Frequently asked questions
This list of Frequently Asked Questions has been developed from questions that have been received by the HealthEZ Customer Service department. If you don't find the answer you're looking for below, please contact Customer Service at 952-896-9130 or
800-203-1514.
What is a letter of medical necessity and who generates it?
What is a pre-existing condition?
How are claims for pre-existing conditions handled?
What does it mean when a health plan states it covers preventive services?
What is the difference between routine and preventive services?
My physician wants to verify my benefit and eligibility at the time of my visit. What do I do?
Why does HealthEZ need to know if I have other coverage?
How will you determine which health plan is primary?
What is a PBM?
My pharmacist said my prescription has been denied. What do I do?
Is there a plan summary that tells me what services are covered?
I just became eligible for my medical plan. How long will it take to get my ID card?
My adult child is enrolled full time in college. My plan allows coverage for a full-time student. What documentation will HealthEZ need from me?
What is a Certificate of Credible Coverage?
How can I get a Certificate of Creditable Coverage for my next benefit plan?
How do I file a claim for services received?
I don't understand how my claim was processed. Who can I contact?
What if I have expenses for an accident that occurs at work or due to a car accident?
How do I get copies of Explanations of Benefits?
What is a PPO and how does it affect my benefits?
What is a letter of medical necessity and who generates it?
This is a letter from your physician that explains why a particular treatment is considered necessary.
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What is a pre-existing condition?
A pre-existing condition is a medical condition you may have been treated for prior to your coverage with HealthEZ. This would include conditions for which you may be using medications to treat.
How are claims for pre-existing conditions handled?
If you have had a lapse in coverage of no more than 63 days, HealthEZ will need a copy of your certificate of creditable coverage (COCC). If a COCC is not received, HealthEZ will contact you by mail for additional information regarding treatment dates and providers. HealthEZ will also contact your providers to determine if you have been treated for any conditions that could be considered preexisting.
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What does it mean when a health plan states it covers preventive services?
Preventive services are used when a person goes to the doctor and they are not sick. Preventive check-ups, include visits for a mammogram, prostate screening, pap smear, etc.
What is the difference between routine and preventive services?
Preventive services are your yearly wellness physicals or tests/screenings you have done on a yearly basis, such as mammograms, eye exams, pap smears, prostate screenings, etc. Routine services are those done on a routine basis such as high blood pressure check, diabetes check, thyroid check, etc.
My physician wants to verify my benefit and eligibility at the time of my visit.
What do I do?
Just give your healthcare provider your HealthEZ identification card. Your physician’s office will call our Customer Service team who will be happy to assist them.
Why does HealthEZ need to know if I have other coverage?
Your plan has a provision known as coordination of benefits. We need to know about any other coverage you or your family may have to ensure that your claims are processed correctly, coordinating payment based on what your other plan covers. We will need to know who holds the other coverage as well as the name and phone number of the other carrier.
How will you determine which health plan is primary?
Primary status is determined through a series of coordination of benefit rules. Generally your employer’s plan is your primary plan. For complete details refer to your summary plan description or call our Customer Service team at 952-896-9130 or 800-203-1514.
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What is a PBM?
A PBM is a pharmacy benefit manager. Your PBM is Caremark. A PBM offers you medications at a discounted cost through their national network of pharmacies or thru mail order.
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My pharmacist said my prescription has been denied. What do I do?
Do not leave the pharmacy. Have your pharmacist call the Caremark help desk at 1-800-241-2784. The phone number is located on the back of your ID card. If this does not resolve the problem, please call HealthEZ immediately. You can also pay for your prescription and send in your receipt to HealthEZ.
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Is there a plan summary that tells me what services are covered?
Yes. A summary plan description is issued to all employees. You may obtain a copy of your plan summary (SPD) by contacting your HR department or by logging in to your account and clicking the Plan Documents link.
I just became eligible for my medical plan. How long will it take to get my ID card?
It generally takes about 10 business days to get a new card sent out to a member once the request is entered in our system. To obtain a copy of your ID card call Customer Service at 952-896-9130 or 800-203-1514.
My adult child is enrolled full time in college. My plan allows coverage for a full-time student. What documentation will HealthEZ need from me?
A letter from the school’s administration department, stating that the student is full-time, or a copy of the student’s enrollment for the current semester. You will need to supply this information on an ongoing basis.
What is a Certificate of Credible Coverage?
This certificate proves your participation in a health plan and gives the length of participation. You will need this if you move to another health plan in order to show that you did not have a lapse in coverage.
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How can I get a Certificate of Creditable Coverage for my next benefit plan?
Contact our Customer Service department at 952-896-9130 or 800-203-1514.
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How do I file a claim for services received?
Generally, your provider will bill HealthEZ for you. If for some reason you do need to submit a claim, you will need an itemized statement from your provider which includes details about the services rendered and the reason for the visit. If you have already paid for the service, you will need to provide proof of payment so that HealthEZ can send any reimbursement directly to you.
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I don't understand how my claim was processed. Who can I contact?
Call our Customer Service department at 952-896-9130 or 800-203-1514 or email us at service@AmericasTPA.com.
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What if I have expenses for an accident that occurs at work or due to a car accident?
HealthEZ investigates all claims that may be injury-related. However, we would like you to call us and tell us if there is another party involved. HealthEZ will still process your claim, but will also pursue payment through other insurance if applicable.
How do I get copies of Explanations of Benefits?
Login to your account and click the Statements link, or call our Customer Service department at 952-896-9130 or 800-203-1514.
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What is a PPO and how does it affect my benefits?
PPO stands for “Preferred Provider Organization.” A PPO contracts with providers of medical care for a discounted rate on their services. Doctors and hospitals under contract are referred to as preferred providers or participating providers. Usually, the benefits with a participating provider are significantly better than with a non-participating provider.
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