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.
Does the contribution amount increase based on the number of children?
- No.
What is the age limit for children?
- 26
Is there a penalty for a covered spouse if they opt out of available coverage from their employer?
- Yes. The penalty is that the plan would only cover 20% of the claim and the spouse would be responsible for the remaining 80%. Deductible and out of pocket max are the same.

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.

If an employee has other coverage can they choose not to be covered under the Mat-Su Borough health plan?

Yes.

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 percentage of the plan costs are paid by the Borough and what percentage are paid by the employees?

	FY23 - June 2022 - July 2023	FY24 - June 2023 - July 2024	FY25 - June 2024 - July 2025	FY26 - June 2025 - July 2026	FY27 - June 2026 - July 2027
Borough	84% of Prior Plan Year Costs	83% of Prior Plan Year Costs	82% of Prior Plan Year Costs
Employees	Employees 16% of Prior Plan Year Costs	Employees 17% of Prior Plan Year Costs	Employees 18% of Prior Plan Year Cost

When an employee uses the Transcarent virtual physical therapy program (SWORD), does the employee have to pay for it?

No. The plan will pay a flat fee that will cover the employee's virtual physical therapy treatment(s), for one or multiple conditions, over a rolling 12-month period.

How does Aetna affect our plan?

Aetna is the preferred provider network for our health plan. In Anchorage, Alaska Regional Hospital and the Surgery Center of Anchorage are the only PPO facilities. You will pay a non-PPO penalty if you use a hospital, surgical center or imaging center other than Alaska Regional Hospital or the Surgery Center of Anchorage, even if they are in the Aetna network. In Mat-Su, Mat-Su Regional Hospital is the PPO hospital but you can use other Aetna PPO imaging and surgical centers, as well.

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

How does out of state coverage for preferred providers work?

Coverage is the same, and you can access Aetna PPO providers.

Tax-Advantage Savings Accounts (FSA, HSA, HRA)

Why would an employee choose a plan with an HRA (Health Reimbursement Account) if they have the a FSA (Flexible Spending Account)?

You may choose to have both a HRA and a health FSA. The health FSA can be used for services that are not eligible under the health plan. The HRA can only be funded by the employer. If you know you will have significant expenses, you may wish to make pre-tax employee contributions into a health FSA. If you choose to have both, the health FSA will be used first.

Is there a list that outlines which medical expenses are covered by the HRA (Health Reimbursement Account)?

Our HRA will only reimburse services that are eligible under the health plan, which includes deductibles, copays and coinsurance.

Will the HRA be prorated based on the hire date of an employee or a change in plan due to a qualifying life event?

No, the full HRA contribution will be made.

Can an employee still have a flexible spending account if they elect a high deductible plan with an HRA?

Yes. An employee can have a FSA and a HRA. However, FSA funds must be utilized prior to using HRA funds.

If I move from a high deductible plan to another one, how does the HRA work?

You will maintain your HRA balance if you move between high deductible health plans.