Who is my insurance company?
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.
Is health insurance required for all Postdoctoral IRTA/CRTA and VF trainees?
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)
What should I do if I lose insurance coverage from a non-FAES plan and need to enroll in the
FAES
insurance plan?
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)
We will be having a baby soon, what do I need to do to add my newborn to the health insurance
plan?
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
I am getting married; what do I need to do to add my spouse to my health insurance plan?
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
I just arrived at the NIH as a trainee; what do I need to do to enroll in health insurance?
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.)
How much of the monthly premium do I have to pay?
Your institute covers the monthly premium to FAES; this premium is not deducted from your
stipend.
How do I submit a medical claim for reimbursement to Luminare Health (formerly Trustmark)?
What do I do if my medical claim is denied and I want to appeal the decision?
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.
What do I do if I receive a medical bill from a provider?
What do I do if I need to submit a prescription claim?
Am I covered while I am traveling abroad?
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
- Emergency: If your COVID symptoms become severe enough to be defined as an emergency and
meet the parameters listed above, please access emergency care.
- Local Care: To verify COVID-19 care within your home country, please consult
local
COVID care guidelines and access to care.
- 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.
- Travel Purposes: Your FAES medical and prescription drug plan does not cover
testing for travel purposes.
My NIH Fellowship is being renewed for another year. What do I need to do to make sure my health
insurance plan doesn’t stop?
I am leaving the NIH; what are my options?
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.
What are my continuation of coverage benefits?
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.
Will my spouse and/or dependents receive a health insurance card?
All covered plan participants will receive their own insurance card with their name listed.
What if I need to see a doctor before I get my insurance card?
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.
How do I obtain the insurance plan documents?
Plan documents are available upon request. Please contact a FAES insurance representative.
What can I do if I lost my member ID card?
I never received my member ID card; what should I do?
Please contact FAES Insurance via email or phone, and we can assist with providing a PDF of
your
card.
Are domestic partners eligible to be covered under the plan?
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.
Can I terminate my plan at any time?
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.
Are dental and vision covered under my plan?
Yes, FAES plan participants have dental and vision coverage through MetLife.
How do I find a dental and vision provider?
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.
Will I receive a MetLife Dental and Vision card?
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.
Are telemedicine visits covered?
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:
Can I be enrolled as the primary subscriber and a dependent under a spouse’s policy if both
policies
are under the FAES plan?
No, you can only be enrolled as the primary subscriber or a dependent but not both under the
FAES
plan.