How do I get my maintenance prescriptions set up through mail order?

Save on medications you take regularly (such as high blood pressure or diabetes medicine) when you have them delivered by mail, in 90-day supplies, from CVS Caremark Mail Service Pharmacy. It’s an easy way to make sure you have the medication you need, when you need it, with one less thing to worry about.

There are two easy ways to get started:

Online – Visit Caremark.com/mailservice

– OR –

By phone – Call the number on your member ID card for live help getting set up.  

Be sure to have a prescription bottle in hand, all the information needed to get started is on the label.

One 90-day supply typically costs less than three 30-day supplies, so you can be sure you’re paying a lower price. CVS Caremark delivers by mail, anywhere you choose, with no-cost shipping.

Mail delivery means no more monthly trips to the pharmacy, and with automatic refills, you won’t need to keep track of refill schedules either. CVS Caremark will alert you 10 days before a refill in case you need to change the delivery date or location.

Every order is filled by a licensed pharmacist, then quality checked before shipping. Our discreet packages are tamper-proof, weatherproof and temperature controlled. Plus, CVS Caremark will send status alerts by email, phone or text – so there’s nothing to worry about. Download the CVS Caremark mobile app to manage mail orders anytime, anywhere!

How can I estimate treatment costs?

Log into https://members.healthadvocate.com/.  Go to the Finance tab and select Health Cost Estimator+ from the drop down menu. Enter a procedure in the first field, your zip code in the next field, and the radius in which you’d like to see results.  Click on the Get Estimates button to get a list of estimates based on your search query.

What is telehealth?

Telehealth uses digital information and communication technologies to allow members to access healthcare away from the doctor’s office.  The Trust medical plan partners with MDLIVE to bring participants remote access to quality healthcare through MDLIVE’s board-certified doctors. They are professionally trained to use virtual technology to treat many non-emergency conditions. MDLIVE’s doctors are board-certified and have an average of 15 years of experience.  Go to https://members.mdlive.com/ect to register now!

I was billed by my provider for expenses I do not think I should have been billed for. Who should I contact for help with this?

Health Advocate’s experts will take on virtually any healthcare or administrative issue so you get to the right care at the right time at no cost to you.  If you’ve received a bill or have a claim that you need help with, call Health Advocate at 866.799.2728 or email answers@healthadvocate.com to have your own personal health advocate tackle the issue for you!  If authorizations are required to resolve your inquiry, the Advocate assigned to your case will send you any required authorizations forms electronically.

How do I read my medical EOB (Explanation of Benefits)?

Since an EOB isn’t a bill, what you pay is for your information only.  If you owe the doctor, or hospital, they’ll send you an invoice. Comparing the EOB and the invoice is a good way to make sure you’re getting billed correctly by the doctor or hospital.

Not all claims generate an EOB. For example, you won’t get an EOB for a prescription. EOBs show you the costs associated with the services you received, including:

• Claim Details, each service or procedure from each provider is explained
• What the provider charged
• What the allowed charges are (this is the contracted amount in which an in-network PPO provider agrees to accept as payment)
• Any non-allowed charges (discount or amount billed over the contracted amount for this service)
• What the Plan pays
• Total covered
• What you pay (summary of Deductibles, copays, and coinsurance)

How do I change my address for my benefits through the Trust?

Contact human resources or your benefits manager to have your address updated for all of the Trust plans you are enrolled in.

What is pre-authorization or pre-certification?

Pre-authorization or pre-certification is a process completed by Conifer Health Solutions, the Trust’s Utilization Management Vendor.  Certain services covered by the Plan require this process (like Hospitalizations, Continued stays at an Inpatient Facility, and some outpatient services).  

If your Physician recommends that you or a covered family member be hospitalized, you must contact the Utilization Management Vendor for assistance with the certification process. Hospitalizations out of the country or when this Plan is the secondary payer do not require pre-certification. All other hospitalizations require pre-certification prior to an elective or planned hospitalization or the next business day after an urgent or emergency admission. To obtain pre-certification for an admission, call Conifer Value-Based Care at 877-687-9527.

