Employee FAQs
Click on the links below for the answers to some frequently asked questions regarding insurance coverage.
Administration - Enrollments, Additions, Terminations
Dental Claims Administration
Vision Claims Administration
Life Insurance Claims Administration
Long Term Disability (LTD) Claims Administration
Short Term Disability (STD) Claims Administration
Employee Administration - Enrollments, Additions, Terminations
Q. Where should I mail forms?
A. Eastern Life and Health Insurance Company
Group Administration Department
PO Box 83149
Lancaster, PA 17608-3149
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Q. I'm a new employee-can I waive coverage?
A. You can waive contributory coverage (coverage where you as the employee would pay all or a portion of your premium). The enrollment form contains a section where you can waive coverage and provide the reason. However, employees generally cannot waive non-contributory coverage (100% employer paid premium). Non-Contributory coverage waivers may be permitted only under specific circumstances, please contact us for additional information.
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Q. I waived coverage, but now I’ve changed my mind. Can I enroll now?
A. An eligible employee can enroll at any time by completing the appropriate enrollment form. However, depending on the type of coverage, you may be subject to late enrollment restrictions or individual underwriting.
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Q. Will I get an ID card?
A. ELH issues ID cards for Dental coverage only. A Dental ID card will be provided for each eligible employee enrolled in Dental coverage (2 cards will be supplied if dependent coverage is selected). The cards will be mailed directly to your employer for distribution.
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Q. I changed my name / address—do I need to tell you?
A. Yes! Failure to notify us within 31 days may carry consequences, so please ask your employer to report this information to us immediately. They should complete an Employee Change Card From U202 and obtain your signature.
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Q. I need to change / add / delete a beneficiary / dependent.
A. Please ask your employer to report this information to us immediately on the Employee Change Card From U202 and obtain your signature. Failure to notify us within 31 days may result in consequences.
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Q. Do I need to enroll a new dependent if I already have dependent coverage?
A. Yes. Even if other dependents are covered at the time of adoption or birth of a new dependent, an enrollment form must be completed for the new dependent. If the enrollment form is received after the 31 day eligibility period, the eligible dependent may be subject to late enrollment restrictions or individual underwriting.
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Q. Can I continue coverage for a covered dependent who has reached the regular age limit on the plan?
A. A covered dependent's coverage may be continued beyond the regular age limit, if we receive written proof that the dependent is a full-time student at an accredited school; primarily dependent upon the employee for support and maintenance, unmarried, and under the dependent student age limit shown in the certificate. The best way to verify student status is to send us a letter from the school. The letter should contain the name of the student, the dates of the specific semester, and notation that the student is classified as a full-time student. We may also accept some other school notice, such as a class schedule providing it includes the information previously noted. We might require additional information if we cannot verify the student's status.
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Q. When does an employee's or a dependent's coverage terminate?
A. Coverage for an employee or dependent who is no longer eligible for such coverage will terminate. This can occur for a number of reasons including, but not limited to:
- Termination of employment;
- Disability;
- Reduction in work hours;
- Retirement; or
- Dependents that no longer meet the definition of dependent.
Refer to the certificate for details.
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Q. What is COBRA?
A. Federal Law gives certain persons the right to continue benefits beyond the date that they might otherwise terminate. Generally, employers with 20 or more full and/or part time employees are subject to COBRA requirements. COBRA requires that the employer provide ELH with timely notification of this coverage extension. For further information regarding COBRA, please speak with the employer.
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Q. Which coverages does COBRA impact?
A. Dental and Vision coverage is impacted if you are subject to COBRA requirements. For further information, please speak with the employer.
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Q. How does an employee or dependent apply for COBRA?
A. If you are eligible for COBRA, you will need to complete Part II of the Request for Continuation of Group Benefits Form U206. Your former employer will need to complete Part I. Instructions are provided directly on the form. For further information, please speak with the employer.
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Dental Claims Administration
Q. Where should I direct forms and questions?
A. Eastern Life and Health Insurance Company
Dental Claims Department
PO Box 83888
Lancaster, PA 17608-3888
Phone: 800-233-0307
Fax: 717-481-8284
E-mail: dentalclaims@elhins.com
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Q. What should I know about Dental claims?
A. Remember these three points:
- Read your certificate
carefully. The more you understand
your Dental coverage, the fewer
questions will arise.
- Take your Dental ID card
to the dental office. Although the
Dental ID card does not guarantee
benefits, the dental office needs the
information shown on the card.
