Frequently Asked Questions
Is LASIK eye surgery an eligible expense?
Contact Midwest Group Benefits at 563-382-9611 to determine if this is covered.
The plan excludes radial keratotomy or other eye surgery to correct refractive disorders. It is eligible for Flexible Spending reimbursement, however.
Who is eligible for the $50 vision exam benefit in even-numbered years?
Employee and/or spouse and children over age 6 are eligible for this $50 reimbursement in even-numbered years.
Can I use the EAP program if I don't have Luther health insurance?
Yes. The EAP (Employee Assistance Program) is available to all Luther employees and their eligible dependents.
What do I do if I need my health insurance while traveling in the U.S.?
Faculty/staff do not need to search for a Midland's Choice or Gundersen network provider while traveling in the United States. For routine or emergency care, eligible claims will be paid subject to deductibles and coinsurance. Depending upon the service provided and location, the provider may or may not submit claims to Midwest Group Benefits. If the provider will not submit the claim, the employee or covered dependent will have to pay for the services and submit claim(s) to Midwest Group Benefits, Inc. for reimbursement. Use the information provided with the health care card.
When do I have to call for pre-certification?
The following services must be precertified or reimbursement from the Plan may be reduced:
- all inpatient services
- breast surgery—excluding biopsies, lesions & reconstruction related to breast
- sclerotherapy and vein ligation/stripping
- sleep studies
- chemotherapy services
The patient or family member must call Hines and Associates, Inc. at 1-800-670-7718, to receive certification of certain Cost Management Services. This call must be made at least 48 hours in advance of services being rendered or within 48 hours after an emergency.
Any reduced reimbursement due to failure to follow cost management procedures will not accrue toward the 100% maximum out-of-pocket payment.
Utilization review is a program designed to help insure that all covered Persons receive necessary and appropriate health care while avoiding unnecessary expenses.
Why has a fee for service been denied?
Most often, fees that have been denied are due to the fact that a precertification was not done. Call Midwest Group Benefits to speak to the claims specialist at 563.382.9611 if this has happened to you.
Why am I being penalized?
When a person has chosen to obtain service from a provider that is not in their network the service is covered at 60% instead of 80% after the deductible. This is also true if a person goes to a provider that is in neither the Midlands Choice or Gundersen network.
Is it okay to see a specialist?
Yes, it is okay to see a specialist. In addition, a person does not have to be referred to the specialist for the service to be covered by insurance.
The Plan realizes that for some situations, a covered person may not have a choice of providers. For this reason, in-network payment will be made for certain non-network services if a covered person is referred by an in-network provider to an non-network provider.