FAQs

• Who do I contact when I have questions?
• How can I find a provider?
• What are my In-Network benefits?
• What are my Out-of-Network benefits?
• How are my laboratory benefits covered?
• How I am covered for emergencies?
• How am I covered for Inpatient Hospitalization?
• If I need other outpatient services, how much will I be responsible for?
• What if I am away on vacation or business and I have an emergency?
• How is Coordination of Benefits handled?

Flex Benefit Questions

• How can I get information about my Flexible Benefit Plan?
• What are the eligible health care expenses for my Flexible Spending Account?
• What are the qualifying expenses for my dependent care reimbursement account?

• Who do I contact when I have questions?

• Empire bluecross
  PO BOX 1407 Church Street Station
  New York, NY 10008-1407
  
  Dial: 1-844-230-4720
  
  East End Health Plan
  c/o Davis Vision
  Vision Care Processing Unit
  PO Box 1525
  Latham, NY 12110
  Phone: 1-800-999-5431
  
  
  EEHP's vision benefit administrator
  
  

• How can I find a provider?

• Dial: 1-844-230-4720

• What are my In-Network benefits?

• When you use a participating East End Health Plan provider your benefits are paid at 100% after a co-payment of $20 in most cases. In some cases, there is no co-payment necessary. For details, please see your East End Health Plan Document, available on this website.

• What are my Out-of-Network benefits?

• Your plan provides coverage when you seek medical attention outside of network. All payments are subject to reasonable and customary (R & C) amounts. First, you must meet the individual calendar year deductible of $1,000 or the maximum family deductible of $3,000. After the deductible is satisfied, you will begin paying coinsurance of 20% up to the maximum coinsurance amount ($3,000). Once the $3,000 out of pocket maximum is met, you will be covered at 100% of R & C. Any charges, which exceed the $3,000 amount, will be excluded from the Out-of-Network benefits. The provider can balance bill you if the charges exceed what is covered under the plan. This is why you receive the most from your plan when a participating provider renders your services.

• How are my laboratory benefits covered?

• If you have a lab test at Labcorp Diagnostic or Quest lab there is no co-pay. If you use another lab there is a $20 co-payment.

• How I am covered for emergencies?

• You are covered at 100% for emergency room charges for emergency diagnosis after paying a $50 co-payment.

• How am I covered for Inpatient Hospitalization?

• Inpatient hospitalizations are covered, both in and out of network at 100%. You must pre-certify inpatient hospitalization by calling the member services number and pre-certifying with the Care Management Department. Pre-certification is required as follows:
  
  30 days prior to an elective (scheduled) admission to the hospital; within 48 hours of emergency or urgent admission; and upon confirmation of Pregnancy. You must obtain pre-certification at least two days prior for some other services, such as; home nursing, ambulance, and medical equipment. Please check your Benefit Sheet or Summary Plan Description for specific services.

• If I need other outpatient services, how much will I be responsible for?

• Outpatient services are subject to a $35 co-payment in network and subject to deductible and coinsurance out of network.

• What if I am away on vacation or business and I have an emergency?

• In cases of emergency, you should seek care from the nearest hospital or non-hospital outpatient facility.

• How is Coordination of Benefits handled?

• If you have coverage under another health plan through a spouse, the primary plan will pay benefits and then the secondary plan will pay benefits.
  
  If you are retired and over age 65, Medicare is your primary carrier. Medicare will pay the claim and then the East End Health Plan will pay for any additional benefits.
  
  Once you reach age 65, you must enroll in Medicare. Failure to enroll may drastically reduce your benefits under the East End Health Plan.
  
  If either you or your spouse is actively working, the East End Health Plan is primary.

• Flex Benefit - How can I get information about my Flexible Benefit Plan?

• Flexible Benefit Plan FAQs

• Flex Benefit - What are the eligible health care expenses for my Flexible Spending Account?

• Healthcare Expenses That Are Eligible

• Flex Benefit - What are the qualifying expenses for my dependent care reimbursement account?

• Qualifying Expenses - Dependent Care Reimbursement Account