Can I change my benefits mid-year?

No. The only times you can make changes to your current benefits are during open enrollment or if you experience a qualifying life event. Not sure what a qualifying life event is? Here are a few examples:

• marriage;
• birth;
• death; and
• loss of other (non-Kairos) coverage.

To find a full list of events that may qualify you to make changes, refer to the Kairos Plan Document on the website, listed under “Benefit Information.”

I lost my ID card. How do I order a new one?

Don’t panic—there are a few ways you can order a new ID card:

1. Call MaxorPlus at (800) 687-0707. They’re available 24/7 to assist!
2. Log in to the Maxor portal at maxorplus.com. From there, you can choose “view/print an ID card.” Note: You must register for an account before you can use this function.
3. Download the MaxorPlus mobile app. The app works the same as the online portal, but from the convenience of your smartphone.
4. Or, you can contact your Kairos team at (888) 331-0222.

I moved and need to update my address. What should I do?

Whenever you need to update your address, contact your human resources/benefits department. They can update your new address in the system, which automatically notifies Kairos and the appropriate carriers.

When does the plan year begin and end?

Kairos is on a fiscal year, so the plan year begins on July 1 and ends on June 30. Among other things, this means that your deductibles and out-of-pocket maximums reset on July 1.

How do I find a doctor?

Finding an in-network provider is simple. All you have to do is:

• Go to the BCBS website: azblue.com.
• Log in to your online BlueNetSM account, or choose “Find a Doctor/Rx” without logging in.
• Narrow your search by ZIP code, city, county, or provider specialty.

I don’t understand all of these insurance terms—deductible, coinsurance, etc. What are the differences?

We understand insurance lingo can be confusing. Below you’ll find a quick rundown. We also have a short video, Medical Benefits 101, that explains the different terms. Watch the video now: https://www.svc.kairoshealthaz.org/home/Medical_Benefits_101.

Premium: The amount of money taken out of your paycheck just to be on the plan.

Deductible: The money you have to pay before your plan pays for any benefits.

Coinsurance: Your cost share once you’ve met your deductible. For example, if your coinsurance is 20%, Kairos picks up 80% of your treatment costs, and you’re responsible for the remaining 20% until you reach your out-of-pocket maximum.

Out-of-pocket maximum: The maximum amount of money you can be required to pay for covered services in a plan year. After that, you’re only responsible for your premiums.

Who do I contact if I was denied coverage, a claim was denied, or I received an inaccurate charge on my explanation of benefits (EOB)?

If you have any questions regarding your medical claims, contact the (800) BCBS number on the back of your ID card, or (844) 817-4116.

Quick tip: the (800) phone line directs you to a dedicated Kairos customer service team at Blue Cross Blue Shield. They’re a great resource for getting quick and accurate responses!

Am I covered outside of Arizona? How about outside the United States?

Yes, you do have coverage outside of Arizona. Use the tip above on “how to find a doctor” to search in-network providers in a different state.

You do not have coverage outside of the U.S.,except for emergencies.You will need to pay for expenses out-of-pocket and submit a reimbursement to BCBS.

I hate going to the doctor for a simple cold. Does BCBS offer any telehealth benefits?

Of course! BCBS offers a telehealth benefit called BlueCare Anywhere. You can use this benefit from your computer/mobile device and connect for a live virtual visit, 24/7.

Visit bluecareanywhereaz.com/landing.htm for more details.

I keep seeing the phrase, “drug formulary.” What does that mean?

A drug formulary is a list of medications that offer the greatest overall value for your health insurance plan. Inclusion on the list does not always guarantee coverage, as Kairos may exclude some medications. It’s best to contact MaxorPlus directly to see if your prescription is covered.

I just found out my medication isn’t covered. Why not?

There are various reasons your medication might not be covered through your pharmacy benefits. Here are a few:

• It’s new or experimental.
• Your doctor prescribed it for a use that is not recognized by the Food and Drug Administration.
• It was given to you in a doctor’s office—an infusion, for example. Medications given in a doctor’s office are not covered under your pharmacy benefits. There may be coverage, though, through your standard medical benefits.
• What you thought was a medication is actually a medical device.
• There’s an over-the-counter option.
• There’s research showing that the medication isn’t safe for some people.

Just keep in mind that if you continue taking a prescription not covered by your plan, you’re responsible for the full cost of the drug.

The drug I take requires prior authorization. How can I request that?

If your prescription needs a prior authorization, contact MaxorPlus member services: (800) 687-0707. They’ll ask for specific information they need to process the prior authorization.

How can I get the most from my prescription benefit?

