Creating an account with Luminare Health will enable you to:

• access your plan information
• print out a temporary member I.D card and request a new card to be mailed to you
• view your explanation of benefits (EOBs) every time you visit a provider

Visit www.myluminarehealth.com

Go to Register > Participant > Create Your Account

MetLife MyBenefits account provides you with a personalized, integrated, and secure view of your MetLife delivered benefits. You can take advantage of a number of self-service capabilities as well as a wealth of easy to access information.

• Visit www.Metlife.com/mybenefits
• Enter Employer Name: FAES

To find an in-network Aetna provider for the lowest out-of-pocket cost, visit the Aetna Signature Administrators - Doc Find page.

There are two (2) in-network labs with our insurance coverage, LabCorp or Quest Diagnostics. Please visit the links below to find a lab near you:

• www.labcorp.com
• www.questdiagnostics.com

Services performed at a facility other than Quest Diagnostics and LabCorp will be considered “out-of-network” and will require higher out-of-pocket costs. If you are having lab work done at your physician’s office and your physician is in-network, then the lab work will be treated as in-network.

Recent data in the last few years shows that ERs are seeing 145.6 million patients per year, but about 4.3% are for non-urgent symptoms. Privately insured patients are unnecessarily visiting the ER 18 million times each year, adding $32 billion per year to national healthcare costs. It’s important to know your options ahead of time to make the right decision when you need to. If possible, we encourage members to utilize urgent care centers since they will save time and money. There are many locations, and they often are open late and on weekends.

Finding an in-network urgent care facility near you is easy: visit the AETNA-Doc Find page.

Generics work the same as brand-name drugs but cost much less.

The average cost of brand-name drugs is 18.6 times higher than the generic equivalent. Generic drugs range from 80% - 85% lower in cost when compared to the brand product. From 2009-2019, the US healthcare system saved almost $2 trillion as a result of generic utilization. Please consult your doctor to determine if you might be able to utilize a generic drug versus a brand-name drug.

Plan participants should tell medical providers the insurance is through Luminare Health (formerly Trustmark). Luminare Health manages the confirmation of benefits, eligibility, and processing of claims. The Luminare Health insurance plan uses the Aetna Signature Administrators network of providers. Please do not tell providers you have Aetna insurance, as this will result in providers not being able to verify your benefits.

Excerpt from the NIH IRTA Policy:

All trainees must have adequate health insurance coverage to receive training in NIH facilities. This requirement may be satisfied by a policy held either in the Trainee's name or in another's name with the Trainee identified as a family member. Verification of health insurance enrollment is required. (https://policymanual.nih.gov/2300-320-7#710C5A2E)

Loss of coverage is a qualifying event to enroll in FAES Insurance. You must enroll in the FAES insurance plan within 30 days from the loss of coverage date. If you experience a qualifying event to enroll in or change coverage, FAES must receive the following within 30 days of the date of your qualifying event.

• For Enrollment after Loss of Insurance Coverage:
  • FAES Election Form
  • Fellowship Activation Forms (pages 1, 2, and 3)
    • The "Effective Date of Change" on page 2 should be the day after the loss of coverage date
    • Pages 1 and 3 of the Fellowship Activation Forms must be signed by the fellow
    • Page 1 must also be signed by the PI or Fellowship Sponsor
  • Proof of loss of coverage (letter from the non-FAES insurance stating coverage, name of insured, and coverage termination date)
  • If you are also enrolling a spouse and/or dependents, FAES must also receive:
    • Marriage Certificate for spouse and/or Birth Certificates for all child dependents (in English)
      • If dependents do not have a social security number, FAES will need a copy of their passports with the stamped date of arrival in the U.S. or I-94 form (dependents must be in the U.S.)
• For Enrollment of a Spouse or Dependent following Loss of Insurance Coverage:
  • FAES Change Form
  • Marriage Certificate for spouse and/or Birth Certificate for all dependent children (in English)
  • If enrollment of a spouse or dependents will change your insurance coverage from individual to family coverage, you must also provide FAES with updated Fellowship Activation Forms.
    • The "Effective Date of Change" on page 2 should be the day after the loss of coverage date.
    • Pages 1 and 3 of the Fellowship Activation Forms must be signed by the fellow
    • Page 1 must also be signed by the PI or Fellowship Sponsor
  • Proof of Loss of Coverage (letter from your spouse or dependents' insurance plan stating the coverage, names of insured, and coverage termination date)

If you have a qualifying event to change coverage, we will need the following within 30 days of the qualifying event date:

• Newborn:
  
  • FAES Change Form
  • Proof of live birth letter or discharge paperwork stating the date of birth of the child
    • Birth Certificate and Social Security Number can be provided later since they may take over 30 days to obtain.
  • If this changes the fellow’s coverage from individual to family coverage, we need to update fellowship activation forms.
    • Fellowship activation forms: pages 1, 2 and 3
      • The effective date of change should be the date of birth of the newborn on page 2
      • Page 1 and 3 signed by fellow
      • Page 1 signed by PI/fellowship sponsor

If you have a qualifying event to change coverage, we will need the following within 30 days of the qualifying event date:

• Marriage:
  
  • FAES Change Form
  • Marriage Certificate
  • If this changes the fellow’s coverage from individual to family coverage, we need to update fellowship activation forms.
    • Fellowship activation forms: pages 1, 2 and 3
      • The effective date of the change should be the date of the marriage on page 2
      • Page 1 and 3 signed by fellow

New Hire Enrollments: We will need the following within 30 days of the new hire date.

