Visitors to U.S.A. / Travel Outside U.S. Medical policies purchased prior to 5/1/2019 and Student Medical Policies purchased prior to 6/5/2019 will have the First Health PPO Network and will continue to have the First Health PPO network and original benefits until they purchase a new policy. Co-Pay FirstHealth Outpatient Pharmacy. Co-Pay (In-network provider) Co-Pay (Out-of-network provider) 1. Working out just got easier. For just $25/month plus a one-time enrollment fee of $25, you can get a standard membership to a fitness center in your area. Track your activity, check your progress, reach your fitness goals, and so much more! Please note: a three-month. First Health ® is an NCQA-accredited Provider Network that has strong provider relationships with more than 5,700 hospitals, over 120,000 ancillary facilities, and over 780,000 professional providers at over 1.5 million health care service locations across all 50 states!
Group Dental Plan No. 301016: Personal & Dependent Dental Care | |||||||||||||||||||||||||||||||||||||||||
The benefits described below apply separately to you and each of your covered dependents for expenses incurred for necessary dental services.
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We will determine orthodontic expense benefits according to the terms of the group plan for orthodontic expenses incurred by a Member. DETERMINING BENEFITS. The benefits payable will be determined by totaling all of the Covered Expenses submitted. This amount is reduced by the Deductible, if any. The result is then multiplied by the Benefit Percentage shown in the Schedule of Benefits. Benefits are subject to the Maximum Amount shown in the Schedule of Benefits. DEDUCTIBLE. The Deductible is shown on the Schedule of Benefits and is a specified amount of Covered Expenses that must be incurred and paid by each Covered person prior to any benefits being paid. MAXIMUM AMOUNT. The Maximum Benefit During Lifetime shown in the Schedule of Benefits is the maximum amount that may be paid for the Covered Expenses incurred by a Member during his or her lifetime. COVERED EXPENSES. Covered Expenses refer to the usual and customary charges made by a provider for necessary orthodontic treatment rendered while the person is covered under this section. Expenses are limited to the Maximum Amount shown in the Schedule of Benefits and Limitations. Usual and Customary (“U&C”) describes those dental charges that we have determined to be the usual and customary charge for a given dental procedure within a particular ZIP code area. The U&C is based upon a combination of dental charge information taken from our own database as well as from data received from nationally recognized industry databases. From the array of charges ranked by amount, your Planholder (in most cases your employer) has selected a percentile that will be used to determine the maximum U&C for your plan. The U&C is reviewed and updated periodically. The U&C can differ from the actual fee charged by your provider and is not indicative of the appropriateness of the provider’s fee. Instead, the U&C is simply a plan provision used to determine the extent of benefit coverage purchased by your Planholder. ORTHODONTIC TREATMENT. Orthodontic Treatment refers to the movement of teeth by means of active appliances to correct the position of maloccluded or malpositioned teeth. TREATMENT PROGRAM. Treatment Program ('Program') means an interdependent series of orthodontic services prescribed by a provider to correct a specific dental condition. A Program will start when the active appliances are inserted. A Program will end when the services are done, or after eight calendar quarters starting with the day the appliances were inserted, whichever is earlier. EXPENSES INCURRED. Benefits will be payable when a Covered Expense is incurred: a. at the end of every quarter (three-month period) of a Program for a Member who pursues a Program, but not beyond the date the Program ends; or b. at the time the service is rendered for a Member who incurs Covered Expenses but does not pursue a Program. The Covered Expenses for a Program are based on the estimated cost of the Member's Program. They are prorated by quarter (three-month periods) over the estimated length of the Program, up to a maximum of eight quarters. The last quarterly payment for a Program may be changed if the estimated and actual cost of the Program differ. BENEFITS PAYABLE UPON TERMINATION. If coverage terminates during a Program quarter, the quarterly benefit payable for that quarter will be pro-rated by day for the period of time that coverage was in-force and fee was received. LIMITATIONS. Covered Expenses will not include and benefits will not be payable for expenses incurred:
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First Health Network Copay Assistance
FirstHealth of the Carolinas Flexible Spending Account Claim Procedures | |
Eligible claims are paid in full when they are received, up to the maximum amount you have elected to deposit in your account for the calendar year. Remember, expenses reimbursed for health and dependent care can not be claimed on your tax return. Time Limits for Filing Claims: To be eligible for reimbursement, claims must be received by March 31st of the year following the calendar year the expenses are incurred. If you leave FirstHealth employment, you have 90 days to submit claims for expenses incurred prior to your last day of employment. REMEMBER THE 'USE IT OR LOSE IT' RULE Any balances remaining after expenses have been filed for the year are forfeited. These funds can not be paid to you, nor can they be carried over to the next year. |
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First Health Network Payer Id
Retirement Benefits Summary | ||||||||
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The following is a summary of the voluntary Short Term Disability Plan offered to FirstHealth employees through pre-tax payroll deduction. Employees applying for coverage during the initial eligibility may apply for coverage without being subject to pre-existing conditions. Employees applying for coverage beyond their initial eligibility date must complete an Evidence of Insurability form in addition to their application. Definitions of Disability In order for an employee to be considered disabled, he/she must not be able to perform his/her job, nor be doing any work for payment, as a result of an injury or sickness. The employee must be under the regular care of a Physician Exclusions Weekly Income Benefits are not paid for any period of disability caused by:
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First Health Network Payer List
Employees and dependents covered under FirstHealth's medical insurance with FirstCarolinaCare Insurance Company are eligible for discounts on prescriptions* filled at the FirstHealth Outpatient Pharmacy. The FirstHealth Outpatient Pharmacy also offers dozens of over-the-counter medications such as Tylenol, Motrin and Claritin for less than you will pay in most area drug stores and supermarkets! The Outpatient Pharmacy offers delivery services available at RMH & MMH as well as convenient payment options:
To transfer a prescription, complete the Rx transfer form.
* This includes new and refill prescriptions. |