These tips can help you save money on prescriptions:

• Generic medications are a less expensive option than name-brand drugs. Before you fill a prescription, ask your doctor if you can substitute a generic drug for a brand medication.
• Pill splitting can help save money without sacrificing drug effectiveness or safety. Some tablets are available at double the dose and at the same or nearly the same cost as lower doses. By splitting the larger doses, you can essentially get two doses for the price of one. There are limitations, however, on the types of pills you can split. Time-release medications and medications in capsule form, for example, can’t be split. Ask your doctor or pharmacist if your medication is available in larger doses, and if it can be split to help save you money.
• Buy a 90-day supply of medication. You can save money on copays by getting a larger supply of your medications. Ask your doctor for a 90-day prescription for any maintenance medication (e.g., for treatment of blood pressure, arthritis, or diabetes), then buy at your local retailer or take advantage of the mail-order program. (Note: You’ll need a new prescription to start home delivery.)
• Shop around for your medications. Medication prices may vary depending on where you do your shopping. Call around to different pharmacies, or go online to check prices through prescription cost comparison tools. And don’t forget warehouse stores, which can sometimes offer better prices than traditional retail pharmacies.
• Ask your doctor if there is an over-the-counter alternative to your prescription. Remember that over-the-counter medications usually come in lower strengths, so you should ask your doctor about appropriate dosing.

I want an HSA account. Do I qualify for one?

That depends. There are specific requirements to open and contribute to an HSA. The IRS requires that you are covered by an HSA-qualified health plan; that you don’t have other health coverage (for example, a traditional [non-HSA] health plan, Medicare, Tri-Care, VA benefits, or even a flexible spending account); and that you’re not claimed as a dependent on another person’s tax return.

What things can I use my HSA funds for?

Your HSA account can be used to pay for any qualified medical, dental or vision expenses, such as contact lenses, dental treatments, hearing aids, lab work, medical supplies, and prescriptions.

These are just a few examples. Refer to IRS Publication 502 for a full list: https://www.irs.gov/publications/p502.

Are employer contributions counted as part of my annual maximum HSA contribution?

Yes. Also, keep in mind that the amount you can contribute to your HSA each year depends on your age and whether your health plan covers just you or you and others. Amounts are adjusted annually by the IRS—click here to find this year’s amounts: https://www.irs.gov/publications/p969.

What if I forgot my HSA debit card and paid another way; can I get reimbursed?

If you’ve paid out-of-pocket for an HSA-qualified medical expense, you can request reimbursement from your health savings account (HSA). You’ll find the form on the Kairos website under Resources & Training—Forms. For faster processing, you can log in to your HealthEquity account at my.healthequity.com/HE.aspx, and submit your reimbursement request directly.

What happens to the money in my HSA if I leave my job?

You take that money with you wherever you go. Even if you switch to another plan that doesn’t come with an HSA option, you can still use your remaining HSA money to pay for qualified medical expenses. You just won’t be able to make additional HSA contributions.

Do I need a referral to see a specialist?

Delta: Yes, your doctor will refer you to see a specialist if needed.
TDA: Yes, your doctor will refer you to see a specialist if needed.

Will I get an ID card for dental services?

Delta: Yes, you’ll get an ID card.
TDA: Yes, you’ll get an ID card, but you don’t need your card to receive care.

Do I have dental coverage outside of Arizona?

Delta: Yes, you do have coverage outside of Arizona.
TDA: No TDA coverage is limited to Arizona only.

Are there age limits for my orthodontic benefit?

Delta: Delta offers orthodontic services for children ages 8-19.
TDA: There are no age limits for orthodontic services.

How do I change my provider with TDA?

To change your provider, just contact TDA at (888) 422-1995 and they’ll be able to help.

Will I get an ID card for vision services?

VSP does not use ID cards. All you have to do is give the provider your date of birth and social security number, and tell them you’re with VSP.

How often can I get new glasses?

You’re eligible for glasses every 12 months. This timeframe also applies to your exam and contact lens benefits.

Does VSP offer any discounts?

Yes. You can get an extra $20 to spend on featured frame brands. Visit vsp.com/specialoffers for more details and offers.

If I leave my employer, am I entitled to COBRA benefits?

Yes. You’re eligible for COBRA in the event of a voluntary or involuntary job loss, or if you have a reduction in hours that results in loss of coverage.

How long do I have to elect COBRA, and how long can I be on COBRA?

You have 60 days to elect COBRA coverage. The 60 days begins on the date the qualifying event letter is mailed or on your loss of coverage date, whichever is later.

In general, you can be on COBRA for up to 18 months. There are also certain circumstances in which you can be on COBRA for up to 36 months: (1) Medicare enrollment; (2) divorce or legal separation; (3) death of a covered employee; and (4) loss of dependent child status under the plan.

Can I change health plans when I elect COBRA?

COBRA works the same as active coverage. You can only make changes to your benefits during the COBRA open enrollment, or if you experience a qualifying life event.