Home
FAQS
About Us
Contact Us
Forms
Calendar
Links
 
 
 
 
 
 
 
 

The Navajo Nation Employee Benefits Program offers a Medical Benefit to its employees and eligible dependents. The Health Benefit is effective on the first day of the month following a sixty (60) day waiting period from the date of enrollment. To enroll in the program the following forms must be submitted, HMA Enrollment Form (PDF), verification documentation (social security card, CIB, birth certificates, etc). Full health coverage is available for eligible employee(s), spouse, and children up to the twenty-six (26) birthday, if qualifications are satisfied.

 

A standard Medical Calendar Year deductible applies and must be met before claims are paid:

Medical Calendar Year Deductible
Per Individual $250
Per Family $500

The Plan pays all covered expenses at 80% per calendar year, when an out-of-pocket maximum is met, the plan will pay 100% of eligible charges for the remainder of the calendar year or to the maximums of the Plan, whichever occurs first.

The maximum out-of-pocket expense is the maximum amount of covered expenses you and/or your family must pay for medical expenses during a calendar year.

The maximum out-of-pocket expenses include both PPO Network and Non-Network Providers as indicated below:

Maximum Out-of-Pocket PPO or Non-PPO Providers
Per Individual $2,750
Per Family $5,500

(Pre-Authorization is required for all non-emergency hospitalization or claims exceeding $300)

Medical benefits are cancelled at midnight at the end of the month of the employee's termination date. Notice of continuation of coverage through COBRA as well as continuation of life insurance will be offered upon termination of employment. Please ask to speak with a Benefit Representative for additional information.

A $250 co-payment will apply per visit if treatment does not result in hospital confinement.

To locate a Preferred Provider for medical care services in your area please visit HMA Inc., website at www.hmatpa.com.

 

A $250 co-payment will apply per inpatient admission.