- Give the dentist a Dental
Claim Form. Even though we will
accept other dental claim forms, it's
best to use our Dental Claim Form.
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Q. What is a Pre-Treatment Estimate and why is it important?
A. Whenever the dentist proposes to do non-emergency
major services that will exceed
$400 in charges, we recommend that the
dentist submit a Pre-Treatment Estimate
to us before starting treatment. We will
process the Pre-Treatment Estimate and
send a Pre-Treatment explanation of
benefits (EOB) to the dentist. This will let
you and
the dentist know what portion of the
treatment will be covered and what the
benefit amount could be. It's a good way
to determine out of pocket expenses
before proceeding with treatment.
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Q. How should a Dental claim be filed?
A. The Dental Claim Form ELH100 should be
used. Just follow the instructions on the
form. The dentist must complete the
provider information area as well as
detailed information about the dental
treatment. The mailing address can be
found on the form and on the back of the
Dental ID card.
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Q. How will I know what my dental plan has paid and what, if anything, is owed to the dentist?
A. You will receive an EOB for every claim
that is processed. This EOB lists the
submitted charges, indicates how much
was covered or not covered, and tells
you what your responsibility will be. If
your dentist received the Dental benefit
check, the dentist will also receive a copy
of the EOB.
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Q. How does ELH determine where to send the Dental benefit check?
A. The Dental Claim Form contains a line
authorizing a release of information
pertaining to the claim and a line
authorizing us to send the benefit check to
the dentist. If authorized, we will send
the benefit payment directly to the
dentist. If not authorized, the benefit
check will be sent directly to the
you.
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Vision Claims Administration
Q. How does the VSP vision provider network work?
A. Eastern Life & Health is in partnership with the VSP vision network. You can reach VSP representatives by calling 800-877-7195.
NOTE: Vision Coverage contains numerous provisions regarding qualifying benefits, limitations, exclusions and other administrative issues such as continuation. It is very important that you READ THE CERTIFICATE CAREFULLY!
NOTE: If you do not have a VSP vision plan, please direct all benefit inquiries, claims, and correspondence to Eastern Life and Health.
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Q. How is the benefit used?
A. You make an appointment with a VSP member vision provider (network doctor) and tell the doctor that you have vision with VSP or Eastern Life & Health Insurance. The doctor and VSP handle the rest. There are no claim forms.
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Q. How do I collect reimbursement after visiting a
non-member (non-VSP) vision provider?
A. 1. Pay the non-member (non-VSP) provider the full amount of the bill and request an itemized copy of the bill.
2. Include the following information with the bill:
- name, address & phone number of
the provider;
- covered employee’s ID number,
name, address and phone number;
- group name and number;
- patient’s name, date of birth,
address, phone number and
relationship to the covered
employee.
3. Send a copy of the itemized bill(s) with
the above information to VSP at:
PO Box 997105
Sacramento, CA 95899-7105.
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Life Insurance Claims Administration
Q. Where should I direct forms and questions?
A. Eastern Life and Health Insurance Company
Life and Disability Claims Department
PO Box 83149
Lancaster, PA 7608-3149
Phone: 800-233-0307
Fax: 717-481-8252
E-mail: disabilityclaims@elhins.com
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Q. How should a Life Insurance claim be filed?
A. You can contact our Life Claims
Department by calling
800-233-0307 or emailing
disabilityclaims@elhins.com. We
will provide step-by-step assistance during
this very trying event. If you or the
beneficiary are unable to call, a Life Claim
Form GB23 can be completed and sent
directly to the Life Claims Department.
Follow the instructions on the form.
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Q. How are Life Insurance benefits paid?
A. Life Insurance and Accidental Death and
Dismemberment proceeds are paid by
check directly to the beneficiary with an
accompanying explanation of benefits
(EOB).
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Q. In addition to a death benefit, Life Insurance provides for continuation of coverage during total disability, how can such a claim be filed?
A. A covered employee who becomes totally
disabled before age 60 and whose total
disability continues for 9 consecutive
months can file for continuation of
coverage. A Continuation of Coverage
Claim Form GB157 must be submitted to
us within 9 to 12 months after the
disability begins. If you also have STD
and/or LTD coverage with us, the
employee does not need to file a separate
continuation of coverage claim form.
