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Is dependent supplemental coverage right for you?

Aug 17, 2018 7:00:00 AM / by Tamara Castellano

Let’s be honest.  Healthcare is expensive.  Even if you have health insurance, most plans have annual deductibles and out-of-pocket expenses like copayments.  If you don’t relish having to pay unexpected medical expenses, the UPREHS Dependent Supplemental Plan (DSP) might be for you.

What is a supplemental health plan?

A supplemental health plan covers expenses that are not covered by your primary insurance.  For example, your deductible for an MRI might be $500 with your primary insurance—if you have a supplemental plan, the deductible of $500 would be covered by the supplemental plan.

Who should enroll in the DSP?

It’s important to note that supplemental health plans are optional.  You should evaluate your dependent’s existing health coverage and any anticipated expenses.  If your spouse had to have knee surgery and your out-of-pocket was $1000, could you pay that?  If the answer is no, you should consider a supplemental health plan.

What does the UPREHS Dependent Supplemental Plan pay for?

When you enroll in the UPREHS DSP, we cover your annual deductible and out-of-pocket maximum copayments for in-network services for eligible dependents who are on the Managed Medical Care Plan (MMCP), the Comprehensive Health Care Plan (CHC) or another employer-sponsored health plan.  PLEASE NOTE:  The plan does not pay for pharmacy costs or any charges related to out-of-network services.

Who is eligible?

Any Challenger Plan UPREHS member is eligible to enroll in our DSP for their eligible dependents (current employees).

If your dependents are on CHC, you’d pay (2018)

National Health & Welfare Plan annual deductibles

Individual /  $325

Family /  $650

National Health & Welfare Plan annual max out-of-pocket

Individual /  $2,800

Family /  $5,600

UPREHS DSP pays

Individual /  $3,125

Family /  $6,250

Your monthly premium (via payroll deduction) is  $130

 

If your dependents are on MMCP, you’d pay (2018)

National Health & Welfare Plan annual deductibles

Individual /  $325

Family /  $650

National Health & Welfare Plan annual max out-of-pocket

Individual /  $1,800

Family /  $3,600

UPREHS DSP pays

Individual /  $2,125

Family /  $4,250

Your monthly premium (via payroll deduction) is  $90

 

What if my dependent has a pre-existing condition?

Any illness or condition that is covered by your primary plan (MMCP or CHC) will be covered by the DSP, up to the plan limits.

What if my dependent has their own employer-sponsored insurance?

The DSP will pay out benefits after the primary health plan has covered their allowable expenses.  Please note: The DSP maximum payout is based on the National Plan deductibles and out-of-pocket maximums.  Depending on the employer-sponsored plan deductibles and out-of-pocket maximums, some expenses may not be completely covered by the DSP.

How and when to enroll

To enroll, complete the enrollment form and email it to help@uphealth.com.

There are two opportunities for enrollment:

  1. When you are hired, or you have a job change such that you become a UPREHS member.  You can enroll in the DSP within 90-days of the start of your coverage with UPREHS; or
  2. During open enrollment, scheduled for November 1-December 15, 2018.

If you had previously been enrolled in the DSP and canceled it, voluntarily or due to non-payment, you can re-enroll three years from the date of your cancellation.

How to file a claim

  1. Your dependent’s claim for services should be submitted to your primary insurance carrier first.
  2. Once your claim is submitted and paid by the primary insurance, you will receive an Explanation of Benefits (EOB).  The outstanding balance you owe for services will be outlined on the EOB.
  3. Please send your EOB to:

UPREHS Dependent

Supplemental Plans

PO Box 161020

Salt Lake City, UT. 84116-1020

Or email to help@uphealth.com

Please be sure to include your UPREHS member ID on each EOB. 

 

UPREHS will review your claim and pay the covered amount directly to you.

You must file your claim within one year of receiving an EOB from your dependent’s primary insurance carrier.  Once enrolled, you are required to stay in this plan for a period of 12 months. You may leave the plan during open enrollment, after 12 months.

Still have questions?

For more information on the UPREHS DSP, contact Member Services at 800.541.0421.  We are open Monday through Friday, 7:30 a.m. - 3:30 p.m., MST.  You can also email your questions to help@uphealth.com.

 

Topics: Plan Information, Member Resources, Dependent Supplemental Coverage

Tamara Castellano

Written by Tamara Castellano

Tamara is the marketing communications guru for UP Health.

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