Question 1

What is a qualifying life event?

Accepted Answer

A Qualifying Life Event (QLE) is a life change that allows you to make adjustments to your benefits outside of the usual enrollment period. Common QLEs include changes like marriage, divorce, the birth or adoption of a child, or turning 26 and losing your parents' insurance coverage.

If you experience a QLE, be sure to reach out to the Peaceful Living Human Resources team within 30 days to update your benefits. You can contact them at 610-287-1200 or hr@peacefulliving.org.()

Question 2

What services and screenings are covered as preventive care?

Accepted Answer

Preventive screenings can help you take better control of your health. They are an important foundation of early detection and prevention of disease.

Preventive care services are NOT subject to a copayment or deductible when using in-network providers and must be billed to insurance with proper preventive coding.

Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_899e5cfbb92b46099a7f66785d7c9bd6.pdf)to learn about the services and screenings that are covered as preventive care.

Please note: Coverage for these services is subject to certain conditions, age and time limits.

Question 3

When can I make changes to my benefit elections?

Accepted Answer

You can make changes to your benefit elections during your healthcare and benefits open enrollment OR if you have a qualifying life event (QLE).

A QLE is a change in your situation, like a marriage, divorce, or having a baby, for example, which allows you to make changes to your health insurance. Take a look a this document (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_1f3a5f76afda4c099b4cda248f4d49b3.pdf)for more information.

You have 30 days to submit your changes online through our benefits enrollment system.(https://www.plbenefits.org/enroll) (https://www.plbenefits.org/enroll)

Here's an overview (https://www.healthcare.gov/glossary/qualifying-life-event/)of qualifying life events from Healthcare.gov.

If you have a QLE, contact your Rightway advocate at 1-833-689-0570.

Question 4

How do I change my plan or enroll my dependents?

Accepted Answer

You can make plan changes and enroll dependents during open enrollment, or if you have a qualifying life event,(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_1f3a5f76afda4c099b4cda248f4d49b3.pdf) by visiting the Enroll Now (https://www.plbenefits.org/enroll)page.

Question 5

I think a provider is billing me an incorrect amount for a service, what should I do?

Accepted Answer

First, make sure you compare the bill you received with the EOB from the insurance. If you need to locate an EOB you can find one by logging into your account at www.meritain.com.(www.meritain.com)
(http://www.meritain.com/) 
If the bill does not match the EOB, please contact Rightway for further assistance.

Question 6

Why did I get billed for my preventive care visit?

Accepted Answer

While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health.  When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed.  However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.

Here’s how to be sure your preventive care visit is free for you:

1. Mention prevention upfront – When scheduling your appointment, confirm that you are scheduling a preventive care visit.
2. Know what to discuss with your doctor during the visit – During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.
3. Ask your doctor - If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.

For more information about preventive care, contact Rightway.

Question 7

Where should I go for medical care?

Accepted Answer

Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_355419f741f54118bbcef443a0dadf9e.pdf)to learn about your choices when it comes to where you should receive care.
 
High level overview:
 
Telemedicine with Teladoc - Consider using Teladoc for non-life-threatening conditions, and when you need 24/7 care. Cost to you:  
 • Buy Up Plan: You pay a $0 copay
 • Base Plan: You pay a $0 copay
 
Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:
 • Buy Up Plan: You pay a $10 copay
 • Base Plan: You pay a $10 copay

Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:
 • Buy Up Plan: You pay a $125 copay
 • Base Plan: After you pay your deductible, there is no cost
 
Urgent Care - Consider an urgent care center for non-life-threatening condition. You'll save time and money over the ER. Cost to you:
 • Buy Up Plan: You pay an $87copay
 • Base Plan: You pay a $75copay

Question 8

Are any of my medications available at no cost?

Accepted Answer

Yes! Take a look at this flyer (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_2734bfe9924c4de28ec37be4446a8baa.pdf)for more details.

Frequently Asked Questions