Frequently Asked Questions
- What is a copay?
- What is a deductible?
- What is coinsurance?
- Does my deductible and coinsurance responsibilities reset each year?
- What happens if I leave the company? How do I continue my benefits?
- I received a bill in the mail; do I still owe money?
- How do I know if my claim has been paid?
- What can I use my debit card for?
- Where can I access forms?
- Where do I mail my completed form?
- Why is it important for me to use in-network providers?
- How do I locate an in-network doctor?
- How do I know if my current physician participates with the network?
- Am I still covered if my physician or hospital is not part of the network?
- Do I need pre-authorization for any medical services?
- I already paid my doctor, can I get reimbursed?
Copay: If your plan has a copay, it will be a fixed amount for an office visit, urgent care, chiropractor or emergency room visit. You will be responsible to pay the provider this fixed copay on the day of your service. (The emergency room copay will be waived if you are admitted to the hospital under most insurance plans.)
Deductible: A deductible is a set amount of money for which you are responsible to pay during your benefit year. You will need to meet your deductible amount before your insurance company starts paying for medical services. This deductible does not apply if your service falls under a fixed copay.
Coinsurance: After you have met your deductible, you are responsible for a percentage of every claim up to a coinsurance cap. Your insurance company will pay the remaining percentage until your coinsurance amount has been met for approved services, then they will pay 100% for the rest of the year.
Deductible and coinsurance responsibilities: Yes. However, if you have met your deductible in the 4th quarter of the benefit year, it may carry over into the 1st quarter of the next benefit year.
Leaving the company: You may or may not be eligible for COBRA. Speak with your human resource representative.
Receiving a bill: For specific claims questions, call our medical customer service representative to go over your statement at 248-948-9900.
Paid claim: Call our medical customer service representative at 248-948-9900.
Debit card: See your specific plan information in your employee handbook or call the EHIM Debit Team at 248-204-6363.
Access forms: Your human resource department, online or EHIM will be glad to email or mail them to you.
Mail in forms: You can mail your completed form to EHIM at Attn: Medical Department. 26711 Northwestern Hwy. Suite 400, Southfield, MI 48033.
In-network providers: Using in-network providers will save you significant out of pocket costs.
Locate an in-network doctor: Most networks are available online but EHIM will be glad to help you.
Physician participation: The most current information is available by calling your provider's office. Be sure to ask the office if they participate with your specific insurance plan.
Out-of-network: Yes. Your medical benefits plan will pay for all eligible healthcare services, but at a lesser amount.
Pre-authorization: Please follow the guidelines of your health insurance company. EHIM does not require pre-authorization for payment of Special Medical Reimbursement claims.
Reimbursement: If you have paid for a service that was covered by your insurance, you can send in a reimbursement form with the provider's bill to: EHIM, Attn: Medical Department. 26711 Northwestern Hwy. Suite 400, Southfield, MI 48033.
For more information please contact the EHIM Medical Department Customer Service at 248-948-9900 or 800-311-3446.