Frequently Asked Questions

Benefit booklets (including, as applicable Summary Plan Descriptions and Summaries of Benefits and Coverage, Life insurance certificates and summaries,) can be requested form your employer’s Human Resources Department. Alternatively, you may contact the applicable vendor using the contact information included under the “Vendor Partner” tab.

Replacement ID cards for Medical/Rx, Dental and Vision benefits can be requested by contacting the applicable vendor as included under the “Vendor Partner” tab.

There are two primary differences between these benefit designs:

1. How cost shares work as far as out-of-pocket expenses paid by the member; and
2. Annual limits and other terms of use for pre-tax treatment of members’ out-of-pocket expenses.

RAGHT’s EPO includes a combination of member cost-shares in the form of co-pays, a deductible   and co-insurance, all culminating in in-network annual out-of-pocket maximums that are specified in the Summary Plan Document for the applicable plan year. Once the applicable in-network out-of-pocket maximum has been satisfied, the plan pays 100% of eligible charges[1].  With the HDHP, members pay 100% of eligible in-network charges until the combined deductible/out-of-pocket maximums have been met, after which the plan pays 100% of eligible in-network expenses.

Portions of members’ out-of-pocket expenses for EPO plan participants may be paid on a pre-tax basis up to the annual federal limit using Flexible Spending Account (FSA) dollars contributed via payroll deduction by the member (applicable for only those entities that offer a FSA). For HDHP participants, the same is true through the use of their Health Savings Account (HSA) dollars, typically also made via payroll deduction.

For more details and eligibility information, please contact your Human Resources department or the applicable vendor on the “Vendor Partner” tab.

[1] Out-of-network out of pocket maximums are unlimited.

For medical and prescription drug benefits your insurance provider is Rural Arizona Group Health Trust (RAGHT). Where this can be confusing is that RAGHT leases the Blue Cross Blue Shield of Arizona (BCBSAZ) network and the Aetna POS II Network for the 49 other states. The Blue Cross logo and Aetna logo appears on member ID cards. With this in mind, and as a general reminder, please verify all providers and facilities that you plan to use are contracted with BCBSAZ (Arizona Only) and with Aetna POS II (49 other states) to ensure your claims are paid as in‑network.

A HSA is used in conjunction with a qualified High Deductible Health Plan that allows users to save pre-tax dollars that can be used for qualified Medical, Rx, Dental, or Vision expenses. Annual Contribution limits are IRS regulated and unused dollars roll over from year to year.

A FSA allows employees to designate a certain amount of income on a pre-tax basis to pay for qualified expenses as defined by the IRS. Funds do not roll over and are forfeited if not used. There are three types of FSA’s.

1. Full Purpose – These dollars can be used for qualified Medical, Rx, Dental, or Vision expenses and are only available to Employees enrolled in the EPO Plan.
2. Limited Purpose – These dollars can ONLY be used for qualified Dental and Vision expenses and are available HDHP Employees IN ADDITION TO the dollars they contribute to their HSA.
3. Dependent Care – These dollars can be used for dependent care expenses for a qualified dependent for whom you are incurring eligible day care expenses.

A Deductible is the amount of medical expenses covered members are responsible for paying before insurance will begin paying benefits. The Deductible amount varies depending on whether you are covered under the EPO or HDHP. Deductible amounts are based on a Fiscal year and start over each July 1. Deductible amounts are outlined in the RAGHT Summary Plan Document which can be found by reaching out to your Human Resources department.

The Out-of-Pocket Maximum is an annual dollar amount based off a Fiscal year, which includes: deductibles, co-insurance and co-pays. When met, the Plan will pay 100% of overed in-network expenses. Out-of-Pocket amounts are outlined in the RAGHT Summary Plan Document which can be found by reaching out to your Human Resources department.

A co-payment is a fixed dollar amount that covered members on the EPO Plan are responsible for paying for specified medical services and/or prescription drugs. For medical services requiring a co-payment the deductible is waived. Co-payment amounts are outlined in the RAGHT Summary Plan Document which can be found by reaching out to your Human Resources department.

Co-insurance is the percentage of eligible expenses the Plan and the covered member are responsible to pay until the out-of-pocket maximum is reached. The percentage varies depending on the covered expense. Co-insurance begins once the deductible is met. Co-insurance amounts are outlined in the RAGHT Summary Plan Document which can be found by reaching out to your Human Resources department.

Case management is a 100% voluntary, no-cost-to-the-member, service made available to members experiencing particularly difficult medical situations. In these situations, the plan may offer (or participants can request) the assistance of a nurse case manager for help on a range of issues from finding specialty providers all the way to facilitating organ transplant and other extremely complex medical services. For more information on case management services, consult the medical Summary Plan Description (SPD) or reach out to American Health Group (AHG) using the contact information included on the “Vendor Partner” tab.

The medical benefit plan does have pre-certification requirements for a list of specific services, and financial penalties for failure to complete these processes. Please consult the Summary Plan Description (SPD) or reach out to American Health Group (AHG) using the contact information included on the “Vendor Partner” tab.