Frequently Asked Questions
Q: Who do I call when I have questions regarding my benefits?
A: IIS Benefits has a dedicated, HIPPA-approved customer service staff trained to handle your questions. If you have a customer service question of any kind, call 877-257-3826 toll free or 702-313-7384 locally.
Q: What happens when I go to the doctor?
A: Your doctor will charge you a co-pay that is part of your policy. If your doctor has questions regarding the plan, please have him or her contact our Customer Service Department using one of the phone numbers above.
Q: What happens when I go to the pharmacy?
A: You will simply pay the co-pay amount listed on your ID card. If the pharmacist has any questions he or she can contact our Customer Service Department at one of the phone numbers above.
Q: What happens when I get an invoice from a physician?
A: Some doctors bill very quickly after your visit. If you receive an invoice from your doctor within 30 days after your visit, please disregard it as it may not be a bill. You will receive an explanation of benefits (EOB) statement from your insurance company. Your physician will be paid based on the EOB.
Q: Who do I call to check the status on my claim?
A: All claims questions are gladly answered by the staff at the IIS Customer Service Department. Call 877-257-3826 toll free or 702-313-7384 locally.
Q: Why did my Employer select this plan?
A: Your employer has seen the cost of your group medical plan increase for the past few years. Instead of lowering your benefits and increasing your contributions, your employer has decided to use an innovative plan to maintain quality benefits and contain the out-of-pocket costs of employees while keeping the company’s costs low.
Q: Who pays my claims and how do I know they have been paid?
A: IIS Benefits has a specially trained claims staff to process all your medical claims. Once your claim has been processed, you will receive an explanation of benefits (EOB) statement from our claims department. You may also logon to MyRSC.com.
Q. What is the purpose of the plan?
A. The purpose of the plan is to reimburse employees covered under the plan for a portion of the medical expenses they incur each year. These reimbursements count toward a special deductible the employer has put in placeunder the Employer's Insured Health Plan. Reimbursements are made on claims incurred while a covered employee is employed with the employer and the plan remains in effect.
Q. What does the term “out-of-pocket” mean?
A. The term “out-of-pocket" refers to an amount of eligible medical expenses to be paid by either the employee or the employer. Out-of-pocket expenses are typically the sum of the deductible amount plus the co-insurance amount (co-Insurance rate or co-Insurance corridor). The out-of-pocket expense can also include specific types of employee pay or employee or employer expenses that may be itemized on the plan's Annual Benefit Summary.
Amount due for eligible medical expense -- only that you have incurred the expense, that you have submitted it to, that it has been processed and reported by them via the EOB, and that it is not being paid for or reimbursed from any other source.
Q. When must the expenses for which I may be reimbursed be incurred?
A. Eligible expenses must have been incurred during the plan year. You may not be reimbursed for any expenses: Arising before the plan became effective Incurred before you became covered under the plan incurred after the close of the plan year Incurred after a separation from service (except for continuation coverage)
Q. Does the plan also provide benefits for my family?
A. The plan provides reimbursement for eligible medical expenses incurred by you, your spouse and any other person you could claim as a dependent on your federal income tax return as long as these eligible individuals are covered under the Employer's Insured Health Plan.
Q. What happens if my claim for benefits is denied?
A. All claims are adjudicated (reviewed for approval under the provisions of the employer's insured health plan). All amounts due under the plan are based on the determination made by the insurance carrier. You will be notified in writing by the carrier via the EOB (explanation of benefits) within 90 days of the date you submitted your claim if the claim is denied. Such notification will set out the reasons your claim was denied and further advise you of what steps, if any, you might take to validate the claim. If a claim is denied under the plan but approved under the employer's insured health plan, you will be advised of your right to request an administrative review of the denial of the claim. You may request a review any time within the 90-day period after you have received notice that your claim was denied. You or your authorized representative will have the opportunity to review any documents held by the administrator and to submit comments and other supporting information. In most cases, a decision will be reached within 90 days of the date of your request for a review
List of Questions
- Who do I call when I have questions regarding my benefits?
- What happens when I go to the doctor?
- What happens when I go to the pharmacy?
- What happens when I get a doctors bill?
- Who do I call to check status on my claim?
- Why did my Employer select this plan?
- Who pays my claims and how do I know they have been paid?
- What is the phone number for Customer Service?