Enroll or Add Benefits/Insured Members

• Within 30 days of your hire date
• Within 30 days of your 1st paycheck date
• During Employer's annual 30-day open enrollment period
• Within 30 days from the date of a qualifying life event

Otherwise

• Wait until next annual open enrollment
• Wait until you have a qualifying life event

Coverage for the Fixed Indemnity Medical Plan and any ancillaries selected begins the Monday following a payroll deduction and continues as long as you have a deduction from your paycheck.

Review Your Check Stub

Make direct payments to PAI if you miss a payroll deduction to avoid a break in coverage. After six consecutive weeks without a payroll deduction, coverage will be terminated and COBRA information will be sent.

You may cancel or reduce coverage at any time, unless your premiums are deducted pre-tax.

To make a change, call 1-866-798-0803.

Coverage for the Fixed Indemnity Medical Plan and ancillary plans selected will begin the Monday following a payroll deduction and continues as long as you have a deduction from your paycheck.

Please review your check stub for deductions. If you do not see a deduction for two weeks, please contact your employer or Customer Service at 1-866-798-0803.

ID cards will be mailed as soon as your enrollment form is received and processed. You should receive your ID card within 10 business days of your effective date.

If you need to receive your ID card(s) sooner you can contact Customer Service at 1-866-798-0803 and request copies to be emailed or faxed to you or your provider.

If you miss a payroll deduction, to avoid a break in coverage you may make direct payments to PAI. After six consecutive weeks without a payroll deduction or six consecutive direct premium payments, coverage will be terminated, and COBRA information will be sent at that time.

If you have questions regarding a missed payroll deduction, or need information on how to make direct payments, please contact Customer Service by calling 1-866-798-0803.

Post-Tax Products: You may cancel or reduce coverage at any time. To make a change, contact Customer Service at 1-866-798-0803.

Pre-Tax Products: You will only have 30 days from your hire date to enroll, add additional benefits or add additional insured members. After this time frame, you will only be allowed to enroll, add benefits or add additional insured members during your annual open enrollment period or within 30 days of a qualifying life event.

To make changes or cancel coverage based on a qualifying life event, please contact Customer Service at 1-866-798-0803.

A qualifying life event is defined as a change in your status due to one of the following:

• Marriage, divorce, annulment (spouse, stepchildren)
• Death
• Birth, adoption, placement for adoption, legal guardianship, or legal custody
• Loss of eligibility for insurance through another plan, change of coverage on spouse's plan, or significant change in premium cost
• Employee/dependent becomes eligible for insurance through another plan, eligible for Medicare/Medicaid, or enrolls in the Healthcare Exchange
• Dependent child marries, reaches maximum age to qualify for coverage (26), or becomes eligible through employer
• Rehire (more than 6 weeks since last assignment)
• Significant reduction in hours

If you experience a qualifying life event, you must submit documentation of the event along with a change form requesting the change within 30 days of the event.

In addition, you may request a special enrollment (for yourself, your spouse, and/or eligible dependents) within 60 days of:

1. Termination of coverage under Medicaid or a State Children's Health Insurance Program (SCHIP).
2. Becoming eligible for SCHIP premium assistance under this Fixed Indemnity medical benefit.

Yes. Eligible dependents include your spouse and your children up to age 26 (this may vary by state). 

You are encouraged to visit providers in the networks to maximize your benefit dollars. To find a participating provider or verify your current medical provider is in-network, please contact Customer Service at 1-866-798-0803.

It is not required that you go to an in-network provider. If you choose a provider who participates in the PPO network, you receive two key advantages:

• PPO discount for all services
• The provider will file the claim on your behalf

Yes. Your provider may call Customer Service at 1-866-798-0803 to receive a schedule of benefits and benefit maximums.

No. There are no restrictions for pre-existing conditions for the Fixed Indemnity Medical Plan and ancillary plans. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.  

For generic and brand prescriptions, present your ID card at a participating pharmacy to receive discounts. Generic and brand prescriptions are payable based on the schedule of benefits up to the annual prescription drug maximum.

To file a claim for reimbursement, save your receipt and submit to PAI. Prescription drug coverage is not provided for drugs administered during a physician office visit or hospital stay. For more information on submitting Rx receipts for reimbursement, please contact Customer Service at 1-866-798-0803.

Yes. Oral contraceptives are covered under the prescription benefit. Non-oral contraceptives are not covered.

Yes. Maternity benefits are covered the same as any other condition under this plan. 

Yes. If you enroll in the Fixed Indemnity Medical Plan, you may still be eligible to receive a subsidy. 

No. Currently, the Federal Affordable Care Act (ACA) individual mandate does not impose a penalty. In addition to Federal Mandates, some states have implemented their own individual mandate.

Please check your state's guidelines for any individual state mandate requirements or penalties.