Below is a list of the most commonly asked questions about the Indemnity Plan:

1. Can I go to any provider (doctor, hospital or lab) that I choose? What is the advantage of going to a preferred provider?

With the Indemnity Plan, you can go to any licensed medical provider with no referral required. However, this plan has certain guidelines for what is called "usual and customary" charges. Although the allowances for PPO providers is high enough to cover most fees, you may have to pay for care that is beyond the scope of your usual and customary care.

For example, your child needs a tonsillectomy. Say you choose a non-contracting surgeon who charges $2,000. The plan will determine the usual and customary fee to be $1,500 and pay 80%, which is $1,200. You will be responsible for 20% ($300) plus the amount over usual and customary ($500) for a total of $800.

2. Why was my claim ineligible?

We may be requesting additional information.

3. Why does the plan keep asking if my bad back or sore shoulder is accident related?

The plan has third party liability provisions, which means that worker’s comp, auto insurance or any type of liability insurance may pay the injury charges. In the event that the claims are pending with these other types of insurance, the plan can pay your expenses based on a lien agreement.

4. Where should claims be sent?

Please do not send claims to the Pleasanton address. Please make sure that your doctors and hospitals update their files with our current address:

P.O. Box 170160, San Francisco, CA 94117.