Deductibles for medical, dental and prescriptions run on the calendar year.
Medical and Dependent Care Reimbursement accounts run on the fiscal year.

Health Insurance FAQs

Eligibility

Q. I am an hourly staff employee, when will my health insurance benefits begin?
An hourly staff employee is eligible to participate in the Plan after completing 90 days of continuous service.

Q. I am a faculty member/salaried staff employee when will my health insurance benefits begin?
A faculty or salaried staff employee is eligible to participate in the Plan upon the effective date of his/her letter of agreement/contract.

Q. I am getting married next month; can I add my spouse on the health insurance?
Yes. If during the year you have a family status change, such as marriage, and you complete the applicable enrollment form, provide legal documentation, agree to make the required contributions and file the necessary forms with the Office Human Resources within 30 days after your acquire the new dependent.  Health Insurance Enrollment Form

Q. My spouse is losing their job and I declined coverage, can I get Taylor’s insurance now?
Yes.  This family status change allows you to change your election after the open enrollment.  You need to complete the applicable enrollment form, agree to make the required contributions and file the necessary forms with the Office of Human Resources within 30 days.

Medical Coverage

You may use a medical reimbursement account to pay for your co-pays, deductibles and other qualified expenses with tax-shelter monies.

Q. What are “room and board charges”?
A hospital’s charges for room and board and other services and supplies made regularly at a daily or weekly rate as a condition of occupancy for the type of accommodations occupied.

Q. What is my co-pay to my family doctor?
Your co-pay to your family doctor, general practice doctor, internal medicine or pediatrician doctor is $30.00.  

Q. What is my co-pay to a specialist?
Co-pays to specialist are $40.00.  Examples of a “specialist” would be dermatologist, or an orthopedic doctor. 

Q. Does my outpatient surgery have to be pre-certified?
Yes.  Out patient surgery does need to be pre-certified.  Please check on the back of your insurance card for more information, or call Managed Care Concepts at 866-750-2723.

Q. My child had a fever and earache this weekend, I took him to the emergency room, what will my co-pay be?
Emergency Room co-pay is $90.00.  This co-pay is waived if you go to the ER and are admitted to the hospital.  However, remember if you have an urgent care facility near you that is a participating provider, the co-pay would only have been $40.00.

Q. I recently had knee surgery and will require physical therapy, what will my co-pay be?
Physical/Occupational/Speech therapies all have $40.00 co-pay.  This co-pay applies to each visit.

Q. What kind of coverage do we have for lab services?
By using LabCorp/PALabs, covered employees and their covered dependents can receive laboratory services with no out-of-pocket costs. For a center near you call 800-377-9364 or visit www.labcorp.com.

Q. My chiropractor is not in the network, will insurance pay?
Yes.  Subject to $700.00 deductible and then claims will be paid at 60%.

Q. Do we have any wellness benefits?
Yes.  Wellness benefits are subject to an annual maximum benefit of $150 for each covered family member.  However, remember that pap smears, wellness mammograms, wellness colonoscopies and sigmoidoscopies, PSA tests and immunizations are not a part of this $150.

Q. What is a deductible?
Deductible means the amount of covered medical, dental and prescription expenses for which a covered family member is responsible each calendar year before benefits are payable under the Plan.  

Q. What does co-insurance mean?
The percentage of covered medical and dental expenses for which the University is responsible under the Plan.  The co-insurance is applied after the covered family member pays the deductible amount.

Q. Do co-pays go toward deductible?
No.  Your co-pays do not go toward your deductible.  The co-pay is your portion of the medical insurance to pay.

Q. Do we have coverage for hearing aids?
No.  We do not cover hearing aids.

Q. What kind of vision coverage do we have?
We do not have any vision coverage.  However, if you have an issue that is for the health of the eye, such as a cataract, the medical insurance will cover these charges, check for a participating provider to get the best benefit coverage.

Encircle participants can receive a discount on vision exams and vision ware through the VSP plan, for more information contact the Office of Human Resources or call 888-574-8180.  

At this time, no discounts are offered through Three Rivers Preferred.

