SHBP Boosts Some Benefits


February 2012


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The Seafarers Health and Benefits Plan (SHBP) in early January wrote to participants concerning increases and other adjustments to various benefits. The letter to participants also contained a reminder about the SHBP’s policy regarding overpayment of claims.


Seafarers Plans Administrator Maggie Bowen noted in the individually mailed letter that, in accordance with the Affordable Care Act, effective Jan. 1, 2012, the Plan has increased its annual limits for cardiac rehabilitation and pediatric preventive dental care to $1.25 million apiece. Pediatric preventive dental care includes all preventive dental services provided to participants under age 19, but does not include orthodontia, the administrator pointed out.


Additionally, as of March 1 of this year, the SHBP will change the respective allowances for the purchase or rental of durable medical equipment that is required by eligible employees. (Durable medical equipment, according to the letter, includes prosthetic devices, medical appliances, and similar items.) Currently, the Plan pays 70 percent of the reasonable and customary charges for such equipment regardless of whether or not the gear comes from an in-network provider.


As of March 1, the Plan will pay 80 percent of the charges allowed by the network if an eligible employee rents or purchases the item or items from an in-network provider. For out-of-network purchases and rentals, the covered percentage will be 65 percent of reasonable and customary charges. This change brings the benefit in line with most others offered through the SHBP.


Finally, the letter reminds participants of the Plan’s policy on overpaid claims. In the event the Plan pays too much to a health care provider (more than that to which they’re entitled under Plan rules), the SHBP will solicit a refund of the overpayment. If the provider refuses, the Plan has the right to deduct the overpaid amount from future payments to the same provider for other services received by the same eligible participant.


As indicated in the letter, individuals with questions about these benefits and policies may contact the Plan at 1-800-252-4674.



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