receive.

I enrolled in the PPO300 because it was the only option available to me. I am now transferring to an area where I have the choice of either PPO or EPO coverage. Can I change my coverage to the EPO before the next open enrollment?
Yes, a move or transfer may result in eligibility for a different plan option since eligibility for plan coverage is determined by zip code. In this case, the option for both EPO and PPO coverage is now available and you may switch your coverage to the EPO. This is the only situation where a midyear change from one plan to another is allowed. If your new zip code provides the same options, a change from one plan to another is not allowed.

Is Lasik surgery a covered benefit?
Lasik is not covered under the Enterprise medical plan. However, by enrolling in the EyeMed Vision Care plan, members can take advantage of a laser vision correction benefit. EyeMed and LCA-Vision have arranged to provide this benefit to all EyeMed Vision Care members through the U.S. Laser Network. Members are entitled to a 15% discount on the usual and customary fees for LASIK and PRK procedures, or a 5% discount on any promotional pricing, whichever is the greater benefit. No claim forms are needed, making it a hassle free process for members. Call to 1-877-5LASER6 with questions.