FAQ

FAQ

FAQ

Frequently Asked Questions

IIS Benefit Administrators has a dedicated, HIPPA-approved customer service staff trained to handle your questions. If you have a customer service question of any kind, call 833-757-0447 toll free.

Your doctor will charge you a co-pay that is part of your policy. If your doctor has questions regarding the plan, please have him or her contact our Customer Service Department using one of the phone numbers above.

You will simply pay the co-pay amount listed on your ID card. If the pharmacist has any questions he or she can contact our Customer Service Department at one of the phone numbers above.

Some doctors bill very quickly after your visit. If you receive an invoice from your doctor within 30 days after your visit, please disregard it as it may not be a bill. You will receive an explanation of benefits (EOB) statement from your insurance company. Your physician will be paid based on the EOB.

All claims questions are gladly answered by your broker. Call 833-757-0447 toll free.

Your employer has seen the cost of your group medical plan increase for the past few years. Instead of lowering your benefits and increasing your contributions, your employer has decided to use an innovative plan to maintain quality benefits and contain the out-of-pocket costs of employees while keeping the company’s costs low.

IIS Benefits has a specially trained claims staff to process all your medical claims. Once your claim has been processed, you will receive an explanation of benefits (EOB) statement from our claims department.

The term “out-of-pocket" refers to an amount of eligible medical expenses to be paid by either the employee or the employer. Out-of-pocket expenses are typically the sum of the deductible amount plus the co-insurance amount (co-Insurance rate or co-Insurance corridor). The out-of-pocket expense can also include specific types of employee pay or employee or employer expenses that may be itemized on the plan's Annual Benefit Summary. Amount due for eligible medical expense -- only that you have incurred the expense, that you have submitted it to, that it has been processed and reported by them via the EOB, and that it is not being paid for or reimbursed from any other source.

Eligible expenses must have been incurred during the plan year. You may not be reimbursed for any expenses: Arising before the plan became effective Incurred before you became covered under the plan incurred after the close of the plan year Incurred after a separation from service (except for continuation coverage)

The plan provides reimbursement for eligible medical expenses incurred by you, your spouse and any other person you could claim as a dependent on your federal income tax return as long as these eligible individuals are covered under the Employer's Insured Health Plan.

All claims are adjudicated (reviewed for approval under the provisions of the employer's insured health plan). All amounts due under the plan are based on the determination made by the insurance carrier. You will be notified in writing by the carrier via the EOB (explanation of benefits) within 90 days of the date you submitted your claim if the claim is denied. Such notification will set out the reasons your claim was denied and further advise you of what steps, if any, you might take to validate the claim. If a claim is denied under the plan but approved under the employer's insured health plan, you will be advised of your right to request an administrative review of the denial of the claim. You may request a review any time within the 90-day period after you have received notice that your claim was denied. You or your authorized representative will have the opportunity to review any documents held by the administrator and to submit comments and other supporting information. In most cases, a decision will be reached within 90 days of the date of your request for a review.