Frequently Asked Questions
& Network Information
Read our frequently asked questions for fast answers.
Still need help? Call us at 1-866-798-0803
or visit www.paisc.com
When can I enroll in the Fixed Indemnity Medical Plan?
You are able to enroll in the Fixed Indemnity Medical Plan within 30 days of your hire date, 1st paycheck date, or your employer’s annual 30 day open enrollment period. If you do not enroll during one of these time periods, you will have to wait until the next annual open enrollment, unless you have a qualifying life event. You have 30 days from the date of the qualifying life event to enroll.
When does coverage begin?
Coverage 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 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 direct premium payment, coverage will be terminated and COBRA information will be sent at that time.
If I do not get placed on assignment right away, will I have to complete a new enrollment form?
After six months if there has not been a deduction from your paycheck, please fill out a new enrollment form. Missing information will delay the process.
Can I make changes or cancel coverage?
You may cancel or reduce coverage at any time unless your premiums are deducted pre-tax. You will only have 30 days from your hire date or first paycheck 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.
(Please refer to your enrollment form, ask your employer, or call customer services to find out if your deductions are pre-tax or post-tax.)
How can I make changes?
To make changes or cancel coverage by telephone call (800) 269-7783. Enter your PIN CODE plus the last four digits of your Social Security number (SSN). Your pin code is located on the take home portion of the enrollment form. Remember, it may take up to two or three weeks for the changes or cancellation to be reflected on your paycheck. Coverage will continue as long as you have a paycheck deduction.
Are maternity benefits covered?
Yes, maternity benefits are covered the same as any other condition under this plan.
How do I enroll?
Enrolling in the Essential StaffCARE plans is easy. You can enroll by completing an Essential StaffCARE enrollment application and returning it to your manager.
What is a qualifying life event?
A qualifying life event is defined as a change in your status due to one of the following:
- Marriage or divorce
- Birth or adoption of a child(ren)
- Death of an immediate family member
- Medicare entitlement
- Employer bankruptcy
- Loss of dependent status
- Loss of prior coverage
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 (1) of termination of coverage under Medicaid or a State Children’s Health Insurance Program (SCHIP), or (2) upon becoming eligible for SCHIP premium assistance under this medical benefit.
Are dependents covered?
Yes. Eligible dependents include your spouse and your children up to age 26.
Is there a pre-existing clause for the Fixed Indemnity Medical Plan?
There are no restrictions for pre-existing conditions for the fixed indemnity medical plan. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.
This benefit plan offers you and your family savings for medical care through discounts negotiated with providers and facilities in the First Health Network. Choosing an in-network provider helps maximize benefits. When you use an in-network provider, you will automatically receive the network discount and the doctor’s office will file the claim for you. If you use a doctor who is not part of the network, you will not receive the discount and you may need to file the claim yourself.
Fixed Indemnity Medical Plan Network
First Health Network
Eyemed Vision Care
Do NOT contact the Networks listed above for questions regarding your medical benefits. All medical benefit questions should be directed to the Essential StaffCARE Member Services line at 1-866-798-0803.
How Do I Locate a Doctor?
Enrolled members are encouraged to visit providers in the networks listed in order to maximize their benefit dollars. To find a participating provider or to verify your current medical provider is in-network, please call or visit the network websites referenced above.
Prescription Drug Network
If enrolled in the Fixed Indemnity Medical Plan, you are automatically covered by the discount prescription drug program through the Caremark Pharmacy Network. Caremark has a national network with over 58,000 participating pharmacies. To find a local participating Caremark pharmacy, you can visit www.caremark.com.
What if I need to have a prescription filled?
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. Please check your benefits at a glance page for more information about how to file a claim. Prescription drug coverage is not provided for drugs administered during a physician office visit or hospital stay.
Do I have to go to an in-network provider?
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 to the plan.
When should I expect an ID card?
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.
Member ID Cards
An ID card and confirmation of coverage letter will be mailed to your home address. If you do not receive these documents within 10 business days of your effective date, or have a change of address, please contact Essential StaffCARE Customer Service at 1-866-798-0803. Present your ID card to the provider at the time of service. These ID cards are used for identification purposes and providers use them to verify eligibility status.