Q. I had charges that were denied because it was over reasonable and customary, what does this mean?
The usual charge made by a physician, dentist or supplier of service was greater than, the charge usually made by such provider or the general or prevailing level of charges made by others rendering or furnishing such services with the area in which the charges were incurred.

Prescription Drug Coverage

You may use a medical reimbursement account to pay for your co-pays, deductibles and other qualified expenses with tax-sheltered money. 

Q. Who is our pharmacy provider?
4D Pharmacy.  For 24 hour member service hotline call 877-647-4026 or visit their website at www.4dpharmacy.com.

Q. I just recently purchased my first prescription of the year, why did it cost me $75.00, I thought my co-pay for this drug was $25.00?
Remember that you have a $50.00 deducible per calendar year, a total of $100.00 for a family.  You were paying your deductible and your $25.00 co-pay. 

Q. What can I expect to pay for a prescription after my deductible?
Based on the kind of prescription you will pay either $15.00 for generic, $25.00 for brand or $40.00 for a brand non-formulary. 

Q. Can I get a 90-day supply for a drug that I take daily?
Yes.  You may get a 90-day supply by using the mail order (WellDyneRx at www.myWDRX.com or call 855-404-0972) or using the Upland Healthcare Pharmacy.  Make sure your doctor writes your prescription for 90 days.  Contact Human Resources if you would like a mail order form.

Dental

You may use a medical reimbursement account to pay for your co-pays, deductibles and other qualified expenses with tax-sheltered money. 

Q. What dentist can I go to?
You may go to any dentist that you want too.  Dentists are not included in the preferred provider organization.

Q. How much dental coverage do I have per calendar year?
Each covered family member has $750 per calendar year for dental expenses.

Q. Will the insurance pay for cleanings?
Yes.  One routine oral examination every 6 months.

Q. Will my insurance cover an x-ray?
Yes.  One periodical x-ray for every 36-month period, one dental x-ray for supplementary bitewing for every 6 month period, and dental x-rays required in connection with the diagnosis of a specific condition requiring treatment.

Q. Am I covered for fillings?
Yes.  

Q. Are implants covered?
No.

Q. Is teeth whitening covered?
No.

Q. Are dentures covered?
Yes.  For the initial installation of partial or full removable dentures, including precision attachments and any adjustments made during the first 6 months after installation.  Remember you only have $750, per calendar year for dental work.

Q. Do I have any orthodontic benefits?
Yes. The Plan will pay 50% co-insurance of the covered dental expenses up to a $1,000 lifetime maximum benefits per covered family member.

Q. Which orthodontist can I go to?
You may go to any orthodontist that you want too.  Orthodontists are not included in the preferred provider organization.

Other information

Taylor University’s third party administrator, they pay medical and dental claims according to TU’s policy:

Automated Group Administration (AGA)
7605 Westfield Drive
Fort Wayne IN  46825
260-489-4589 or 800-677-4589
You may view your claims at www.aga-tpa.com

PPO:

Encore Health Network
8520 Allison Pointe Blvd, Suite 200
Indianapolis, IN  46250
888-446-5844
Group #6859
www.encoreconnect.com, please remember to select the Encircle button to get the list of doctors that give you the best benefit.

Three Rivers Preferred
PO Box 2600
Fort Wayne, IN 46801
800-258-0974
Group# 6859
www.threeriversmd.com

Pharmacy:

4D Pharmacy
24 hour Member Service Hotline
877-647-4026
www.4dpharmacy.com

90-day mail order:

WellDyneRx
Phone: 855-404-0972
Fax: 877-221-1259
www.myWDRX.com

Your health care provider’s office can fax a prescription to 877-221-1259 or they can call it in to 855-404-0972.

To search for generic drugs that are available at low-prices, visit:

www.medtipster.com

Pre certification:

For services, such as outpatient surgery, in-patient hospitalization or other tests:

Managed Care Concepts
866-750-2723

Managed Care Concepts 24 hour nurseline:
866-751-2723
Program that gives employee and dependent family members access to experienced and licensed nurses assistance anytime, 24- hours a day, 7 days a week.