County Medical Plans

Q: Will I have insurance coverage if I go to a doctor who is not on the list?

A: This is really two questions. (1) If your doctor is not listed on the provider list, you may contact the Medical Network Providers to see if they have recently contracted with your provider. If your doctor is not a part of the Medical Network Providers, you may want to ask them to contact him or her to see if they would be interested in joining the network. (2) Anytime you receive services from an out of network provider, you greatly reduce the coverage you will receive. That means that more of the costs will be paid for out of your pocket.

Q: What happens if there is no provider in-network?

A: Again, contact UnitedHealthcare to verify that there is no provider. If they verify that there is no provider, you may have benefits covered under a special provision. The benefit is a little better than out-of-network, but does not cover as much as in-network.

Q: I received a form from UnitedHealthcare asking me questions about a claim they received. Do I have to complete that form? Can’t they get all of that information from the doctor?

A: If you receive a questionnaire from UnitedHealthcare regarding the circumstances of a claim, it is very important that you do complete that and send it back as soon as possible. If you do not complete the form, your claim may be denied.

Q: What is subrogation?

A: Please refer to Section H of the Employee Benefits Manual. Whenever a third party is liable for your injuries, and if you have the right to recover damages from that third party, you agree to transferring or subrogating those rights to the Insurance Plan. You agree to cooperate and allow the Plan to make a claim on your behalf and recover the money it has paid for benefits.

Q: Is massage therapy covered?

A: No, massage therapy is not covered. However, there is a limited Chiropractic benefit on Plan A only. See Section H of the employee handbook.

United Health Care EPO/ HMO Plan

Q: How much are immunizations under United Health Care EPO/ HMO Plan .

A: Medically necessary immunizations are covered with a $25 copay.

Q: Do I have to choose a primary care physician under the United Health Care EPO/ HMO Plan?

A: No, Participants have open access to both primary physicians and specialists.

Q: Do I have an annual deductible under the United Health Care EPO/ HMO Plan?

A: No. Only the copays are required

County Dental Plans

Q: Can I go to the dentist of my choice?

A: Yes. It is not required that you use an in-network dental provider.

Q: Are dental appliances covered?

A: Dental appliances, restoration, and procedures for: altering vertical dimension; restoring or maintaining occlusion; splinting; replacement of tooth surface lost by abrasion or attrition; treatment of TMJ; or implants are excluded from coverage.

Q: Is TMJ covered?

A: TMJ is the treatment of dysfunction of the temporo-mandibular joint. As explained in section 5.7 of the Employee Benefits Manual, that is excluded from coverage.

Q: My dentist is charging me an extra fee for Infection Control. Is this a covered expense?

A: No. The County plan does not cover charges for Infection Control and Sterilization of Dental equipment. Some dentists charge this fee, but many others do not.

Long Term Disability Insurance

Q: What is a long term disability policy?

A: This is an insurance policy which pays income replacement benefits to an employee who is disabled 90 days or more. This policy is not available to family members.

Q: How much will I collect on this policy?

A: A qualifying employee will receive 60% of his/her last monthly pay rate, less offsets. Offsets include Social Security and Workers Compensation benefits. The employee is always guaranteed a benefit of not less that $100.00 per month.

Q: If I did not sign up for LTD as a new hire, can I sign up during open enrollment?

A: If an employee did not elect this coverage during the first 30 days of employment, he/she may complete an LTD application form at any time during the year. However, this late application will be sent to Standard Insurance Company where it will be reviewed by the medical underwriting department for either approval or denial.

Supplemental Life Insurance

Q: Do I have to wait until open enrollment to add Life coverage?

A: No, you may apply at any time for initial supplemental Life coverage or additional supplemental life coverage. However, you must complete part B and the application will go through medical underwriting for approval or denial of coverage.

Q: Do I have to wait until open enrollment to terminate Life coverage?

A: No, you may terminate at any time. However, if you ever want to renew Life coverage, you must reapply and go through medical underwriting for approval or denial of coverage.

Q: How much supplemental insurance can I apply for?

A: You can apply for up to $300,000 or six times your annual wages, whichever is greater. You may not apply for more coverage for your spouse than you request for yourself.

Q: If I apply for additional Life insurance, how long will it take to find out if I have been approved?

A: Standard Insurance Company will process your application through their medical underwriting department. If they are able to find all of the information that they need, it is possible to have a decision within two to three weeks. However, if they have any difficulty obtaining information (medical records, etc.), the investigation could take two to three months. It is very important to promptly reply to any correspondence that they send to you. The quicker you provide them with the information and/or medical records that they need, the quicker they are able to approve or deny your request. Applications may be denied for lack of information.

General Eligibility

Q: Until what age can I cover my children on my insurance?

A: An eligible dependent includes the eligible employee's spouse (as defined by the plan) unless divorced (documentation proving a legal marital relationship may be required), and all unmarried children (as defined by the plan) under 25 years of age, provided the children are principally dependent upon the eligible employee for support and maintenance. A married dependent child shall not be considered as an eligible dependent under this plan.

Q: Can I cover my common-law spouse?

A: A spouse can be covered two ways. One is to have a certificate of marriage. The other is to have a certificate of common-law. The date on the certificate of common-law will serve as the marriage date.

Q: Can I cover my parent who is my dependent?

A: No. Parents are not eligible dependents under any of our insurance plans.

COBRA

Q: Where do I make my COBRA payment?

A: You make your check out to and mail to: UnitedHealthcare and all payments must be by the 1st of the month. If payment is not received by the 1st, your coverage will automatically show terminated until payment is received. That can be especially important if you need to pick up prescriptions on the 1st. You may have to pay for them in full and then submit a claim reimbursement.

Q: How long can I continue COBRA insurance coverage?

A: As an employee who terminates employment voluntarily, is terminated involuntarily (except for gross misconduct), or loses coverage due to a reduction of hours; you and your dependents qualify for 18 months of additional coverage under COBRA. Spouses and dependents may be eligible for 36 months of COBRA coverage if there is a qualifying event such as: death of an employee, employee’s Medicare entitlement, divorce or legal separation, or dependent child ceasing to be a dependent.

Q: Why are COBRA premiums so much higher than the premiums I was paying as an active employee?

A: As an active employee, you receive a large contribution from Williamson County for your premiums. When you elect COBRA coverage, you are no longer receiving that contribution. You are also paying an additional 2% administration fee.

Retirees

Q: Where do I make my premium payments, and when are they due?

A: You make your check out to Williamson County. Monthly payments are due in the Human Resources department by the 1st of the month. You may either mail in that payment our stop by in person. Our mailing address is: Williamson County Human Resource Department, 301 S.E. Inner Loop, Suite 108 , Georgetown, TX 78626.

Q: How long may I keep county insurance once I retire?

A: According to our retiree eligibility definition, Williamson County will stop insurance coverage on both the retiree and dependent(s) on the last day of the month when one of the following occurs: 1) the retiree reaches age 65; (or age 70 if the retirement occurred prior to April 1, 1994); or 2) the retiree fails to submit the required set premium rate. The retiree and the dependent(s) would then be eligible for COBRA coverage.