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1. I'm getting divorced. Can I take my spouse off of my insurance?

Yes, but only once the divorce is final. Until that time the spouse must remain on your insurance. If the former spouse needs to remain insured by order of the Divorce Decree, the former spouse will drop off of the City's group plan and COBRA rates will apply. If this happens, please provide HR with a copy of the Divorce Decree indicating the length of time the former spouse must be insured.

2. What happens if I don't use my medical flex or child care account by the end of the calendar year?

Any amount NOT used is forfeited. You have 60 days from the end of the calendar year to submit reimbursement requests. If you separate service mid-year, other rules apply and you should consult Human Resources. To avoid forfeiture, it is important that you plan your contributions carefully.

3. How can I verify what networks my doctor participate in?

You can check a list of participating doctors, hospitals and facilities by checking out the Rocky Mountain Health Network website below. Once you've accessed the link, select EBMS-City of Billings on the dropdown menu labeled Insurance Accepted.

Rocky Mountain Health Network site

4. How does the hospital and/or facility preferred network plan work when I go out of the network?

You are free to utilize a network provider or a non-network provider at any time. However, the benefits payable under the Plan will be at a higher level if you receive your care from an in-network hospital or facility. In addition, if you go
out-of-network, you may incur other costs, in addition to any applicable out-of-network deductibles and coinsurance, such as:
• If your hospital or facility bills an amount above the level considered reasonable and customary by your Plan, you will be responsible for that entire difference, in addition to any other deductible and coinsurance responsibilities.
• You are responsible for obtaining any required pre-certification for certain inpatient admissions. If you do not obtain the required pre-certification in advance of treatment, the amount of benefits available will either be reduced or the expenses may not be covered at all.
• In some cases, you will be required to complete claim forms and file claims with your insurer in order to receive payment of benefits.
• Certain benefits which are eligible for reimbursement if you go in-network may not be reimbursable on any basis if you use a non-network hospital or facility.

5. What happens if my physician determines I need specialty care that is not available from any hospital or facility

If the type of care you require is not available from any hospital or facility in the preferred network, you may be eligible to have the care you receive from a non-network hospital or facility paid at the higher, in-network level of benefits. Typically, your treating physician will need to put in writing the medical necessity why you are being referred out of network. This letter needs to be provided to EBMS for approval.

6. Do I have medical coverage in a foreign country?

When you are in a foreign country and need services, you will most likely need to pay for your services. Hospitals in foreign lands do not always coordinate with our insurance coverages here at home.
To submit your bill to your plan for reimbursement, you will be responsible for having your statements and the medical records that may be required translated to English and your costs converted to American dollars. This will be at your expense, as the plan will not provide these services to you. Reimbursement will never be more than the cost of the same care, had it been given by your plan. Care for urgent situations where treatment could not have been reasonably delayed until you return to the United States may be reimbursed if you gain authorization from CARE LINK at (800) 777-3575 prior to services being received. Inpatient care not pre-approved by your plan may not be covered or may be covered at the lower benefit level.

7. What happens to my network coverage for my dependent child who moved out of the area for college?

If In-Network affiliates are not available in the area the student is living for college, coverage will be at the in-network level.

8. What is pre-authorization?

Before a Covered Person enters a Medical Care Facility on a non-emergency basis, or receives other listed medical services, the utilization review administrator will, in conjunction with the attending Physician, certify the care as appropriate. A non-emergency stay in a Medical Care Facility is one that can be scheduled in advance. The Physician or Covered Person must contact CareLink at 406-245-3575 or 866-894-1505, 7:00 am - 7:00 pm Monday - Thursday, and 7:00 am - 5:00 pm, Friday, prior to the following treatments:
* Inpatient admissions to a Hospital
* Inpatient admissions to free-standing chamical dependancy, mental health, and rehabilitation facilities.
* Cancer treatment programs, administered on an inpatient or outpatient basis.
* Inpatient or outpatient surgeries relating to hysterectomies, spine surgery, or bariatric surgery.

9. Do I ever need to file a medical claim form?

Preferred hospital and facility plans do not require you to file a claim form when you visit a preferred hospital or facility. They will submit the claim electronically directly to EBMS. If you elect to receive care from a non-network hospital or facility, you may be required to pay in advance and then file a claim for reimbursement from the plan. However, should you ever require care for life-threatening situations, your preferred hospital and facility plan understands that you may receive care before contacting CARE LINK. The emergency room where you receive care may be outside of the preferred hospital and facility network. Most hospitals will file your claim for you; others may send the bill directly to you for you to coordinate with your plan.
If you do need to submit a claim form, which is available on the website below, you can mail it directly to: Employee Benefit Management Services, P. O. Box 21367, Billings, MT 59104 Otherwise, you can forward the forms to the City of Billings, Human Resources dept for EBMS. They pick up mail daily.

EBMS website

10. What if I lose my ID card or I need to request additional one?

You can log into your EBMS account by accessing the website below. If you are a new user, select the new user sign up button. Complete the registration form. (Note: If you are already registered, you will just need to login with the user name and password you previously set up.) EBMS will immediately validate your eligibility status. Once verified, you will have instant access to your miHealthManager and miBenefits, which includes personal health information, claims, flex status, requesting ID cards, and much more. You may also contact EBMS directly at (406) 869-5505 or HR at (406) 657-8265.

EBMS website

11. When can it elect or terminate dental coverage?

With the City of Billings, you can enroll in dental coverage at your time of hire or during Re-Enrollment time. Once you enroll, there is a 2 year requirement to stay on the plan. Dental coverage can be terminated during the Re-Enrollment time once the 2 years has been met.

12. Is there an open enrollment period for the 457 Plan?

No, the 457 Plan is funded by you; therefore, you may start, stop, or change your contribution amount at any time. Please contact HR for the appropriate paperwork.

13. Do I have to wait until the Benefits Enrollment period to update or make changes to my beneficiaries?

No, you may update or make beneficiary changes at any time. Please contact HR for the appropriate paperwork.

14. Do I need to update my address and phone number if it changes?

Yes, please notify HR anytime you have a change in address or phone number by filling out the Employee Information Record Change form. HR will update these changes in the city payroll system and EBMS. All other personal vendors, for example 457 vendors and HealthEquity (HSA account vendor) the employee will need to update on their own.