skip to main content
Open to Everyone.
Mother with child

Frequently Asked Questions

General Questions

  • 1. Do I need to submit a claim form?

    When you use a network provider, you don’t need to file a claim. Just show your ID card, and your provider files the claim for you. Make sure you carry your ID card with you, since it includes the address your provider will need to submit your claims.

  • 2. How do I obtain a claim form?

    For your convenience, you can view and download a copy here.

  • 3. Where do I send my claim?

    Network providers usually file claims for you. However, if you need to submit a claim please use the following address:

    Medical claims:

    MHBP
    PO Box 8402
    London, KY 40742-8402

    For prescription drug claims:

    CVS CAREMARK
    Attn: Claims Department
    P.O. Box 52136
    Phoenix, AZ 85072-2136

    For MHBP Dental Plan claims:

    MHBP
    PO Box 8403
    London, KY 40742

    For MHBP Vision Plan claims:

    VSP
    P.O. Box 997105
    Sacramento, CA 95899-7105

  • 4. How do I file a claim?

    When you use a network provider, you don’t need to file a claim. Present your ID card at the time of service and your provider will file the claim for you. When you use non-network providers you may have to file your own claim. To file your claim, print this form. Complete the form and mail it to the address on the form. If you have questions, just call us at 800-410-7778.

  • 5. What should I do to file a disputed claim?

    Follow the Federal Employees Health Benefits program disputed claims process if you disagree with our decision on your claim or request for services, drugs, or supplies, including a request for preauthorization/prior approval. View the appeals/disputed claims process.

  • 6. What is precertification?

    Before you're admitted to the hospital as an inpatient, you’ll need to get your stay precertified. Precertification is the process by which we evaluate the medical necessity of your proposed stay and how many days are required to treat your condition. Any stay greater than 23 hours must be precertified, except maternity admission for a routine delivery.

    OPM requires all Federal Employee Health Benefits program plans to precertify hospital stays. In most cases, your physician or hospital will take care of precertification. However, you are still responsible for making sure that we are asked to precertify your care. So always check with your physician or hospital that they have contacted us.

    Warning: We will reduce our benefits for the inpatient hospital stay by $500 if no one contacts us for precertification.

    We will not change the decision we make on medical necessity, unless we are misled by the information given to us. In addition, if the stay is not medically necessary, we will not pay any benefits for the room and board charges.

    If you are admitted for services or supplies we don't cover - for example, non-covered cosmetic surgery - we will not pay any benefits.

  • 7.How do I precertify for a hospital admission?

    You, your representative, your doctor, or your hospital must call the Plan at least two working days before admission. The toll-free number is 800-410-7778. Provide the following information:

    • Enrollee's name and Plan identification number
    • Patient's name, birth date and phone number
    • Reason for proposed hospital stay
    • Name and phone number of the doctor who will admit you
    • Number of planned days in the hospital

    We will then tell the doctor and hospital the number of days in which the patient is approved to stay in the hospital. Our decision will be sent to you, your doctor, and the hospital.

  • 8. What do I do in case of an emergency?

    When there is an emergency admission you, your representative, the doctor, or the hospital must telephone 800-410-7778 within two business days after the day of admission, even if the patient has been discharged from the hospital.

  • 9. What is preauthorization?

    Preauthorization is required for:

    • Inpatient hospital visits
    • Services for mental health and/or substance abuse
    • Certain prescriptions
    • Some radiology and imaging services: CT/CAT scan, MRI, MRA, NC and PET scan (you must contact the plan before receiving these services at 800-410-7778)
    • Injections for the treatment of back and neck pain
  • 10. Do I still need to precertify for hospital admission if I use a network hospital?

    Yes. The Federal government requires that all members of a fee-for-service plan must precertify their hospital admissions.

  • 11. How do I find a network provider?

    You may visit our Find a Provider tool to look up providers who participate in the network. If you prefer, you may send us an e-mail. You may also call the toll-free number on your ID card, and we will help you find a participating provider near you.

