Below are some frequently asked questions regarding the USA Viva Health & Dental Plan. If you cannot find an answer you are looking for, please contact Customer Service at 800-294-7780 or firstname.lastname@example.org.
May I join any of the three plans offered by the University: Base Plan, Standard Plan, USA-Viva Health & Dental Plan?
No, if you are a new employee you may select between the Standard Plan and the USA-Viva Health & Dental Plan. Only employees hired before January 1, 2013, are eligible for the Base Plan.
Does the USA-Viva Health & Dental Plan offer dental benefits?
Yes, the USA-Viva Health & Dental Plan offers the exact same dental benefits that are offered in both the Base Plan and Standard Plans.
If I join the USA- Viva Health & Dental Plan can I switch back to the Base Plan or Standard Plan?
Yes, but only to the Standard Plan and only during the annual open enrollment month (generally in November) for coverage starting January 1st of the following year. You may not switch plans during the year unless you have a change in your residence and you reside outside the state of Alabama. If you are able to change from the USA-Viva Health & Dental Plan you may only join the Standard Plan; you may not transfer back to the Base Plan.
Will my doctor be covered under the USA-Viva Health & Dental Plan?
The USA-Viva Health
& Dental Plan's network is limited to physicians from USA along with a select few additional specialists affiliated with other hospitals. The provider directory can help you determine if your physician(s) are in the network. You can also call Viva
at 800-294-7780 or www.viva-usa.com
or go to the web site for the provider listing at www.viva-usa.com/Doctor-Search
to verify your physician's status. Remember, medical providers that are not Network Providers are not eligible for benefits.
Under the USA-Viva Health & Dental Plan, if my Network Physician refers me to a Non-Network medical provider will that be covered by the Plan?
No, generally no out-of-network medical providers will qualify for benefits. The only time a Non-Network medical provider will qualify for benefits is when Viva Health's medical director has approved the medical expense or service for payment of benefits in advance of the medical procedure or expense.
What should I consider when deciding whether to join the USA-Viva Health & Dental Plan?
You should consider that only a limited network of medical providers will qualify for coverage. This may not be the best plan if you have a chronic illness and are currently receiving medical care from multiple providers and specialists. In that case, you will want to verify that the medical providers you use are Network Providers and are listed in the provider directory. If they are not Network Providers, you should elect to remain with the Standard Plan option or the Base Plan option.
Why are the benefits better and the cost less for the USA-Viva Health & Dental Plan?
The medical providers on the USA-Viva Health & Dental Plan have agreed to accept a lower fee for services, resulting in lower costs for you. These medical providers also work to achieve better medical outcomes through quality of care, which also reduces costs. The USA-Viva Health & Dental Plan benefits are better for medical services but the pharmacy and dental benefits are the same as the Standard Plan benefit.
Who selects the medical providers for the USA-Viva Health & Dental Plan?
Viva Health, Inc. has the sole responsibility for selecting medical providers to be included as Network Providers. Viva Health, Inc. monitors these providers for access and quality of care as well as medical outcomes to ensure the highest level of medical care. Viva Health, Inc. has the sole authority to add and remove providers from the listing of Network Providers.
How do I join the USA-Viva Health & Dental Plan?
You must complete an enrollment form and file it with the University's Human Resources Department. When you file that form you will attest that you understand:
- The USA-Viva Health & Dental Plan is a limited network plan that does not provide benefits for out-of-network medical providers except for emergency medical care (and then only after proper notification) and services prior approved by Viva Health's medical director;
- It is your responsibility to ensure that medical care is provided by a Network Provider; and
- You may not change from the USA-Viva Health & Dental Plan except during open enrollment for coverage effective January 1st of the following year unless if you have a change of residence and reside outside the state of Alabama (see the change-in-status event rule described in your Member Handbook).