• FAES Election Form
• Fellowship activation forms: pages 1, 2 and 3
  • The level of coverage selected on page 2
  • Page 1 and 3 signed by fellow
  • Page 1 signed by PI/fellowship sponsor
• If they are enrolling dependents (spouse or children)
  • Proof of relationship: marriage certificate for spouse and birth certificate for children
    • If the dependents do not have a social security number, we will need:
      
      • A copy of their passports with the stamped date of arrival in the U.S. or I-94 form (dependents must be in the U.S.)

Your institute covers the monthly premium to FAES; this premium is not deducted from your stipend.

Please fill out a Luminare Health Claim Form. The form has instructions on how to complete it.

For information on a denied claim, you can contact Luminare Health (formerly Trustmark) Customer Service at 888-270-2044. The FAES Insurance team is available to assist you with navigating the claims and appeals process.
Information on appeals can be found in the paperwork with your explanation of benefits (EOB) from Luminare Health. Complete, detach, copy and send in the form provided on your EOB within one hundred eighty (180) calendar days from receipt of notification of the denial. Include the reasons you feel the claim should not have been denied along with any additional information and comments relevant to the claim. You are entitled to receive, upon request and free of charge, copies of all documents relevant to the denial. You will be notified of the decision within a reasonable period of time, not later than 60 days after the plan receives your request for review.

Please see the Insurance Claims and Verification Info Sheet for more information.

Please complete an Express Scripts (ESI) Claim Form.

There is no network to access your FAES medical and prescription drug plan outside of the US. If you

have a medical emergency and are outside of the US – here are your care options:

1. Utilizing your FAES medical and prescription drug coverage while outside of the US: You

are only covered in a true emergency. The FAES medical and prescription plan only

covers emergency care outside the US. To help define what constitutes emergency care, please

see below:

An accidental injury, or the sudden onset of an illness where the acute symptoms are of

sufficient severity (including severe pain) so that a prudent layperson who possesses an

average knowledge of health and medicine could reasonably expect the absence of

immediate medical attention to result in:

• Placing the covered individual’s life (or with respect to a pregnant woman, the
• health of the woman or her unborn child) in serious jeopardy or
• Causing other serious medical consequences, or
• Causing serious impairment to bodily functions, or
• Causing serious dysfunction of any bodily organ or part.

Please note that if you have an emergency and need to seek care, you will have to pay the

costs upfront out-of-pocket. You will then submit for reimbursement and will need to

provide supporting documentation. You are responsible for all out-of-network

deductibles, copays, and coinsurance. It is highly recommended before you leave the

facility to get all documentation with details surrounding procedures, treatments, codes,

and proof of payments.

2. While in the country of your home residence, You need to evaluate your access to care options

as a resident of your home country.

3. COVID Exposure, Symptoms, & Testing for Travel

1. Emergency: If your COVID symptoms become severe enough to be defined as an emergency and meet the parameters listed above, please access emergency care.
2. Local Care: To verify COVID-19 care within your home country, please consult local COVID care guidelines and access to care.
3. Expatriate Support: Subscribers can consult with the US Embassy or Consulate in the Country they are visiting to determine testing sites. If the person is a citizen of the Country they are visiting they can seek out local testing options for citizens.
4. Travel Purposes: Your FAES medical and prescription drug plan does not cover testing for travel purposes.

All Fellows must provide a Fellowship Termination Notification to FAES when leaving the NIH or transitioning to a full-time employment position (FTE) with NIH. The form may be faxed to 301-480-3585 or emailed to faesinsurance@mail.nih.gov.

Our continuation of coverage administrator, BRI, will send follow-up information on how to continue health insurance coverage.

When any covered member loses health insurance coverage based on a termination of employment or the occurrence of other qualifying events, the member will be eligible to elect continuation of coverage. Once your termination of health insurance coverage is processed, you will receive a continuation of coverage packet in the mail from our administrator, BRI. You will have 60 days to elect for continuation of coverage. Once elected, your coverage is retroactive to the date you lost coverage. There will be no lapse in coverage. Please contact an FAES insurance representative for additional information on pricing regarding the continuation of coverage.