When you call, have your Medical ID number, Employer name, patient name, home phone number, physician name and phone number ready.

Notification may be initiated by you, a family member, your Physician, or representative from the hospital. The Utilization Management Vendor will review your Physician’s recommendations based on the medical information supplied and accepted standards and criteria for hospital admission. In most cases, the Utilization Management Vendor will notify you, your doctor, and the hospital of your certification approval within 24 hours. (For hospitalizations, the hospital will be advised of the number of approved days when Conifer provides certification approval).

Who is Health Advocate, and how can they help me?

Navigating the healthcare system, improving your health and addressing personal problems can be challenging.  Health Advocate’s experts will take on virtually any healthcare or administrative issue so you get to the right care at the right time.  Health Advocate will also provide personalized coaching to help you reach your health goals and confidential counseling to help you work through personal issues. All at no cost to you.  Click here to watch a short video to find out more about Health Advocate’s service.

Who is Conifer Health Solutions?

Conifer Health is a certified health solutions company and a national leader in personal health management and healthcare technology. With 30 years in the healthcare industry and on-the-ground experience in 135 markets nationwide, Conifer knows the ins and outs of local health systems, physician groups, employers and unions. Conifer helps members navigate the healthcare system and provide the tools for them to adopt healthy behaviors through collaboration and education. The Utilization Management provisions of the Trust’s Plan are administered by Conifer, our Utilization Management Vendor. The staff at Conifer are Physicians and Registered Nurses who monitor the use of your health care benefits to ensure that you and your family:

a. Receive the best medical care possible in the most appropriate health care setting;
b. Avoid unnecessary surgery and excess hospital days; and
c. Receive answers to questions you have regarding medical care.

Components of the Utilization Management program include:

a. Pre-certification of all hospital admissions,
b. Continued Stay Review of all hospitalizations;
c. Pre-certification of all Outpatient surgeries and the following: Residential Treatment Facility for Mental Health and Substance Abuse (considered inpatient); Birthing Centers; Clinical Trial Patient Cost Coverage; Intensive Outpatient Services for Mental Health and Substance Abuse, Durable Medical Equipment over $1,500 per Calendar Year; Home Health Care; Hospice Care; Skilled Nursing Facility, and Surgical treatment of morbid obesity;
d. Case management of potentially catastrophic cases;
e. Disease Management.

Pre-certification, continued stay review, and outpatient pre-notification decisions are based on the medical policy guidelines of the Utilization Management Vendor. Otherwise, all Medical Necessity reviews will be performed by the Claims Administrator utilizing CareFirst BlueCross BlueShield and other applicable medical policies.

How do I find a doctor, hospital, or urgent care center near me?

It’s easy to find the doctors you need at www.cfablue.com.

Select the Members tab on the top right-hand side of the screen.

Select Search Providers under Find a Doctor on the left-hand side of the screen.

Select Find a Doctor under Medical.

Enter your Location then enter ECT as the plan prefix.

Click on the Continue button.

Select one of the search options: Doctors by name, Doctors by specialty, Places by name, or Places by Type.

Populate the search field(s) with your search criteria.  Click the magnifying glass icon, or hit the enter key to review a directory based on your search criteria.

What is telehealth?

Telehealth uses digital information and communication technologies to allow members to access healthcare away from the doctor’s office. The Trust medical plan partners with MDLIVE to bring participants remote access to quality healthcare through MDLIVE’s board-certified doctors. They are professionally trained to use virtual technology to treat many non-emergency conditions. MDLIVE’s doctors are board-certified and have an average of 15 years of experience. Your employees can go to https://members.mdlive.com/ect to register.

My employee (or their dependent) was billed by their provider for expenses I do not think they should have been billed for. Who can they contact for help with this?

Health Advocate’s experts will take on virtually any healthcare or administrative issue for your employees, their dependents, their parents, or their in-laws!  If they have received a bill or have a claim that they need help with, they can call Health Advocate at 866.799.2728 or email answers@healthadvocate.com to have their own personal health advocate tackle the issue for them!  If authorizations are required to resolve your inquiry, the Advocate assigned to your case will send your employee (or their dependent) any required authorizations forms electronically.