    While we strive to include correct, complete and current provider information, keep in mind that this information may have changed. Please call your doctor before your appointment to confirm his/her network status.

  • 12. Can I obtain a paper directory listing network providers?

    Paper directories become outdated quickly as new providers join our growing network.

    Print a copy of the directory from the Find a Provider tool by selecting the printer icon shown on the page after you have performed your search.

  • 13. Can I access network providers while traveling?

    Members have access to providers in our network virtually anywhere in the United States. Whether you are on vacation, business travel or away at college, you and your eligible dependents can find providers who participate in our network.

  • 14. When my doctor refers me to a specialist, must I confirm that the specialist participates in the network?

    Yes. While we encourage network doctors to refer their patients to other network doctors, this may not always be possible. You should confirm that the doctor is a member of our network. Likewise, if your doctor refers you to a hospital, please confirm that the hospital is in our network.

  • 15. How do I get my physician or dentist to participate in the network?

    If your doctor or dentist does not currently participate in our network, you may submit a physician nomination form or a dentist nomination form to have him/her considered. Fill out the patient section and ask your doctor or dentist to complete the rest. After we receive the form, it can take up to six months for us to complete the review process. If you have questions, please send us an e-mail or call the toll-free number on your ID card for assistance.

  • 16. How can I replace a lost ID card?

    To get a new ID card, you may order it online through My Online Services, call us at 800-410-7778, or email us.

  • 17. Whom do I notify if I change my address?

    Please report your new address in writing to the address below:

    MHBP
    P.O. Box 8402
    London, KY 40742-8402
    USA

  • 18. Whom do I notify to add/delete dependents?

    Contact your Human Resources department and complete a Standard Form 2809.

Consumer Option Questions

  • 1. What is an HSA?

    Health Savings Accounts (HSAs) are tax-exempt trusts or custodial accounts, similar to an IRA.

    The money deposited into an HSA account is 100% tax-free and can be used to pay for qualified medical expenses. Any money that isn't used remains in your account and keeps growing on a tax-favored basis to cover future medical expenses or to supplement retirement.

  • 2. Activating Your HSA

    In order for MHBP to make the Plan contribution, you will need to establish your health savings account (HSA). To set up your account, you should have received an HSA Enrollment Form as part of your Welcome Kit. Complete this form and return it to the address provided on the form. Once returned, you will receive your HSA Debit Visa card. To access your HSA account information online, you will need to sign into My Online Services to access HealthEquity and follow the registration procedures.

  • 3. Contributions to Your HSA

    MHBP will contribute up to $900 for Self Only coverage, or up to $1,800 for Self Plus One and Self and Family coverage per year to your HSA.

    Plan contributions are made in monthly installments of $75 for Self Only coverage, or $150 for Self Plus One and Self and Family coverage, for each month you are enrolled in Consumer Option and eligible for an HSA.

    You can also make tax-deductible contributions to your HSA. Your contribution may be made in one lump sum at the beginning of the coverage year, or incrementally throughout the course of the coverage year. Your eligible family members may also contribute to the HSA on your behalf.

    • For 2016, you may make a contribution to your HSA, up to $2,450 for Self Only, or $4,950 for Self Plus One or Self and Family.
    • For 2017, you may make a contribution to your HSA, up to $2,500 for Self Only, or $4,950 for Self Plus One or Self and Family.

    The maximum annual contributions to your HSA (plan contributions and your contributions combined) are:

    • For 2016, $3,350 for Self Only, or $6,750 for Self Plus One and Self and Family.
    • For 2017, $3,400 for Self Only, or $6,750 for Self Plus One and Self and Family.

    These amounts may change in future years.

    Please note - you are responsible for keeping track of your contribution totals, which must not exceed the IRS limit. We recommend reviewing IRS Publication 969 for additional information about funding your HSA.

