It's been a hot summer so far in July; those of us with air conditioning are spending more time inside (unless there's a neighborhood pool). The Trust thought that instead of idling summer away, we'd help by suggesting an overview list for your benefits paperwork - what to keep, and why. So here's the scoop on benefits paperwork, as related to your Trust benefits, and what you need to know...

PAPERWORK

Whenever you enroll in a benefit for the first time or make a change, you should keep a copy of your Enrollment and Change form. The same thing applies to Affidavits of Dependent Status. (Your Payroll/Personnel office may also keep copies, but you probably want to have your own copies for your own personal files.)

Dental

Pre-treatment estimates: These are recommended in all three plans offered by the Trust for services over $300. Contact your plan to find out what written documentation they'll need from you and your dentist, and make sure you keep a copy of what you provide to the plan.

If you're in the DMO:

• Booklet-certificate.
• ID card (sent each year that you participate in the plan after July 1).

If you're in the Preferred Choice or Quality Dental Plan:

• Plan booklet (sent after you enroll).
• Claim forms (members of Quality Dental, or Preferred Choice receiving care from a non-network dentist). Take a form with you when you go to your provider to receive care.
• Explanations of Benefits (MetLife sends you a statement explaining its decision This statement is called the Explanation of Benefits, or EOB).

If you appeal a dental claim payment decision, keep a copy of your appeal form and all related correspondence too.

Vision

Whether you're in Cole or VSP:

• Claim forms (members receiving care from a non-network eye care provider).

Basic Life Insurance

Since this is automatically given, you don't have an enrollment form. However, the form you will use is the:

• Beneficiary designation form - keep a copy of the original, as well as copies of any changes filed.

Prudential will also send you a booklet-certificate. Keep this handy, along with any updates Prudential may send (for instance, when your pay rate changes or you change your beneficiary): let your family members know whereto find it. A good place to file it could be along with your will and other documents of record.

Also, it seems elementary, but saving your paystubs is a good thing to do. Your paystub shows proof of your regular pay rate, which means it shows how much basic life coverage you have.

Supplemental Life Insurance

If you elect this benefit, or make changes to it for yourself or your dependents, keep a copy of your Supplemental Life form (remember to copy both the front and the back).You'll also want to keep any copies of any changes you make to your beneficiaries, made via the Beneficiary designation form.

Disability Gap Insurance

No forms to worry to enroll, since this is another benefit you receive automatically from the Trust after one year of continuous State service. Once you exhaust your State disability benefits due to reaching the lifetime maximum, contact the Trust. We'll help you through the paperwork. Working Solutions Service No forms to worry about at all. See how we saved the easiest for last?

STORAGE ISSUES/CLAIMS

For the two life insurance plans, you should save the documentation for as long as the plan remains in place or you are covered under it. If you or your family needs to file a claim, the documentation you have will help speed the benefits you're owed. For dental and vision coverage, you should save your enrollment information and any plan booklets or booklet-certificates, but you need to save your claim information only until you and your provider have completely settled the claim. You'll know the claim isn't settled if you receive a bill... This section applies to claims from the Quality Dental or Preferred Choice out of network, but could also apply to most medical plans as well(non-managed care).

Submitting claims properly

• Find out if your provider submits the claim for you or if you need to do it.
• If you need to do it, review the information to be sure it is complete and correct.
• File it as soon as you get the bill from the provider.
• Send it to the right address.
• Keep a copy for your reference.

Getting a bill

So, if you receive a bill from your provider, review the charges and make sure you are billed only for procedures you actually received and that you are only billed once. If you think the bill is incorrect, notify your insurance company, in writing, of the mistake. Review your policy, plan document or booklet first, and carefully, to be sure the service in question is covered. Contact the Trust (the plan sponsor) or your plan if you need help filing your claim. Make sure you fill out all claim forms accurately and completely. Attach copies of bills when requested, and keep your originals. Keep copies of everything you send the company, including a record of the date you filed the claim.

Getting a response

Allow reasonable time for the company to process your claim. The company should inform you if it needs any additional information to complete the claim. Sometimes, it will request additional information directly from the providers or return the claim form to you to get more information. After the company has all the information it needs, it has a certain number of working days to process your claim. Your company should pay your claim within plan limits after it receives your completed claim form and has gathered all necessary information. If the company rejects your claim or pays only part of it, the company will give you an explanation.

Reviewing denied claims

Now that you've received and reviewed your EOB, if you disagree with the basis stated for denial, check your policy or plan booklet for the appeal procedures. If you don't understand the reasons for the denial or need assistance appealing, contact your plan If you're not getting answers promptly or feel like you're getting the run-around, contact the Trust. Our service is free and we are here to help by following up with the plan. We'll want to know what happened, who was involved, and why you think the benefits should have been approved. It will also help to know if/how you've tried to appeal the denial. We'll also need your name, social security number, plan, the social security number and relationship of person receiving care (when not the State employee), and your daytime phone number with area code (if you want a call back).