2024 Archdiocese of Atlanta / Lay Employee Quick Guide - Flipbook - Page 8
What happens if I have other medical coverage?
This plan is primary to any other health plan you may have, including in most cases, Medicare. If you do
have other health coverage, confirm this with your other health insurer.
Notifying Employee Benefits of changes in eligibility
Qualifying Events and Special enrollment situations - To avoid a denial of claims, you must notify
Employee Benefits within 31 days if you wish to add a dependent as a result of a special enrollment situation
or qualifying family status change. Failure to notify Employee Benefits within 31 days of the event means that
you will need to wait until the next annual enrollment to make changes to your benefits.
Q: My wife is pregnant and will be quitting her job. When should I enroll her and the new baby?
A: You must request enrollment within 31 days following the birth of your new child and 31 days following the
termination of your wife’s employment. Coverage will be retroactive to the date of the event. The same 31 day rule
applies to any special enrollment situation.
Loss of eligibility - You must notify Employee Benefits within 31 days of any event that results in a loss of
coverage—such as divorce, or dependents exceeding the maximum age. If you wish to extend coverage for
these dependents, you must notify Employee Benefits within 31 days of the event.
Pre-existing conditions
Pre-existing condition exclusions do not apply to this medical plan.
Features of your plan
Understanding the features of the health plan that the Archdiocese of Atlanta has designed for you is the first
step to maximizing the benefits of your healthcare coverage.
You will be responsible for some out-of-pocket expenses.
Co-payments (co-pays) and deductibles are costs you will encounter when you receive healthcare services.
Co-payment (Co-pay): An amount of money that a participant is required to pay each time he or she visits a healthcare
provider, or fills a prescription.
Deductible: The annual out-of-pocket amount that a plan participant is responsible for paying before the health plan covers
his or her medical costs. Until a person meets the annual deductible, he or she pays the full cost of healthcare services
received, unless the service is not subject to the annual deductible as stated in the benefit schedule.
After you meet any applicable deductible, you will still pay a portion of your medical costs. Your plan pays for
a percentage of the costs your healthcare provider charges. The remaining difference is your responsibility.
Your plan also has an out-of-pocket maximum, which is the most money you are expected to pay in a calendar
year for covered health expenses.
Important note: Not all costs are subject to your deductible or apply to the out-of-pocket maximum.
See your Plan Document for more detailed information.
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