Who can my employees contact with a question I’m unable to answer?
For Medical plan questions, Member Services representatives are available Monday through Friday, 8 a.m. to 5 p.m. at:
HMO Members – 775.770.6060 or 800.863.7515
PPO Members – 775.770.6900 or 800.433.3077
For Pharmacy questions, your employees can contact Catalyst Rx Member Services Department at 866.358.9534.
Who should I call to verify if an employee is enrolled?
Member Services representatives are available Monday through Friday, 8 a.m. to 5 p.m. at:
HMO Members – 775.770.6060 or 800.863.7515
PPO Members – 775.770.6900 or 800.433.3077
You can also log onto the Employer Online Services and enter your login and password and click on Eligibility Lookup. If you do not have a login and password, call 775.770.7998 to obtain one.
How can my employee order a new membership ID card?
To request a new membership ID card, Saint Mary’s Health Plans members can call:
HMO Members – 775.770.6060 or 800.863.7515
PPO Members – 775.770.6900 or 800.433.3077
Or members can login onto our Member Online Services. If the member has not used the online member services before, they can become a registered user by following the new user directions under the login box. They can also use the Employer Online Services to print a temporary ID card as well.
Can I call on behalf of my employees’ or employees dependents regarding claim issues?
Due to HIPAA regulations, an Authorization for Disclosure form needs to be completed by the covered member to authorize a discussion of any personal Health Information.
What is a waiting period? How can I find what our company waiting period is?
A waiting period is the established time set forth in a policy by the employer, which each employee must complete before coverage begins. To obtain the waiting period Saint Mary’s Health Plans has on file for your company, please refer to your Group Contract.
When is our company open enrollment?
A Group Open Enrollment Period is held for at least 15 days once every 12 months. During this time eligible employees may enroll or dependents may be added. This is set by the employer, usually in the month prior to the policy effective date. Please contact your broker or your Saint Mary’s Health Plans Account Manager to confirm your open enrollment period.
What if my employee has not received their ID card?
New Members will receive an Evidence of Coverage or Certificate of Coverage with ID cards inside the front cover. Please allow 7-10 working days for delivery. Please verify employees’ address.
If your employee has not received an ID card after verifying the above information, please contact Member Services, Monday through Friday, 8 a.m. to 5 p.m. at:
HMO Members – 775.770.6060 or 800.863.7515
PPO Members – 775.770.6900 or 800.433.3077
An ID card can also be requested online through Employer Online Services. Enter your login and password and select Online Employer Services. Choose Please send a new ID card. If you do not have a login or password, call 775.770.7998 to obtain one.
How do I order new member packets?
Contact your broker or your Saint Mary’s Health Plans Account Manager, or log onto our Employer Online Services. Enter your login and password, click on Online Employer Services and choose Please forward new hire packets. If you do not have a login or password, call 775.770.7998 to obtain one.
Who do I call regarding my premium bill?
Premium billing can be contacted at 775.770.6474.
What is a qualifying event?
Employees who decline coverage for themselves or their dependents during Open Enrollment and later decide they want coverage for a dependent, they will not be eligible to make the change until the next Group Open Enrollment Period. However, if an employee or their dependent refuses coverage at the time of enrollment because they have other Qualifying Coverage, they will be eligible to enroll if one of the following has occurred:
- Employee or dependent is no longer eligible for benefits under the other Qualifying Coverage
- Expiration of COBRA continuation coverage • Termination of employment causing termination from the other Qualifying Coverage
- Reduction of the number of hours of employment, resulting in termination of the other Qualifying Coverage
- Employer contributions toward other Qualifying Coverage terminated
- Death or divorce of a spouse resulting in the termination of the other Qualifying Coverage for Dependent Children
- Marriage
How can I obtain a Summary of Benefits?
Log onto our Employer Online Services. Enter your login and password and click on Subscriber Benefit Lookup. If you do not have a login or password, call 775.770.7998 to obtain one.
Where can I find the current Provider Directory?
Log onto our Employer Online Services, select Provider Directory from the services menu.
How can a member view processed claims?
Members can log on to the secure Member Portal with their login and password and select My Claims and EOB’s. If the member has not used the online member services before, they can become a registered user by following the new user directions under the login box.
For member-specific Frequently Asked Questions, please click here.
My invoice looks different than I am used to – what do the different sections mean?
For a comprehensive explanation about the new Saint Mary’s Health Plans monthly employer statements (as of September 1, 2012), please click here.
Where can I send my monthly Premium Billing statements?
Monthly payments made in the form of a check can be mailed to our secure lockbox at: Saint Mary’s Health Plans, Department 33396, PO Box 39000, San Francisco, CA 94139-3396.
Where can I fax completed Enrollment Forms?
Completed Enrollment Forms can be faxed to Saint Mary’s Health Plans at 775.770.3820.