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Long Term Disability (LTD) Claims Administration
Q. Where should I direct forms and questions?
A. Eastern Life and Health Insurance Company
Life and Disability Claims Department
PO Box 83149
Lancaster, PA 17608-3149
Phone: 800-233-0307
Fax: 717-481-8252
E-mail: disabilityclaims@elhins.com
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Q. How should an LTD claim be filed?
A. Contact our claims department by calling 800-233-0307 or e-mailing disabilityclaims@elhins.com to report the claim. We will send you the LTD claim form with instructions. If you have STD coverage with ELH, a separate LTD claim form is not needed.
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Q. When should an LTD claim be filed?
A. An LTD claim should be filed as soon as
you are aware that your
disability may continue beyond the
maximum benefit duration limit of your
short term disability coverage or salary
continuation / sick leave program or the
LTD elimination period. You should report
the claim at least 45 days prior to
the end of the LTD Elimination period.
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Q. When are LTD benefits paid?
A. LTD benefits begin after completion of the
first full month of total disability following
satisfaction of the LTD Elimination period.
LTD benefits are paid monthly.
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Q. How are LTD benefits paid?
A. LTD benefit payments are made by check.
Each LTD benefit check will provide an
explanation of benefits (EOB) statement
that lists the gross benefit amount
payable, taxes withheld, net benefit paid
and payment period.
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Q. Where are LTD benefit checks sent?
A. LTD benefit payments are usually mailed
directly to the disabled employee at the
address we have on file.
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Q. Are LTD benefits taxable?
A. LTD benefits are taxable in direct
proportion to your contribution to the
premium payments. For example, if your employer
pays all of the premium payment, the
benefit is 100% taxable. If your employer pays half
of the premium payment, the benefit is
50% taxable.
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Q. How are taxes withheld / paid?
A.The employee's portion of Social Security and Medicare taxes are withheld from LTD benefit payments and deposited by us in accordance with applicable tax laws. LTD benefits are taxable for Social Security and Medicare, subject to annual taxable income ceilings, on all LTD benefits paid during the first full 6 months following the end of the month in which the disability begins. Federal tax withholding is optional and taxes are only withheld when the employee specifically requests the withholding on the claim form. We do not withhold state or local taxes.
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Short Term Disability (STD) Claims Administration
Q. Where should I direct forms and questions?
A. Eastern Life and Health Insurance Company
Life and Disability Claims Department
PO Box 83149
Lancaster, PA 17608-3149
Phone: 800-233-0307
Fax: 717-481-8252
E-mail: disabilityclaims@elhins.com
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Q. How should an STD claim be filed?
A. Contact our Disability Claims Department
by calling
800-233-0307 or e-mailing
disabilityclaims@elhins.com to report the
claim. Or, you can submit a claim using
ELH STD Claim Form GB119. Just follow
the instructions on the form.
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Q. When should an STD claim be filed?
A. An STD claim should be filed as soon as
you are aware that you are
disabled. Effective claims administration
requires early claim reporting. To ensure
prompt claim reporting and intervention
by our claim management team, a copy of
the completed employer/employee section
of the STD Claim Form should be faxed to
us at 717-481-8252.
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Q. When are STD benefits paid?
A. STD benefits begin after completion of the
first full week of total disability following
satisfaction of the STD elimination period.
STD benefits are paid weekly.
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Q. How are STD benefits paid?
A. STD benefit payments are made by check.
Each STD benefit check will provide an
explanation of benefits (EOB) statement
that lists the gross benefit amount
payable, taxes withheld, net benefit paid
and payment period.
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Q. Where are STD benefit checks sent?
A. STD benefit payments are usually mailed
directly to the disabled employee at the
address we have on file.
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Q. Are STD benefits taxable?
A. STD benefits are taxable in direct
proportion to your employer's contribution to the
premium payments. For example, if your employer
pays all of the premium payment, the
benefit is 100% taxable. If your employer pays half
of the premium payment, the benefit is
50% taxable.
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Q. How are taxes withheld / paid?
A. The employee's portion of Social Security and Medicare taxes are withheld from
STD benefit payments and deposited by
us in accordance with applicable tax laws.
STD benefits are taxable for Social
Security and Medicare, subject to annual
taxable income ceilings, on all STD
benefits paid during the first full 6 months
following the end of the month in which
the disability begins. Federal tax withholding is
optional and taxes are only withheld when
the employee specifically requests the
withholding on the claim form. We do not
withhold state or local taxes.
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