ACHIA PLANS

Preferred Provider plan (PPO)
The Preferred Provider plan contains a hospital preferred provider benefit. This affects only your choice of hospital for in-hospital stays and in-hospital surgery, as well as for out-patient surgery. It does not affect where you have your labwork, MRI's, X-Rays, CT scans or other out-patient procedures such as EKG's done. It does not affect your choice of physician or care provider.

For further Preferred Provider information, see PPO letter in the news and update section. For a list of Preferred Providers, see www.medavanthealth.com.

Traditional plan
If you do not want one of the PPO plans and you are not on Medicare, your only option is to select the Traditional plan. In the Traditional plan you are able to choose your hospital without decreasing your benefit.

Medicare Supplement plan
If you are on, or elect a Medicare Supplement plan, you will receive a NON-PPO policy. The Medicare Supplement plan is available to those under sixty-five years old, as well as those over sixty-four years old, who are Medicare eligible. Click HERE to download and view an Outline of Medicare Supplement Coverage Plans A and F.

Medicare Carveout plan
The Medicare Carveout plan is available to Medicare eligible members under the age of 65, who are also ACHIA eligible. Under a Medicare Carveout there is a coordination of benefits between Medicare and the Traditional $1000 deductible ACHIA plan. The Medicare Carveout is a non-PPO plan.

Medicare is the primary payor. ACHIA is the secondary payor. It is your responsibility to inform your provider of ACHIA's secondary status. ACHIA covers the portion that Medicare leaves as "your total responsibility", after your ACHIA deductible is met. If a benefit is covered by ACHIA and not by Medicare, that benefit is covered by ACHIA as primary payor, the same as under a regular $1000 deductible non-PPO policy .

ALL MEDICARE MEMBERS: Please see that Medicare is billed for all Medicare eligible benefits. Note that diabetic supplies and pulmonary nebulizers are covered by Medicare, as well as nebulizer medications. You must request that your pharmacist electronically bill Medicare at the time that you pay for your medicine and supplies. Medicare then reimburses you for 80% of reasonable cost for the pulmonary medication, and as per Medicare benefit for supplies.

Note that beginning on January 1, 2006, ACHIA no longer covers prescription drugs for Medicare eligible individuals. This exclusion only applies to drugs provided under Medicare Part D, but does not affect drugs provided under Medicare Part B.

Note that there is a 115% Limiting Charge for all providers who do not accept Medicare assignment. That is, the provider cannot charge you more than 115% of the Medicare approved amount.

Warning: Do not sign a private contract with a provider who does not give services through Medicare, or no Medicare payment will be made for the services you get through this doctor. Under a private contract, no limiting charge will apply, and ACHIA Medicare Carveout or Supplement plans may not pay. (See pg. 55 of the Medicare & You 2001 booklet.) You may be personally responsible for the entire bill under a private contract.

Pharmaceutical network program

For all plans that include prescription benefits, as of July 1, 2002, ACHIA is offering a prescription network program. When you use a network pharmacy, the claim will be filed electronically for you and you will receive the discounted price. There are currently fifty-four pharmacies in Alaska that participate in the program. For the benefits of using a participating pharmacy please click HERE.

For a listing of these pharmacies click HERE

RATES: The following rates are in effect as of January 1, 2008.

EFT - Electronic Fund Transfer is available for convenient payment of premiums.

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Premium Rates Effective January 1, 2008 through December 31, 2008

Medicare Supplement Plan
Montly Premium Rates
Attained Age	Plan A	Plan F	Plan I
0-64	$223	N/A	$218
65	$150	$228	$218
66	$155	$237	$225
67	$163	$248	$236
68	$171	$260	$248
69	$176	$268	$253
70	$181	$276	$261
71	$186	$284	$268
72	$192	$292	$276
73	$195	$298	$281
74	$199	$303	$286
75	$203	$309	$292
76	$206	$315	$297
77	$210	$320	$303
78	$213	$324	$307
79	$215	$328	$310
80+	$223	$340	$321

Medicare Carveout Plan
Deductible:	$1,000
Coinsurance:	80%
Out of pocket maximum:	$2,500
Maximum:	$2,000,000
Age	Monthly Premium Rates
0-18	$98
19+	$229

Applications & Inquiries

There are two different application forms.

The first one is for all regular applicants - i.e. those persons who are NOT eligible for the "Trade Assistance Adjustment Act" (TAA)/HCTC federal program.

Click HERE to view and download the regular ACHIA application form.

The second application is for those persons who have been determined to be eligible for the TAA/HCTC federal program.
If you are in doubt as to whether you qualify, please read the information about this program in our News and Update section.

Click HERE to view and download the ACHIA TAA application form.
You will need the Adobe Acrobat® Reader plugin to read and print the application form.

The application must be complete when printed off. If you have any problems or questions, please call (888) 290-0616

BMI information list for ACHIA

Customer Service
Hours: 8 AM to 5 PM  Monday - Friday
Phone: (888) 290-0616
Fax:
    Claims Department: (620) 792-0535
    Premium Billing & Enrollment Department  (620) 793-1199
Email Address:  achia@bmikansas.com

Precertification
Phone: 1-866-295-1779

Send all Medicare Primary claims to:
Benefit Management, Inc
P.O. Box 1090
Great Bend, KS 67530

Send all other claims to:
NPPN/BMI-KSKA-190
419 East Main Street
Middletown, NY 10940

Correspondence/Appeals
ACHIA
P.O. Box 1090
Great Bend, KS 67530

Premium Payment
ACHIA
P.O. Box 10
Otis, KS 67565

Preferred Provider 
NPPN
Website:  www.medavanthealth.com
Phone: 800-557-1656

Prescription Network Services
Prescription Network
Pharmacy Services /Customer Service 1-800-279-3022