Frequently Asked Questions
General Questions

Q. What is the difference between a subscriber and a member?

A. A subscriber is the employee or individual who elects coverage under the plan or the person that the coverage is through. A member is any person covered under an employee benefit plan as either a subscriber or a dependent.

Q. What is a medical emergency?

A. A medical emergency is any medical condition leading a prudent layperson to seek immediate medical attention. Examples of medical emergencies include, but are not limited to, conditions placing a person’s health in significant jeopardy; serious impairment to a bodily function; serious dysfunction of any bodily organ or part; inadequately controlled pain or situations when the health of a pregnant woman or her unborn child are threatened. You must notify your health care plan within 24-48 hours after seeking emergency care.

Q. What is a formulary list?

A. A formulary, or preferred drug list, is a list of medications that are covered for a specific copayment amount by a health care plan. This list may vary from one plan to another.

Q. What is a preventive service?

A. Preventive services are those that are concerned with preventing disease or early detection. Examples of preventive services include annual exams, mammograms, pap smears, well-child care, etc. Refer to your plan’s summary of plan benefits for a complete list of services.

Q. When should I call my medical plan?

A. Whether you are participating in a POS or PPO plan, call your plan first when you have questions regarding claims, service issues, pre-certification, case management, and pharmacy issues.

Q. How long can I keep medical coverage through MCHCP as a surviving spouse?

A. You may keep the coverage as long as you pay the premium and the Public Entity participates with MCHCP.

Q. How long can children be covered under MCHCP?

A. Dependent children can be covered up to the age of 23.

Q. My child lost coverage under my spouse’s plan since he/she no longer meets the dependent criteria for that plan. May I enroll him/her in my MCHCP plan at this time?

A. YES. You can apply for late entrant coverage for that dependent child as long as the child meets dependent eligibility requirements, and you apply within 60 days of the event.

Q. If my dependent has a child, can that newborn be covered?

A. YES, as long as your dependent is covered and the newborn is enrolled within 31 days of the birth. If you do not elect to enroll the newborn at this time, you cannot enroll the child at a later date. The child can only be covered as long as your dependent is also covered. Once your dependent loses coverage or is no longer eligible for coverage, his/her dependent would no longer be eligibile for coverage through MCHCP.