How does my employee read their medical EOB (Explanation of Benefits)?

Since an EOB isn’t a bill, the “what you pay” section is for your employee’s information only.  If the employee or dependent owes the doctor or hospital, they will send your employee or dependent an invoice. Comparing the EOB and the invoice is a good way to make sure they are getting billed correctly by the doctor or hospital.

Not all claims generate an EOB. For example, employees will not get an EOB for a prescription. EOBs show you the costs associated with the services your employee received, including:

• Claim Details, each service or procedure from each provider is explained
• What the provider charged
• What the allowed charges are (this is the contracted amount in which an in-network PPO provider agrees to accept as payment)
• Any non-allowed charges (discount or amount billed over the contracted amount for this service)
• What the Plan pays
• Total covered

• What the employee or dependent pays (summary of Deductibles, copays, and coinsurance)

How do I change my employee’s address for their benefits through the Trust?

If your group utilizes Benefitfocus for submitting enrollments, you must submit the address change in the Benefitfocus portal.  The address change will then feed electronically to CFA, Delta, and VSP accordingly.

If your group sends a file feed directly to CFA, you must submit the address change in the system that feeds this data to CFA.  The address change will then feed electronically to CFA, and then to Delta and VSP accordingly.

What is pre-authorization or pre-certification?

Pre-authorization or pre-certification is a process completed by Conifer Health Solutions, the Trust’s Utilization Management Vendor.  Certain services covered by the Plan require this process (like Hospitalizations, Continued stays at an Inpatient Facility, and some outpatient services).  

If your employee’s (or their family member’s) Physician recommends they or a covered family member be hospitalized, the participant must contact the Utilization Management Vendor for assistance with the certification process. Hospitalizations out of the country or when this Plan is the secondary payer do not require pre-certification. All other hospitalizations require pre-certification prior to an elective or planned hospitalization or the next business day after an urgent or emergency admission. To obtain pre-certification for an admission, the participant can call Conifer Value-Based Care at 877-687-9527.

When they call, they should have their Medical ID number, Employer name, patient name, home phone number, and physician name and phone number ready.  

Notification may be initiated by the employee, a family member, their Physician, or a representative from the hospital. The Utilization Management Vendor will review the Physician’s recommendations based on the medical information supplied and accepted standards and criteria for hospital admission. In most cases, the Utilization Management Vendor will notify the employee or family member, their doctor, and the hospital of the certification approval within 24 hours. (For hospitalizations, the hospital will be advised of the number of approved days when Conifer provides certification approval).

Who is Health Advocate, and how can they help my employees and their family members?

Navigating the healthcare system, improving your health and addressing personal problems can be challenging.  Health Advocate’s experts will take on virtually any healthcare or administrative issue so employees and families can get to the right care at the right time.  Health Advocate will also provide personalized coaching to help your employees reach their health goals and confidential counseling to help them work through personal issues.  Click here to watch a short video to find out more about how Health Advocate can help your employees and their families.

Who is Conifer Health Solutions?

Conifer Health is a certified health solutions company and a national leader in personal health management and healthcare technology. With 30 years in the healthcare industry and on-the-ground experience in 135 markets nationwide, Conifer knows the ins and outs of local health systems, physician groups, employers and unions. Conifer helps members navigate the healthcare system and provide the tools for them to adopt healthy behaviors through collaboration and education.  The Utilization Management provisions of the Trust’s Plan are administered by Conifer, our Utilization Management Vendor. The staff at Conifer are Physicians and Registered Nurses who monitor the use of your employees’ and their family members’ health care benefits to ensure they:

1. Receive the best medical care possible in the most appropriate health care setting;
2. Avoid unnecessary surgery and excess hospital days; and
3. Receive answers to questions they have regarding medical care.

