Click on a topic below to see more about each item, or scroll down to see everything all at once.
1. How do I change my address?
2. How do I obtain another set of Identification cards?
3. How do I add my newborn child?
4. Where do I send my COBRA payment?
5. I used my last payment coupon and I have not received new ones. Should I send my payment in anyway?
6. What is a subrogation inquiry?
7. What is full time student status?
8. What is coinsurance? I don't have any other insurance but you.
9. Do outpatient procedures require precertification?
10. Why doesn't the amount of the claim match the payable amount?
11. How can I see who was paid?
12. The information I see is incorrect. How can I change it?
How do I change my address?
Obtain a record change form from your employer. Under the section "other change" write in your new address, sign and date the form. Then have your employer submit the form to our office. Address changes cannot be made over the phone.
How do I obtain another set of Identification cards?
Contact us either by email at email@example.com or by phone at (216) 566-1455 or (800) 722-7374 ext. 7005, and include your name, member ID, group name and/or number and type of cards you wish to order. You may also request a card via SFPIOnLine.
How do I add my newborn child?
Upon the birth of your child, obtain a record change form from your employer. Complete the "addition of dependent" section, sign and date the form. Then have your employer submit the form to our office. Please note: You do not need the Social Security Number of a newborn in order to enroll the newborn. Social Security Numbers are required in order to enroll all dependents other than a newborn. However, due to certain government reporting requirements, you must provide the newborns' Social Security Number as soon as it is issued.
Where do I send my COBRA coupon?
Your COBRA payment should be sent to Self-Funded Plans, Inc., 1432 Hamilton Ave., Cleveland, OH 44114, ATTN: COBRA Department
I used my last COBRA payment coupon and I have not received new ones. Should I send my payment in anyway?
If you have not received new payment coupons for the new Plan year, this means we have not received the new COBRA rates. Do not send in a payment until you receive your new payment coupons as the payment amount may change and also, the payment cannot be processed without a payment coupon. Once we receive the new COBRA rates, new payment coupons will be issued and you will be given thirty dates from the date on the cover letter of your payment coupons to bring your account up to date, even if it is after your scheduled due date.
What is a subrogation inquiry?
A claim has been received that may have resulted from an accidental injury or illness. When you receive this form, you must complete it to the best of your ability and return this form to our office. If, the charge in question was not resulting from an accidental injury or illness, you can indicate on this form - "Not Accidental" and return the form to our office. If, the charge in question was resulting from an accidental injury or illness, you will need to complete this form in full to the best of your ability and return it to our office. Please remember, this questionnaire is based upon the information submitted on the claim, if it is not accidental, you should not ignore this form, you must indicate that on the form and return it to our office.
What is full time student status?
The ACA no longer requires dependents to be full time students to be considered eligible dependents for medical coverage. However, the requirement may still apply for coverages other than medical. With the onset of HIPAA regulations and federal privacy regulations, we are no longer able to contact individual colleges to determine the eligibility of a dependent child. When a claim is received for a dependent child who may be a full-time student, we will send a request to you asking that you or your child have the college registrar's office submit to us proof of full-time student status.
What is coinsurance? I don't have any other insurance but you.
When this appears on your explanation of benefits it does not mean that you have other insurance coverage. Your medical plan pays your benefits at a specific percentage. The amount that is listed under the coinsurance portion of your explanation of benefits would be your portion of the coinsurance which you must pay. For example, if your benefit plan pays 80%, the amount listed in the coinsurance portion would be the 20% of the allowable charges which would be your responsibility.
Do outpatient procedures require precertification?
No pre-notification is required on outpatient procedures including diagnostic x-ray and laboratory procedures. For example, an MRI or CAT Scan. The services are covered based on medical necessity. EXCEPTIONS: If an outpatient stay/observation is beyond 24 hours OR an outpatient procedure becomes an inpatient admission. Please call 1-800-919-3311 to do an inpatient admission notification.
Why doesn't the amount of the claim match the payable amount?
There can be many reasons why these amounts do not match. Deductibles and co-insurance are two reasons. Please look in the middle section titled "Claim Processing Information" for more information.
How can I see who was paid?
Please refer to the bottom section titled "Payment Information"
The information I see is incorrect. How can I change it?
You cannot directly change the information listed. However, you can send an email to firstname.lastname@example.org requesting that the incorrect information be changed. Please be explicit about what needs to be changed, and include your name, member ID, group name and a way to contact you.