  • 4. HSA Account and Bank Routing Numbers

    To determine your 12-digit HSA account number, you can reference your account statement or log in to My Online Services where you can access your statement online. The routing number for your HSA is available online. You should use these numbers when depositing funds into your account.

  • 5. Accessing Your HSA Funds

    You may access funds in your HSA for qualified medical expenses in two ways:

    • Using your MHBP HealthEquity Debit Card
    • HSA Withdrawal Form (obtain from HealthEquity)
  • 6. How to use your MHBP HealthEquity Visa Debit Card

    You have the freedom to spend your HSA on the qualified medical expenses that you consider are most important to you.

    • Once you have returned your banking paperwork and your HSA has been established, you will receive your Visa Debit card.
    • You can use your Visa debit card at the pharmacy to pay for prescription drugs. HSA funds – when available – will be automatically withdrawn from the HSA when you present your card at the pharmacy counter.
    • When you get a medical bill from a health care provider, please allow for the provider to bill the insurance prior to providing your HSA debit card information to pay your bill. This will allow for any discounts to be applied to your services before you make a payment. Also, depending on how your HSA account is set up, We will either pay the provider directly from your HSA after any applicable discounts are applied, or leave the choice to you whether to use your HSA or other funds. Your doctor's office will typically send you a statement after the insurance discount has been applied to advise of you outstanding balance (if any).
    • As the account holder, it is your responsibility to make sure that your HSA disbursements are for qualified medical expenses to be eligible for tax-free treatment.
    • Please note – You have the ability to withdraw funds at any time for any reason subject to any specific rules related to the use of the debit card that the HSA bank or the Plan may impose.

      If you withdraw money for items other than qualified health expenses, it will be subject to income tax and – if you are under 65 years old – an additional 20% penalty tax on the amount withdrawn.

  • 7. Qualified Medical Expenses

    You may use the funds in your HSA to pay for qualified medical expenses.

    For your convenience, we have included a handy list of some of the most common qualified expenses.

    For complete detailed information, refer to “IRS Publication 502 – Medical and Dental Expenses,” Catalog number 15002Q.

    When you incur expenses for qualified medical expenses not covered by the MHBP Consumer Option HDHP, such as dental care, you may submit a Withdrawal Form to the address provided on the form.

  • 8. HSAs and FSAs

    OPM offers a Limited Expense Health Care Flexible Spending Account (LEX HCFSA) for employees in FEHB high deductible health plans (HDHP) with a health savings account (HSA).

    The Limited Expense Health Care Flexible Spending Account (LEX HCFSA) is for eligible dental and vision expenses only.

    HSA enrollees are not eligible for general health care flexible spending accounts (HCFSA), according to Section 125 of the Internal Revenue Code. However, you can have both an HSA and a limited purpose HCFSA.

    With the LEX HCFSA, HSA enrollees will be able to set aside pre-tax FSA dollars for dental and vision services, just as non-HSA enrollees can.

    For further information, visit the OPM website.

  • 9. Health Reimbursement Arrangements

    If you are not eligible to establish an HSA, the Plan will provide you with a Health Reimbursement Arrangement (HRA).

    At the start of the Plan year, the MHBP will credit your HRA with up to $900 for Self Only coverage or $1,800 for Self Plus One or Self and Family. These amounts may be prorated for mid-year enrollments.

    Please note – enrollee contributions to an HRA are not permitted.

    These funds can be used to pay for any of your health-related expenses, such as office visits, deductibles and prescription drugs.

    When you or a health care provider submit a claim to the Plan for qualified medical expenses, funds will automatically be withdrawn from your HRA and sent to you or your provider as payment.

    Likewise, when you purchase prescription drugs from a retail pharmacy, funds will automatically be withdrawn from your HRA at the time of purchase to cover out-of-pocket expenses such as deductibles and copayments.

    Once your HRA has a zero balance, you will be required to pay for covered medical and/or pharmacy related services until you reach your deductible.