Components of the Utilization Management program include:

1. Pre-certification of all hospital admissions,
2. Continued Stay Review of all hospitalizations;
3. Pre-certification of all Outpatient surgeries and the following: Residential Treatment Facility for Mental Health and Substance Abuse (considered inpatient); Birthing Centers; Clinical Trial Patient Cost Coverage; Intensive Outpatient Services for Mental Health and Substance Abuse, Durable Medical Equipment over $1,500 per Calendar Year; Home Health Care; Hospice Care; Skilled Nursing Facility, and Surgical treatment of morbid obesity;
4. Case management of potentially catastrophic cases;
5. Disease Management.

Pre-certification, continued stay review, and outpatient pre-notification decisions are based on the medical policy guidelines of the Utilization Management Vendor. Otherwise, all Medical Necessity reviews will be performed by the Claims Administrator utilizing CareFirst BlueCross BlueShield and other applicable medical policies.

How can my employee find a doctor, hospital, or urgent care center?

It’s easy to find the doctors you need at www.cfablue.com. Below are instructions you can pass along to your employee.

Select the Members tab on the top right-hand side of the screen.

Select Search Providers under Find a Doctor on the left-hand side of the screen.

Select Find a Doctor under Medical.

Enter the preferred location and click on Select a Plan to enter ECT.

Select a Category of care to Find a Provider.

Search for a doctor or facility by entering Name, Specialty and even more options based on your preferences. Enter the information for the area in which you would like to search for providers.

How can my employee request a new vision ID card?

VSP does not send member ID cards. 

The front page of the benefit summary lists the steps in order for the member to use their benefits, but members can download a card from the website if they would like to have one handy.   Have the employee go to www.vsp.com and log in to the members portal.  From the member home page, they should click on the Member ID Card tile to print or download a copy of their vision ID card.

How can my employee request a new dental ID card?

Call Delta Dental Benefit Services at 800.237.6060 to request a new dental ID card.  If the employee is in a rush to get a copy of their card, instruct them to log in to the Delta Dental of Virginia subscriber portal at www.deltadentalva.com to print a copy of their own card.  Click on the Print ID Card hyperlink on the left side menu upon logging in.

How can my employee request a new medical ID card?

Log in to the CFA member portal at www.cfablue.com. Click the Request ID Cards tile.  Follow the instructions and click Submit my Request. The employee will receive a replacement member ID card in 7-10 business days.  Need one sooner? On the CFABlue home page, click on the Digital ID Card tile. Follow the instructions to view and print or download a copy of the ID card to provide to your employee.

Who can help me resolve a claim issue for my employee?

Dealing with insurance companies can be hard!  Health Advocate can do that for you. Have your employee call 866.799.2728, or email answers@healthadvocate.com, or log into the Health Advocate website from their computer, or they can download their app to have a dedicated advocate untangle medical bills and resolve claim and billing issues. The employee (or family member) should have their insurance ID card, bill or Explanation of Benefits (EOB), and the provider’s name and office contact information to get the process started with Health Advocate.

How do I request a new dental ID card?

Call Delta Dental Benefit Services at 800.237.6060 to request a new dental ID card.  In a rush? To print your own card, log in to the Delta Dental of Virginia subscriber portal at www.deltadentalva.com. Click on the Print ID Card hyperlink on the left side menu.

How do I request a new medical ID card?

Log in to the CFA member portal at www.cfablue.com. Click the Request ID Cards tile.  Follow the instructions and click Submit my Request. You’ll receive a replacement member ID card in 7-10 business days.  Need one sooner?  On the CFABlue home page, click on the Digital ID Card tile.  Follow the instructions to view and print your ID card.

If you are unable to log into the CFA member portal, please contact CFA member services at 877.889.2478.  Once your identity is verified, a member services representative will be able to order a new card for you.

Who can help me resolve a claim issue?

Dealing with insurance companies can be hard!  Health Advocate can do that for you.  Call 866.799.2728, email answers@healthadvocate.com, log into our website from your computer, or download our app to your device to have a dedicated advocate untangle medical bills and resolve claim and billing issues for you. Have your insurance ID card, bill or Explanation of Benefits (EOB), and the provider’s name and office contact information to get the process started with Health Advocate.