FAQ

Listed below are a number of frequently asked questions submitted by employees with benefit programs administered by JI. We post new questions all the time, so it’s a good idea to check back from time to time. If you have a question not posted, call Customer Service at (800) 808-6372, Monday through Friday, from 8:30 am to 5 pm.

Claims

Where do I send claims for processing?
The claim submission address is printed on the back of your Medical identification card. It is important to present this card to each medical provider you see so they record the proper address.
How do I check the status of my claim?
To check claims status, visit JI Benefits Online at https://www.jibenefitsonline.com. If you do not have access to JI Benefits Online, contact Customer Service at the number listed above.
What is an Explanation of Benefits (EOB)? Is it a bill? How do I read it?
The EOB is not a bill. The EOB is a detailed description of a claim that has been received and processed for payment. The EOB will include a breakdown of how benefits were applied, including payment, deductibles, co-insurance and patient’s responsibility. Click here for a more detailed explanation: Your Guide to the EOB.
I have received a bill from my doctor. Why didn’t you pay this bill?
There are several reasons why a bill may not have been paid. It is helpful to ask these questions: Has the doctor submitted the bill to our office? Does the doctor have your most current insurance information? Is the claim submission address they used correct? Is the bill for fees the patient is responsible for, such as co-pays, co-insurance or deductibles?
I need to see the doctor, but I haven’t received my ID card. What should I do?
When you arrive at the doctor's office, provide the receptionist with your social security number, your Group ID number if you have one, and our toll free number (800) 808-6372. We can verify coverage and benefits for your doctor by phone.

COBRA

What is COBRA?
COBRA stands for Consolidated Omnibus Reconciliation Act, and is a temporary extension of your Medical and/or Dental insurance if you have been terminated from the plan or have been terminated from your employment for any reason other than gross misconduct. To determine your eligibility for COBRA benefits, contact the benefit coordinator at your former employer.
I am no longer working for my company. Can I continue coverage under the plan?
Yes (under most circumstances), within a specified period of time, you have the option to elect to continue your Medical and/or Dental coverage through COBRA. If you elect to participate in COBRA, it is important to understand that you will be responsible for premium payments. Your former employer will not make payments on your behalf. COBRA premiums must be paid within 30 days of the due date or coverage will terminate. For additional information, contact the benefits coordinator at your former employer.
How long am I eligible for COBRA?
COBRA eligibility is based upon the qualifying event. Termination from employment entitles you to 18 months of coverage. Death of a covered employee, divorce or legal separation from the covered employee, a dependent child ceasing to be covered as defined in the terms of the plan, or a covered employee becoming entitled to Medicare benefits entitles the insured to 36 months of coverage. For additional information, contact the benefits coordinator at your former employer, or click here: U.S. Department of Labor.
If I elect COBRA, how will I be billed for premium?
Upon receipt of the original signed and dated COBRA Election Form (enclosed in your COBRA packet) you will receive a confirmation letter and payment coupons.

Eligibility

Who do I notify when I have a change of address?
It is important to notify your employer when you have a change of address. In order to update our records, you should obtain a coverage change form from your employer, and that form should be filled out and faxed or mailed to our office.
How do I add a new dependent to my plan?
Obtain a coverage change form from the benefit coordinator at your employer. The form should be filled out and faxed or mailed to our office. It is very important to note that in order for coverage for a new baby to continue beyond 31 days, you must add the new dependent to your plan.

Benefits

What is HIPAA?
Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal act requiring, in addition to other things, that employer and health insurance carriers provide documentation of coverage when an individual loses health coverage. This certificate (called a certificate of creditable coverage or “HIPAA Certificate”) provides evidence of your prior health coverage. To request a HIPAA certificate for the time you were covered by our plan call Customer Service at the number listed above.
Do I need to choose a Primary Care Physician (PCP)?
If you are enrolled in a Preferred Provider Organization (PPO), you are not required to utilize a PCP to direct your medical care. In order to receive the highest level of benefits under the plan, it is important to utilize a network provider for your medical care.
Do I need a referral to see a specialist?
No, if you are enrolled in a PPO plan. However, in order to obtain the highest level of benefits under the plan, it is important to utilize a network specialist. You may contact your network to determine which specialists are participating in the network in your area. For a link to your network’s provider directory, click here.
Do I need to fill out a claim form to get reimbursement when I have paid for medical or dental services myself?
Claim forms are not required for reimbursement of payment for our members; however, they are helpful in that by using one, it is more likely that we will receive all the information we require to process your request. If you elect not to use a claim form, it is important to note that the medical statement you submit for reimbursement must include the patient’s name, member’s identification number, provider’s name and address, the diagnosis code(s), procedure code(s) and the date(s) of service. Claim forms are available by contacting Customer Service at (800) 808-6372; or, click here: Medical/Dental Claim Form.
What is Coordination of Benefits (COB)?
Coordination of Benefits (COB) is a special provision in your plan that applies in the event a person is covered by more than one benefit plan. COB information is used to determine how to process your claims appropriately under the plan. Every 12 months we request updated COB information to determine which insurance coverage is primary and (if applicable) which insurance coverage is secondary.

General Information

Who is JI Specialty Services and what is the mailing address if I have an inquiry?
JI Specialty Services specializes in third-party administrative services for both Property/Casualty and Employee Benefits. Administration services are provided for all types of workers’ compensation, liability, property and casualty coverages as well as health, life, dental, disability, and Section 125.
The mailing address for health and dental inquiries is:

JI Specialty Services
P. O. Box 26610
Austin, TX 78755-0610

This information can also be found on your ID card.

What is a Third Party Administrator (TPA)?
A Third Party Administrator (TPA) is not an insurance company. A TPA provides certain administrative services on behalf of an employer’s Plan. This could include premium accounting, review and payment of claims, maintenance of employee eligibility records and negotiations with insurers that provide stop-loss protection for large claims.
What is a PPO Network?
A network consists of providers participating in your health plan. Participating providers enter into contracts with the network, and as such, agree to accept discounted fee arrangements to help keep cost down for the health plan. Generally, when you see network providers, you will receive a higher level of benefits and greater out of pocket savings than if you see a provider who is not participating in the network.

Pre-Certification

Whose responsibility is it to contact JI for precertification?
It is the member’s responsibility to contact JI for pre-certification. While the doctor or facility can or may call our pre-certification line at (888) 580-6804 to obtain prior authorization for services as required by the plan, it is important to note that it is ultimately the responsibility of the covered individual or employee to ensure that a pre-certification has been set up prior to services being rendered.
How do I know which services need to be pre-certified on my plan?
This information can be found under the Cost Containment Section of your Plan document. It is also located in your Schedule of Benefits. If you have a question about pre-certification, please contact Customer Service at (800) 808-6372.