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

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

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.)

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.

For in-network providers:

1. Review the bill and check if it notes any payment from the insurance carrier, Luminare Health (formerly Trustmark).
2. If the bill does not contain insurance payment information, please contact the provider’s office and inform them of the insurance information on the front of your ID card.
3. Request your provider to submit the claim for processing to Luminare Health (formerly Trustmark).
4. If you encounter issues or have questions during this process, please contact the FAES Insurance Department for additional assistance.

For out-of-network providers:

In most circumstances, out-of-network providers will not submit a claim on your behalf.

1. Complete a Luminare Health Claim Form with proof of payment and documentation.
2. Submit the Form with supporting documents to Luminare Health (formerly Trustmark) for processing via one of the following methods:
   • EMAIL:
     • HBEVClaimsubmission@luminarehealth.com In the subject line, write “FAES OON Claim Submission.”
   • PORTAL:
     • Sign in to your www.myluminarehealth.com account
     • Click on the link for “Messages.”
     • Select “General Inquiry”
     • In the Subject line, type “OON Claim Submission.”
     • Attach claim/itemized statement/proof of payment
   • MAIL TO:
     • Luminare Health
       PO Box 2920
       Clinton, IA 52733-2920
3. If you encounter issues or have questions during this process, please contact the FAES Insurance Department for additional assistance.

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.

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%

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.

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