Frequently Asked Questions

If you cannot find the answer to the question you have in mind, please contact us. We will be happy to help you!

Q1 Is my doctor in the network?

Q2 Why hasn't my claim been paid?

Q3 Why are my rates going up?

Q4 What is a formulary drug?

Q5 How is it determined which drugs are on the formulary?

Q6 Can I use non-formulary drugs?

Q7 I have a Humana prescription plan and I don't understand what it covers and how much my copayment is. Can you explain it to me?

Q8 Why is my pharmacy copay rate going up from year to year?

Q9 How do I get my doctor in the network?

Q10 Can I have more than one plan design?

Q11 What is the difference between an HMO and a PPO?

Q12 How soon should you add a newborn baby?

Q13 When is my premium due?

Q1 Is my doctor in the network?
It is a good idea to always verify with the insurance carrier that your doctor is in the network. Click on Find your Doctor to see if your doctor is in your network.  Here are some other ways to verify your doctor is in your network. 

• Look in your provider directory (you or your benefits administrator should have a copy of the provider directory). 
• Call your insurance company. BACK

Q2 Why hasn't my claim been paid?
It usually takes from 30-45 days to process a claim. However, claims can be delayed for a number of reasons such as the provider did not submit the claim properly or they did not have your correct insurance information. To help the claim process, it's a good idea to always show the provider your insurance card and let them verify that they have the correct information on file. If you would like us to look into the status of your claim, simply download the Claim Resolution Form, complete it, attach the bill and/or other pertinent information and fax the information to Rigby Group Benefits at 630-236-7301. See Avoid Claim Problems for more information about how to handle your claims. BACK

Q3 Why are my rates going up?
There are many reasons your rates are rising. Healthcare inflation, greater frequency of illness, and age related reasons are common examples of why rates go up. However, we at Rigby Group Benefits work very hard to establish and maintain an extremely favorable relationship with the insurance companies, something you can leverage through their willingness to work with us on your behalf. This is a benefit for you because many times we are able to negotiate more favorable rates. BACK

Q4 What is a formulary drug?
A prescription drug formulary is a listing of preferred drugs selected by a panel of physicians and pharmacists. Both brand name and generic drugs that provide effective, safe and appropriate drug therapies are listed on the formulary. BACK

Q5 How is it determined which drugs are on the formulary?
Each insurance company has a nationally recognized panel of physicians and pharmacists that continually reviews and updates their formulary list. Medications (both brand name and generic) are evaluated on their comparative usefulness, safety, uniqueness and cost-effectiveness with evidence supported by published clinical trials. BACK

Q6 Can I use non-formulary drugs?
Yes. However, a higher co-payment will likely apply for non-formulary drugs. BACK

Q7 I have a Humana prescription plan and I don't understand what it covers and how much my copayment is. Can you explain it to me?
The new Humana prescription plans can be confusing. Go to Humana's Web formulary site for information about their forumulary list and prescription plans. You can also contact us for a copy of our Humana Prescription Guidelines brochure that helps explain Humana's prescription drug plans. BACK

Q8 Why is my pharmacy co-pay rate going up from year to year?
Pharmaceutical expenses are on the rise. Instead of passing these costs on to the employer by increasing premiums, insurance companies are passing these rising costs on to the people using the benefit by increasing their co-pay rates. BACK

Q9 How do I get my doctor in the network?
If your doctor is not in your network but you would like him/her to be, contact the insurance company and request that the insurance company get a contract with the doctor. There is no guarantee that they will get a contract with the doctor, but the more people that call with the request, the better the chance of getting a contract with the doctor. BACK

Q10 Can I have more than one plan design?
Yes, you can have several plans if that's what you desire to meet the needs of your company. Contact us to discuss your options. BACK

Q11 What is the difference between an HMO and a PPO?
The two primary differences between HMOs (Health Maintenance Organization) and PPOs (Preferred Provider Organization) is illustrated by the following two scenarios:

You want to go to a doctor other than you primary care physician. With an HMO you must get a referral from your primary care physician. If you do not get a referral, you risk having your claim denied by the insurance company. With a PPO, you can go to any doctor within your network for eligible services, and your claim should be paid according the plan's benefit design.

You want to go to a doctor outside of the network for eligible services. If you are in an HMO and you go outside the network for eligible services, your claim will not be paid. PPO patients can to a doctor outside the network for eligible services and their claim will be paid, but at a reduction in benefits. For example, the claim may be paid at 70% instead of 100%. BACK

Q12 How soon should you add a newborn baby?
A newborn should be added within 31 days of birth. You can always get all the paperwork you'll need to add the baby ahead of time and simply fill in the appropriate information as soon as the baby is born. It's also a good idea to contact the insurance company as soon as you are aware you are pregnant. You can verify that your coverage is exactly what you expect it to be. Also, sometimes the insurance company will provide prenatal videos and other valuable information regarding pregnancy. BACK

Q13 When is my premium due?
Your insurance carrier will send you a premium statement each month. The due date of the premium is always indicated on the statement. Try to always pay the premium prior to the due date. If payment isn't received within 31 days after the due date, a lapse in coverage may occur. BACK