Frequently Asked Questions:
Can you refer me to a Doctor, Dentist or Ophthalmologist? No, it is our policy that we do not endorse any medical professional, please use the links for Blue Cross, Delta Dental of Idaho and VSP to find a provider.
Medical:
When will I receive my ID cards from Blue Cross? ID cards take 3 weeks from the time we receive the employees application.
Dental:
Will Delta Dental of Idaho issue ID Cards? No, the ID number is the employees social security number, dependents need to use the employees social as well.
Vision:
Will VSP issue ID Cards? No, the ID number is the employees social security number, dependents need to use the employees social as well.
Contact your employer for your specific plan information. Plans vary from employer group to employer group. Dental and vision is an option, not all employer groups choose to subscribe.
AGC 2012 Health Plan Offering
Basic: Medical/Life/STD — Blue Cross of Idaho/Metlife
Plan 1 (click for summary)
- $750 individual/$1,500 family deductible
- $30 Primary Care/$45 Specialist office visit copay
- 75%/25% coinsurance in-network
- 55%/45% coinsurance out-of-network
- $3,000 individual/$6,000 family out-of-pocket maximum in-network
- $4,500 individual/$9,000 family out-of-pocket maximum out-of-network
- Rx—$5 generic, 25% brand formulary, 50% nonformulary with $5,000 out-of-pocket limit $1,000 Deductible Plan — Blue Cross of Idaho
- $1,000 individual/$2,000 family deductible
- $30 Primary Care/$45 Specialist office visit copay
- 75%/25% coinsurance in-network
- 55%/45% coinsurance out-of-network
- $3,000 individual/$6,000 family out-of-pocket maximum in-network
- $4,500 individual/$9,000 family out-of-pocket maximum out-of-network
- $1,500 individual/$3,000 family deductible
- $30 Primary Care/$45 Specialist office visit copay
- 75%/25% coinsurance in-network
- 55%/45% coinsurance out-of-network
- $3,000 individual/$6,000 family out-of-pocket maximum in-network
- $4,500 individual/$9,000 family out-of-pocket maximum out-of-network
- $2,500 individual/$5,000 family deductible
- $30 Primary Care/$45 Specialist office visit copay
- 75%/25% coinsurance in-network
- 55%/45% coinsurance out-of-network
- $3,000 individual/$6,000 family out-of-pocket maximum in-network
- $4,500 individual/$9,000 family out-of-pocket maximum out-of-network
- $5,000 individual/$10,000 family deductible
- $30 Primary Care/$45 Specialist office visit copay
- 75%/25% coinsurance in-network
- 55%/45% coinsurance out-of-network
- $3,000 individual/$6,000 family out-of-pocket maximum in-network
- $4,500 individual/$9,000 family out-of-pocket maximum out-of-network
This is not a policy. Please refer to the actual policy for complete benefits, exclusions, limitations and other general provisions. To learn more about the benefits of working with AGC or obtain a list of brokers, contact the Idaho AGC at (208) 344-9755.
Life Insurance – Met Life
- Short-Term Disability $100 weekly benefit 14/14/13 wk
- $25,000 life insurance
- $25,000 accidental death and dismemberment life insurance
- $5,000 dependent life
AGC Deluxe Plans – Basic Medical/Life/STD with added option of Dental and Vision benefits
Dental — administered by Delta Dental
- $50 Deductible, $150 Family applies to Basic & Major Services
- 100%/80% Preventive Services for 2 exams/cleanings per year (In/Out)
- 80%/80% Basic Services (In/Out)
- 50%/50% Major Services (In/Out)
- $1,000
- $10 copay for exam
- $20 copay for materials, one set of lenses every 12 months and frames once every 24 months
The Idaho AGC dental and vision plans are self-funded, not insurance and do not participate in the state guaranty association.
All deductibles are effective January 1 through December 31.
Terms and Conditions
Groups of 2–50 eligible employees are able to purchase health care coverage regardless of health status. An eligible employee is an employee who works at least 30 hours per week. “Family” as mentioned herein refers to dependent coverage. A dependent is:
- a legal spouse
- dependent child under the age of 26
- an unmarried child of any age who is medically certified as disabled and dependent upon the parent
Initial premium is established based on expected claims costs as determined by the underwriting information provided by the group. Blue Cross of Idaho’s Underwriting Department may adjust renewal premium for past or expected future utilization. Premium will change for the group as the age and/or number of enrolled members change.
Policies shall be in force and guaranteed renewable unless terminated due to the following:
- termination by the employer without cause with 30 days written notice
- nonpayment of premium
- fraud or intentional misrepresentation of material fact by the employer
- noncompliance of minimum participation requirements set forth by Blue Cross of Idaho
Waiting periods for preexisting conditions will be credited for employees and their dependents who were enrolled under previous qualifying coverage. This is contingent upon the previous qualifying coverage ending not more than 63 days prior to the effective date under this coverage. New enrollees without previous qualifying coverage will be subject to a 12-month waiting period for preexisting conditions. Benefi ts for preexisting conditions may be denied until the member has been enrolled for coverage on this policy for a continuous 12-month period. This waiting period shall not apply to newborn children who shall be covered from the moment of birth or to adopted children or children in the process of adoption who have been placed with the enrolled employee. Preexisting condition means a physical or mental condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within six (6) months prior to the effective date of this coverage. Genetic information shall not be considered a preexisting condition in absence of a diagnosis of the condition related to such information. A pregnancy existing on the effective date of coverage will not be considered a preexisting condition.
Contacts
Medical – Specific questions regarding medical proceedures or prescriptions not included in the summaries above, please contact Blue Cross Of Idaho at 1.866.283.6354.
Dental – Delta dental of Idaho 800.388.3490
Vision – VSP 800.877.7195
Forms
Prescription reimbursment claim form
Short Term Disability Claim Form – MetLife – return completed form to the Idaho AGC Health Plan – PO Box 7386, Boise, ID 83707 or fax 208.336.2121 **do not submit direct to MetLife**
