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Benefit Summaries
To be eligible you must be a resident of one of the following counties; King, Snohomish, Pierce, Whatcom, Skagit, Island, San Juan, Kitsap, Lewis, Thurston, Mason, Grays Harbor (zip codes 98541, 98557, 98559 and 98568) Benton, Columbia, Franklin, Kittitas, Yakima, Walla Walla, Whitman & Spokane. Proof of residency must accompany your application, such as a copy of a Washington State driver’s license, voters registration card or a current utility bill, with your name and address clearly visible. In addition, you must not be eligible for Medicare. Enrollment Forms & Instructions
Completed enrollment materials must be received in our office on or before 20th of the month to be effective on the first of the following month (e.g., June 20th for July 1st effective date). 1. Complete the Group Health Cooperative Enrollment Application, check the box for dental coverage if you desire it, and review the Terms and Conditions document. Be sure to include proof of residency information as requested and a check for the first month’s premium. Only one application is necessary per family. We strongly recommend that you complete the Electronic Funds Transfer Form as well so that monthly premiums are not missed by accident. 2. Complete the Standard Health Questionnaire. A separate questionnaire must be completed for each enrolling family member unless:
3. Submit your Enrollment Application, Check for first month’s premium, Standard Health Questionnaire, and Proof of Residency to: R. L. Evans Company, Inc. Your Enrollment Application and Standard Health Questionnaire must include an original signature (faxed copy is not acceptable). Please note: In some situations, not all family members will qualify for coverage through the health insurance carrier based on the Standard Health Questionnaire. If an applicant or any family member does not qualify for coverage from the health insurance carrier, within 15 business days they will be provided with information on how to apply for coverage through WSHIP (Washington State Health Insurance Pool). Those family members who do qualify may still obtain coverage through the carriers they applied to.
Q. How do I choose a doctor, and can I switch if I decide I want someone else? A. You can use GHC’s provider directory for Western Washington or Eastern/Central Washington and North Idaho to choose a primary care or self-referral provider online or to switch providers. To register your choice of primary care provider, call the Customer Service Center, or select a provider online before making an appointment. Once you've registered your choice with the Customer Service Center, call your doctor's office directly to make appointments. Let them know you're a Group Health member. If you want to change doctors — for any reason — just call the Customer Service Center. Some areas may have limits on when you can change doctors. Q. Who can I call if I am ill after hours? A. If you need medical advice after your doctor's office has closed for the day, call our Consulting Nurse Service. The consulting nurse will give you advice on how to best treat your condition and, when necessary, recommend that you come in to an urgent care facility or the emergency room. Q. What do I do in case of an emergency? A. In a life-threatening situation, call 911 and the medics will take you to the nearest hospital. If you or a family member are admitted to a hospital while traveling, you must call within 24 hours to notify us or to request follow-up care (exception: Medicare members do not need to notify us). The number to call (1-888-457-9516) appears on the back of your Group Health card. For urgent medical needs other than emergencies, call your regular Group Health medical center or doctor. After hours, call the Consulting Nurse Service. Q. What's the difference between urgent care and emergency care? A. A life-threatening emergency is the sudden onset of a condition which requires immediate medical attention to prevent death or permanent injury. Examples of life-threatening emergencies include stroke, unstoppable bleeding, heart attack, and convulsions. Urgent care is treatment for a condition that requires prompt attention, but does not pose an immediate, serious health threat. Ear infections and sprained ankles are examples of conditions that urgent care staff can treat. Q. How do I get a referral to a specialist? A. Group Health members can now make appointments directly with most Group Health specialists at Group Health-owned or
To get a specialty consultation from Group Health doctors at Group Health- operated medical centers , call the specialist's office directly or call Customer Service for assistance. Western Washington specialists are listed in the online provider directory. Eastern Washington and North Idaho specialists are listed in both the self-referral and specialty care sections of the printed provider directory. For mental health or chemical dependency (alcohol and drug problems) treatment, contact Behavioral Health Services. For other specialties, contact your primary care provider, who will discuss your health care needs with you and decide if referral to a specialist is appropriate. Many Options and Alliant members may also choose to see an out-of-network provider without a referral and be covered at a lower benefit level. Q. How do I get a second opinion about a medical condition? A. For primary care issues, call your medical center and request an appointment to another primary care provider in your clinic. For specialty issues, call the specialty clinic where you had your first appointment and request a second opinion. An appointment will be made with another specialist. Q. I've been trying to get through to my doctor's office all day and get either a busy signal or put on hold. Can you help me? A. We apologize for the trouble. If you call the Customer Service Center, we can check the number to make sure it's correct (numbers sometimes change) and can also check to make sure there is no technical trouble. You might find it helpful to know that some times are busier than others. Monday is the busiest day of the week, and morning is the busiest time of every day. If you call in the late afternoon, you'll find it easier to get through. Remember, if you have a life-threatening emergency, call 911. However, if it's another urgent matter, you can also call the Customer Service Center; the staff will try to get you through. For communication that is not urgent, try our online secure messaging service to talk to your health care team. To use this service, you must