All covered plan participants will receive their own insurance card with their name listed.

Please check with an FAES insurance representative if a temporary card is available. Cards are mailed within 7-14 business days of the processing of your enrollment.

If you lost your member ID card, you can view a PDF on https://myluminarehealth.com/ or on the myLuminareHealth phone app.

Please contact FAES Insurance via email or phone, and we can assist with providing a PDF of your card.

Domestic partners are not eligible. Eligible dependents are spouse or dependent children. FAES requires proof of relationship for dependents. For a spouse, we require a marriage certificate. For dependent children, we require a birth certificate, legal adoption paperwork or legal dependent status documentation.

Subscribers covered under the plan can only terminate at Open Enrollment (usually in September) unless they have a qualifying event. A qualifying event to terminate insurance outside of Open Enrollment would be marriage or newly obtained coverage elsewhere. Fellows have 30 days to notify FAES of this qualifying event to terminate coverage. The renewal of your fellowship does not count as a qualifying event to terminate coverage.

Yes, FAES plan participants have dental and vision coverage through MetLife.

Our dental and vision plan is through MetLife. You can visit metlife.com and choose our plan (Dental PDP Plus and Vision PPO) to find an in-network provider.

No, you will not receive a separate MetLife Dental and Vision card. The MetLife Dental and Vision group number and contact information will be on the back of your member ID card.

Yes, below is the in-network and out-of-network coverage. Please consult with your provider if they are capable of telemedicine visits.

In-network telemedicine visits:

• Primary Care Provider: $15 Copayment
• Specialist: $25 Copayment

Out-of-network telemedicine visits:

• Deductible then 30%
  

No, you can only be enrolled as the primary subscriber or a dependent but not both under the FAES plan.

Plan participants can review this document for additional information.

Yes, the FAES medical plan allows members to seek mental health care from both in and out-of-network providers for office visits at the same copay. Members will have the same coverage for mental health when going in or out of the network. There are no restrictions when selecting your mental health provider, as you can go to any provider in the United States. This means that you can see an in-network mental health provider for your office visits, as well as a provider who is outside of the network.

As of November 1, 2023, FAES no longer offers Talkspace services as a group plan. Plan participants can pay out-of-pocket for services and submit claims to Luminare Health (formerly Trustmark). This Talkspace article provides information on how to access Superbill to submit for reimbursement.

In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, contains new requirements for cost transparency and provides protections for consumers against surprise medical billing. The changes you will see in response to the No Surprises Act are:

• ID Cards will include benefit information for Office Visit Copays, Specialist Copays, Emergency Room Copays, Medical Deductibles Individual & Family and Maximum Out of Pocket Limits Individual & Family
• Surprise Billing – Plan participants are protected from surprise bills from emergency or non-emergency situations where the participant could not choose an in-network provider. Participants are only responsible for in-network cost-sharing amounts and out-of-network providers cannot balance bill members for any amount exceeding the in-network allowed charges.
• Price Comparison Tool – You will have access to an online tool to compare prices between providers and facilities when making decisions on services beginning January 1, 2023
• Continuity of Care – Insurance carriers will notify members when a provider or facility leaves the network, and they will provide transitional coverage to ensure continuity of care for members
• Advanced Explanation of Benefits (this is not in place yet because final regulations are pending) – These Advanced EOB’s will require providers to provide a good faith estimate for the cost of services for plan participants and send the estimate to the insurance company
• Independent Dispute Resolution – If a provider disputes the amount that the insurance carrier pays, there is now an Independent Review Process that can be started to coordinate negotiations between the provider and the insurance carrier. This is in place to eliminate Surprise bills for members.
• Machine Readable Files – Beginning July 1, 2022, medical in-network provider negotiated rates and historical out-of-network allowed amounts must be posted and available online. These files must be updated monthly. Access these Machine Readable Files with this link and select Aetna Signature Administrators.
• Pharmacy Benefit and Drug Cost Reporting (currently delayed until December 31, 2022, and pending further guidance) – Pharmacy Benefit Managers must provide reporting on drugs in a number of categories and include cost and rebate information for that medication.

Machine-readable files related to the FAES Luminare Health (formerly Trustmark) Insurance Plan are available online. Please open this link to the Healthcare Bluebook Home Page and then select Aetna Signature Administrators.

Effective June 1, 2023: All non-FTE fellows are covered by the Trainee Professional Liability Insurance Program. The Liability Insurance (FEPLI) Program offers both legal defense and financial liability coverage and protects covered fellows from allegations of misconduct. Please refer to the attached informational flyer.

If you didn’t find the answers to your questions here, please contact an FAES insurance representative:

Hours: 9:00 am - 4:00 pm, Monday - Friday
Phone: 301.496.8063
E-mail: FAESinsurance@mail.nih.gov
Secure Fax: 301.480.3585