Topic

MSB Employee Benefit FAQ

Insurance Dictionary

What is a deductible?

A deductible is the amount of money you pay for healthcare services before your insurance starts covering its share. For example, if you have a $1,000 deductible, you pay the first $1,000 of your medical bills, and then your insurer pays a portion after that.

What is the out of pocket limit?

Your out-of-pocket limit is the maximum amount you'll pay for covered health care services in a plan year. Once you reach this limit, your health insurance plan pays 100% of the cost for any additional covered medical care for the rest of the year.

Three-stage infographic illustrating how health insurance costs are shared throughout the plan year. In Stage 1, the member pays 100% of covered services until the deductible is met. In Stage 2, the member and insurance company share the cost of covered services based on their respective percentages. Once the out-of-pocket maximum is met, Stage 3 begins, and the insurance plan pays 100% of covered services for the remainder of the plan year.

Enrollment and Eligibility

When can I enroll in health insurance?

You can enroll during the annual open enrollment period or within 30 days of a qualifying life event.

Can I make changes to my health plan during the year?

Only if you experience a qualifying life event such as marriage, birth, or loss of other coverage.

What is a qualifying life event (QLE)?

A QLE is a major change in your life—like getting married or having a baby—that allows you to make mid-year changes to your coverage.

Can I cover my spouse or children?

Yes, you can add eligible dependents, including your spouse, and children up to a certain age.

When does coverage start after I enroll?

Coverage usually begins on the first day of the month after your enrollment or qualifying event, unless stated otherwise.

Using the Plan

How do I find an in-network doctor or hospital?

You can search the provider directory on your Allied member portal.
For surgical, imaging and hospital care in Anchorage see your plan document for in network facilities.

Do I need a referral to see a specialist?

How do I know if a procedure is covered?

Check the plan documents or contact Allied to confirm coverage and any requirements.

What should I do in an emergency?

Call 911 or go to the nearest emergency room.

Why is our plan out of network with Providence Hospital?

Alaska Regional Hospital was able to give us a better contracted rate for surgeries.

Costs & Money Savings

How can I lower my health care costs?

Use in-network providers
See Capstone for urgent care, primary care and preventative care when possible
Use Teledoc through Transcarent for telehealth services
Choose generic medications through CVSCaremark
Take advantage of preventive care annually
Compare treatment costs when possible

How does the Capstone Direct Bill Contract work to save costs?

When you see a provider at Capstone, instead of Capstone billing Allied for the visit, they bill the Borough directly. This contract saves our health plan enough money that the Borough does not need to pass any of the cost down to employees.

What If & How Do I?

What if my provider doesn't bill insurance?

If your provider does not bill insurance directly and you paid for services out of pocket, you may still be eligible for reimbursement. Simply submit a manual claim form, and the plan will process the claim according to the provider's network status and your applicable benefits. Any eligible reimbursement will be paid based on what the plan would normally cover for that service.
- Medical Claim Form
- Dental Claim Form