register with MyGroupHealth, the personalized version of this Web site, and complete the ID verification process at your medical center. Q. I've had an on-the-job injury. What should I do? A. If you are injured on the job, tell your employer immediately and complete any necessary internal forms. Here's what you'll need to do: Q. How do I know what my Group Health plan covers? A. When you enrolled with Group Health, you received a benefit summary (also called a certificate of coverage) that lists most covered services. If you have a coverage question that is not answered in the benefit summary, contact the Customer Service Center. Q. Are prescription drugs part of my coverage? A. The $500 and $1000 deductible Comprehensive programs include a limited prescription drug benefit. The Catastrophic plans do not. If you have questions about whether a prescription you are currently taking will be covered, call a Group Health pharmacist or check our online pharmacy information. You also may call Customer Service; they can tell you what medications are covered on your plan. Q. I am expecting a baby next month. How do I add my child to my Group Health policy? A. You have 60 days after a baby's birth to sign up your child for Group Health coverage. Contact the Customer Service Center. Q. My family has a vacation planned. What medical coverage do we have while we're away? A. Group Health enrollees are covered for emergency and urgent care while traveling anywhere in the world. This coverage is described in your Group Health certificate of coverage or medical coverage agreement. If you or a family member are admitted to a hospital while traveling, you must call within 24 hours to notify us or to request follow-up care (exception: Medicare members do not need to notify us). The number (1-888-457-9516) appears on the back of your Group Health card. While traveling outside the Group Health coverage area, members of Group Health Cooperative may get care at any facility of Kaiser Permanente. Check When you are traveling to learn more. You are also covered for medically necessary outpatient services (except outpatient prescription drugs) when these are provided by a participating health maintenance organization (HMO). You can also call our Consulting Nurse Service to determine a course of care. The Customer Service Center can tell you if there is a participating HMO where you are visiting and more about your coverage. Some questions to ask the Customer Service rep: Q. How do I add dental benefits to my coverage? A. Consumers on certain individual and Medicare plans have a dental option available to them. See individual dental information on this web site to find out if you are eligible for dental coverage. Q. My daughter will be attending college out of the area next year. Will she continue to be covered under my policy? A. Group Health enrollees who attend school in Central and Eastern Washington are covered through Group Health Cooperative services in Eastern Washington and North Idaho. Enrollees attending schools in other states are covered for urgent and emergency care only. Full time students may be covered until age 25. Q. I have a question about a bill I received. Where do I call? A. There are three types of bills for Group Health services: Patient Financial Services bills both for copayments that were not paid at the time of service and for services you received that are not covered in your contract. For questions about these bills, contact the Customer Service Center. Individual members of Group Health receive a monthly dues billing. If you have a question, contact the Customer Service Center. Services from non-Group Health providers (e.g., an emergency where you were taken to the nearest emergency room) may be billed by the outside provider. If you receive such a bill, send a copy to: Group Health Claims Administration If you have any questions about where to call, contact the Customer Service Center. Q. Where do I send a bill for reimbursement from an outside provider? A. Group Health Claims Administration Q. I just joined Group Health. How do I get started using my health care? A. New Group Health members should receive materials including an identification card, a benefits booklet/certificate of coverage, a "Your Guide to Group Health" manual, and a provider directory. If you have not received these items, contact the Customer Service Center. Q. How do I get a copy of my medical records? A. To protect patient confidentiality, Group Health is required to obtain a medical release form — signed and dated by the consumer — for the release of most medical records (including X-rays). You can get a release form from our Customer Service Center. A release is not required if you only want immunization records. Q. I lost my Group Health ID card. How can I get another one? A. You can order a new ID card online if you are registered and logged in to MyGroupHealth. Or you can contact the Customer Service Center. You will receive a new card in the mail in approximately 10 business days. If you have not yet done so, log in or register with MyGroupHealth for Members to access the ID card order form. Meanwhile, you can still receive medical care from your medical center if you need care. Q. What do all those numbers on my card mean? A. If your membership card was issued after June 2003, it lists your name, the name of your insurance plan, your unique identification number, and two columns of numbers below. The numbers on the left side of the card help us process your pharmacy claims. The numbers on the right side of the card list your copay amounts for office visits, pharmacy, inpatient services, and emergency room visits. Group Health is phasing out cards that contain other information, such as subscriber name and number, birthdate, and Web access number. All members should have the new black and white cards by May 2004. Q. What is Group Health's relationship with Virginia Mason? A. Virginia Mason Medical Center and Group Health formed an alliance in 1993. They contract with each other for shared Seattle hospital services and the Alliant health plan. Q. What is Group Health's relationship with Kaiser Permanente? A. Kaiser Permanente, the nation's largest nonprofit health care system, and Group Health created an alliance in 1997. Both remain independent and separate, but collaborate on regional and national marketing and share best clin
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Home | Associates | Location | Privacy Policy Plaza 600 Building : 600 Stewart Street : Suite 1210 : Seattle, WA 98101 |
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