Plan Coverage Questions
- You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays health care expenses without regard to fault. This is called “double coverage”. When you have double coverage, one plan normally pays its benefits in full as the primary payor and the other plan pays a reduced benefit as the secondary payor. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners’ (NAIC) guidelines. For more information on NAIC rules regarding the coordinating of benefits, visit https://www.naic.org/store/free/MDL-120.pdf.
For complete details about how we coordinate with other health plans and a Primary Payor Chart, see Section 9. of the official plan brochure under Coordinating Benefits with Medicare and Other Coverage.
When you use a doctor in our network, you generally don’t need to file a claim. Just show your ID card, and your doctor files the claim for you. Make sure you carry your ID card with you at all times since it includes the address your provider will need to submit your claims. Also, you might need to buy prescriptions at a network pharmacy and you’ll need your ID card to do so.
For your convenience, you can view and download a copy here.
Doctors in our network usually file claims for you. But, if you need to submit a claim please use this address:
Rural Carrier Benefit Plan
P.O. Box 14079
Lexington, KY 40512-4079
When you use a doctor in our network, you generally do not need to file a claim. Present your ID card at the time of service and your doctor will file the claim for you. When you use out-of-network doctors you may have to file your own claim. To file your claim, print this form. Complete the form and mail it to the address provided on the form. If you have questions, call us at 800-638-8432.
Follow the Federal Employees Health Benefits Program disputed claims process outlined in section 8 of your RCBP Plan Brochure if you disagree with our decision on your claim.
Before you’re admitted to the hospital as an inpatient, you need to get your stay precertified. Precertification is the process by which we evaluate the medical necessity of your proposed stay and how many days are required to treat your condition. Exceptions include:
- Maternity admission for a routine delivery with the 48/96 hour rule
- Admission to hospitals outside of the United States
- Another group insurance is the primary payor for the hospital stay
- Medicare part A is the primary payor for the hospital stay
OPM requires all Federal Employee Health Benefits Program (FEHBP) plans to precertify hospital stays. In most cases, your doctor or hospital will take care of precertification. However, you’re still responsible for ensuring that we are asked to precertify your care. So always verify with your doctor or hospital that they have contacted us.
You, your representative, your doctor, or the hospital must call us at least two working days before admission. The toll-free number is 800-638-8432. Provide the following information:
- Enrollee’s name and Plan identification number
- Patient’s name, birth date and phone number
- Reason for proposed hospitalization
- Name and phone number of the doctor who will admit you
- Number of planned days in the hospital
We’ll tell the doctor and hospital the number of days in which the patient is approved to stay in the hospital. Our decision will be sent to you, your doctor, and the hospital.
Yes. The federal government requires that all members of a fee-for-service plan must precertify their hospital admissions.
When there is an emergency admission you, your representative, the doctor, or the hospital must call 800-638-8432 within two business days following the day of admission, even if the patient has been discharged from the hospital.
In-Network Provider Questions
You may visit our Visit our Find a Provider page to look up providers who are in the network. You can also call 800-638-8432, and we’ll help you find one near you.
Provider information can change. So please call your doctor before your appointment to confirm his/her network status.
Paper directories become outdated quickly as new providers join our growing network.
You can easily print a copy of the directory from the Find a Provider tool by selecting the “Print” option at the top of your search results.
Members have access to providers in our network virtually anywhere in the United States. Whether you’re on vacation, business travel or away at college, you and your eligible dependents can find providers who participate in our network.
Yes. While we encourage doctors in our network to refer their patients to other network doctors, this may not always be possible. We recommend that members always confirm that the doctor is part of our network. Likewise, if your doctor refers you to a hospital, please confirm that the hospital is part of our network.
If your doctor does not currently participate in our network, you may submit a Provider Nomination form to have him/her considered. Fill out the patient section and ask your doctor to complete the rest. After we receive the form, it can take up to six months for us to complete the review process. If you have questions, just call us at 800-638-8432.
ID Card Questions
To get a replacement ID card, you may order a new one online through Aetna Navigator®, or call 800-638-8432.
Questions, Suggestions or Complaints
Please visit our Contact Us page for hours and contact information.