Topic

MSB Employee Benefit FAQ

General Coverage

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.

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/domestic partner 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?

No.

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?

Go to the nearest emergency room.

Costs & Money Savings

How can I lower my out-of-pocket health care costs?

• Use in-network providers

• See Capstone for urgent care, primary care and preventative care when possible

• Choose generic medications

• 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 so much money that the Borough does not need to pass any of the cost down to employees.