    Remember, you will save money – and the funds in your HRA will go further – when you receive care from network providers and use generic medications.

    When you incur expenses for services not covered by MHBP Consumer Option, such as orthodontia and Medicare premiums, you may submit a Reimbursement Request to the address provided on the form.

Health Savings Accounts (HSAs) Questions

  • 1. What is an HSA?

    Health Savings Accounts (HSAs) are tax-exempt trusts or custodial accounts, similar to an IRA.

    The money deposited into an HSA account is 100% tax-free and can be used to pay for qualified medical expenses. Any money that isn't used remains in your account and keeps growing on a tax-favored basis to cover future medical expenses or to supplement retirement.

  • 2. What are the advantages of an HSA?

    HSAs encourage savings for future expenses, such as medical, out-of-pocket and long-term care expenses.

    • Accounts are owned by the individual, not the plan or employer.
    • Accounts are completely portable, regardless of the individual's employer, employment status, area of residence, age, marital status or future medical coverage.
    • There is no requirement to use unspent balances within a specific timeframe, unlike a Flexible Spending Account (FSA).
    • Accounts grow through interest and investment earnings.
    • All contributions are made to your account pretax.
  • 3. Contributions to your HSA
    • MHBP will contribute up to $900 for Self Only coverage, or up to $1,800 for Self Plus One or Self and Family coverage per year to your HSA.
    • Plan contributions are made in monthly increments of $75 for Self Only coverage, or $150 for Self Plus One or Self and Family coverage for each month you are eligible for an HSA.
    • You may make an additional contribution to your HSA, up to $2,450 for Self Only coverage, or $4,850 for Self Plus One or Self and Family coverage.
    • Your contribution may be made in one lump sum at the beginning of the coverage year, or in increments throughout the course of the coverage year. Your eligible family members may also contribute to the account on your behalf.
    • The maximum annual contributions to your HSA (plan contributions and your contributions combined) are: $3,350 for Self Only coverage, or $6,750 for Self Plus One or Self and Family coverage. These amounts may change in future years.

    Please note - you are responsible for keeping track of your contribution totals, which must not exceed the IRS limit.

  • 4. How does my HSA work?
    • You can choose to use your HSA funds to pay for qualified medical expenses such as office visits, lab work and prescription drugs while you are meeting your annual deductible. Expenses you incur for services covered under your health plan will count toward your annual deductible.
    • You may also choose to use your HSA funds for qualified services not covered by the health plan, such as dental care, weight loss programs and eyeglasses. However, expenses that are not covered by your health plan will not count toward your annual deductible.
    • If you prefer, you can choose to save any or all of your HSA funds, and pay for your medical expenses out of pocket throughout the year, until you meet your annual deductible.
    • Once you've met your deductible, additional health care expenses are covered under the terms of your medical plan. You can choose to use your HSA funds to pay for fixed expenses, such as copayments.
    • If you don't use all of your HSA dollars, the remaining amount will carry over into the next year. Please check the Official Plan Brochure for more information about your HSA.
  • 5. Who is qualified to participate in an HSA?
    • Only people covered by a high-deductible health plan (HDHP) can participate in an HSA.
    • Those who are eligible for Medicare cannot actively participate in an HSA, although HSA funds that have accrued prior to that time may be used to pay for qualified medical expenses without being taxed.
    • An individual who may be claimed as someone else's dependent cannot participate in an HSA.
    • Generally, a person with an HSA cannot be covered under any other health plan. However, the legislation provides exemptions for certain types of "permitted" (generally limited) health coverage such as that provided under state workers' compensations laws, property insurance, insurance for a specified illness, and hospital indemnity insurance. A health reimbursement arrangement (HRA) or flexible spending account (FSA) limited to these types of benefits may still be offered alongside an HSA. In many cases, members would like use the FSA for dental.
    • If you have enrolled in the MHBP Consumer Option and you do not qualify for an HSA, the plan will open a Health Reimbursement Arrangement (HRA) for you.
  • 6. How do HSA contributions work?
    • HSAs are "above the line" deductions, meaning the deduction is always available and is not dependent on earnings, tax-filings status, employment status or whether or not you itemize tax deductions. Interest earnings inside the HSA account are not taxed.
    • Distributions taken from an HSA are tax free if they are taken for qualified medical expenses incurred by the person covered under the HDHP, their spouse or their dependents.
    • It can be used to pay for other health insurance except:
      • COBRA premiums for the continuation of health care benefits
      • Health coverage while receiving unemployment compensation
      • Medicare premiums and out-of-pocket expenses
      • Long-term care insurance
    • Members between the ages of 55 and 65 can make additional pretax "catch-up" contributions of $1,000 each year.
    • If you make your maximum annual contribution early in the coverage year, and then you leave your employer before that coverage year has ended, you will be responsible to pay the taxes on any amount that exceeds the coverage.
  • 7. What counts as a "qualified medical expense?"

