Double Coverage

PIBF DOUBLE COVERAGE

 

Dear Member:

If you have qualified for coverage on your own and if you are eligible as a dependent under your spouse’s policy please be aware that you have TWO policies with PIBF. This is known as “PIBF Double Coverage”.  Your children are also eligible as dependents under both policies.

In order to expedite the processing of your medical claims, it is imperative for you to present both insurance cards to your providers of service.  It is your responsibility to notify all providers that you have both primary and secondary policies with PIBF and clarify which card is your primary insurance and which card is the secondary.

MEDICAL

All medical claims are submitted electronically to BC/BS. The electronic filing process has greatly increased the importance for providers to have correct insurance information to expedite the filing process of your medical claims. Claims that are submitted with the incorrect policy number could automatically deny as “unidentifiable” or indicate the claim cannot be processed because another policy is the primary plan.  If this occurs and you receive an explanation of benefits with a denial, you should contact the provider and supply the proper insurance information.

DENTAL

Dental Network of America PPO (DNoA) is the PPO Network contracted with PIBF. Please present your dental providers BOTH of your PIBF dental cards.  Your dental provider should submit all claims to PIBF indicating both the primary card number and secondary card number on the claim. The claims address is located on the back of the dental card.

VISION

Vision care providers can submit a paper claim to PIBF.  The claims address is located on the back of the BC/BS card.  Members can also submit an itemized billing statement and paid receipt to PIBF for reimbursement. Please remember to indicate both the primary card number and secondary card number on the claim.

PRESCRIPTIONS

On June 1, 2006 the Board of Trustees of the Pipeline Industry Benefit Fund reinstated the secondary prescription coverage for married couples and their dependents with “PIBF Double

Coverage”.  If you are eligible as a dependent under your spouse’s policy, your deductible and co-pay amounts for prescription medication can be reimbursed under your PIBF secondary policy. Once the $500 deductible is met, PIBF will reimburse the remaining prescription costs at 100% under the secondary plan.  The time period for filing claims is one year from the date of service or date of purchase for prescription medication.

HRA

Reimbursement under PIBF’s HRA plan cannot be completed until the medical or prescription expenses have been processed through ALL insurance sources.  In other words, your medical expenses must have been considered under BOTH of your PIBF policies before any remaining balance can be submitted to the HRA Department.  If prescriptions are applied to your deductible under your PIBF secondary policy, you can submit the prescription charges to the HRA Department by providing a copy of the explanation of benefits from the secondary policy.

If you are unclear which PIBF policy is your primary and which is your secondary or if you need any additional information regarding this letter, please contact the PlBF Claims Department at (918) 280-4800.

The PIBF staff would like to thank you for your cooperation in this matter.

 

Sincerely,

Robert Kime, Director

Pipeline Industry Benefit Fund

 

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