AmeriBen’s growing critical mass enables us to partner with best-in-class networks and vendors; yet AmeriBen is still small enough to maintain its ever-constant focus on strategic flexibility and personal touch. Additionally, we possess the sophistication and nimbleness required to effectively administer both bundled and unbundled self-funded health plans.
Our mission extends well beyond accurately administering benefits as we focus on the greater mission of touching and improving lives. Our 350+ employees are acutely aware that there is a person behind every claim and a complex issue behind every call.
What is a deductible?
A deductible is the amount of medical expenses you are responsible for paying before your insurance starts covering you. The deductible amount can be found in the CCT Summary Plan Description (SPD) booklet, which is available through your Personnel/Human Resources Department, and also on this web-site.
What is a co-payment?
A co-payment is a fixed-dollar amount that you are responsible for paying for a particular medical service. Co-payment services generally do not require the satisfaction of a deductible before payment can be made. CCT co-pay amounts can be found in the CCT Summary Plan Description (SPD) booklet, which is available through your Personnel/Human Resources Department, and also on this web-site.
Do my copayments count toward the annual deductible?
No, copayment services do not count toward meeting the annual deductible.
What is coinsurance?
Coinsurance is the cost of a medical service that you are responsible for paying after satisfaction of the annual deductible. Unlike a co-payment, which is a fixed-dollar amount, coinsurance is expressed as a percentage. CCT’s coinsurance amounts can be found in the CCT Summary Plan Description (SPD) booklet, which is available on this web-site.
How do I find a BCBSAZ participating provider?
You can easily locate a provider by searching the provider directory at www.azblue.com/CHSnetwork.aspx. Or, if you prefer to speak with a Customer Service representative, please call AmeriBen at (855)258-6455.
Whom do I call to request additional ID cards?
You can request replacement cards by calling AmeriBen Customer Care toll-free at (855)258-6455 or online at myameriben.com. You should receive your new card within 7 to 10 calendar days from the date of your request.
What is a qualifying change of status?
If the plan participant has any of the following qualifying change of status situations during the year, the plan participant will be allowed to make a mid-year change in their coverage selections and change who is covered under the medical coverage:
1. Change in legal marital status: Marriage, divorce, legal separation, annulment, or death of spouse.
2. Change in the number of dependents: Birth, adoption, or death of dependent child.
3. Change in employment status or work schedule: Start or termination of employment or change in employment status of the employee, their spouse or their dependent child.
4. Change in dependent status under the terms of this Plan: Age, or any other reason provided under the definition of an eligible dependent.
5. Change of residence or worksite: If the change impairs the plan participant’s ability to access the services of network providers.
6. Change required under the terms of a Qualified Medical Child Support Order (QMCSO).
7. Increase to the employee in the cost of the benefits.
8. Significant changes in the benefits.
9. Changes in employer coverage of a spouse, former spouse, or dependent.
Two (2) rules apply to making changes to the benefit selections during the year. If both rules are not met, the eligible employee or dependent will have to wait until the next open enrollment period to make any change in the coverage:
a. any changes to be made to the benefit selections must be necessary, appropriate to and consistent with the change in status, and approved as such by the Plan Administrator or its designee
b. the Plan must be notified in writing within thirty-one (31) days of the qualifying change in status
Do I have to get authorization, or a referral, for any services?
The medical benefit plan does require pre-certification of certain services. This program is designed as a cost containment measure through a company called AmeriBen Medical Management to maximize the Plan benefits and reduce unnecessary hospitalizations, surgical procedures, diagnostic and other services. Failure to comply with the pre-certification requirements may result in a $300 penalty, or may disqualify coverage of the benefit. It is always up to you, and the physician you choose, to determine what services you need and who will provide your care, regardless of what this Plan will pay for. Once a pre-certification is received, it is valid for ninety (90) days.
IMPORTANT: Pre-certification of a procedure does not guarantee benefits. All benefit payments are determined by AmeriBen in accordance with the provisions of this Plan.
Pre-certification is required on the following:
-Diagnostic tests and surgical procedures over one thousand dollars ($1,000)
-All non-emergency Hospital admissions or admissions to any type of care facility
-Maternity admissions that exceed forty-eight (48) hours (ninety-six  hours for Cesarean Section)
-Occupational, Speech and Physical Therapy treatment programs
-Psychological and neuropsychological testing
Call 1-800-388-3193 for more information.
No matter your position – CEO, Superintendent, City Manager, HR Director, Director of Finance, or Administrative Assistant – understanding employee benefits can be overwhelming. Health Care Reform has drastically changed the landscape of employee benefit programs, and continues to do so. Staying abreast of ever-changing legislation, focusing on corporate compliance and continuing to educate employees on their benefits package is no easy task. ECA partners with our clients as an extension of staff to give objective advice, through transparent policies and comprehensive education.