    The Internal Revenue Service has defined qualified medical expenses in a very broad way, to include "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body." Based on that definition, qualified medical expenses include many services from acupuncture to dental procedures to weight-loss programs. Prescription medications are included as well. However, expenses that are merely beneficial to general health, such as vitamins or vacations, do not qualify. In general, health insurance premiums do not qualify either.

  • 8. Does this plan work like a traditional health plan?

    Consumer Option provides traditional style benefits after you meet your deductible. The difference is that the deductible is higher than most traditional plans and you get a health savings account that offers tax advantages. The deductible applies all services except Network Preventive care. For care that's related to an illness or injury, you can use funds from your HSA to pay for that care.

  • 9. What happens when I go to my first doctor visit?

    You should not use your HSA Visa debit card at the doctor’s office. To ensure that you receive the Network discount, tell your doctor's office to bill MHBP first. We will apply the appropriate discount. When you get the bill, you can simply fill in your debit card number as a form of payment and the funds will be taken out of your HSA to pay for the covered medical expense. Once you reach your deductible and are eligible for traditional plan benefits, you can simply pay your copayment at a Network doctor using your debit card.

  • 10. How is an HSA different from a Flexible Spending Account (FSA)?

    An FSA is a "use-it-or-lose-it" account. You fund it with a specified amount of money, tax-free, and if you don’t use that money by the end of the year, you lose it. In addition, you cannot earn interest on the money in an FSA. The money in an HSA, on the other hand, is yours to keep, year after year, to spend as you wish on qualified medical expenses (or even for other expenses, with tax and penalties). You can earn tax-free interest on money in your HSA.

  • 11. What would happen to the money in my HSA should anything happen to me? Would my family be able to keep it? Would they have to pay taxes?

    Your HSA is like any other investment account in this way; you name a beneficiary, and any money remaining in your account goes to that person should you pass away.

  • 12. What happens after I turn 65?

    If you enroll in Medicare, you can no longer make contributions to your HSA; however, you can continue to withdraw money tax free for qualified medical expenses. And when you’re 65, you can even withdraw money for non-medical expenses and pay only your current income tax rate.

  • 13. Am I eligible for an HSA if I’m enrolled in TRICARE or Medicare?

    No. You are not eligible for an HSA if you are covered by TRICARE, Medicare or by another traditional health plan, such as a spouse’s employer-sponsored coverage.

  • 14. What if my spouse and I both have HSA-eligible High Deductible Health Plans?

    You can have an HSA, but the total amount you can contribute each year will depend on the IRS Defined Limits. The total amount that can be collectively (by MHBP and you) contributed each year must not exceed the statutory limit--$3,350 Self Only coverage and $6,750 for Self Plus One or Self and Family coverage.

 
Learn more

Have Questions? Call 1-800-410-7778

24 hours a day, 7 days a week, except major holidays