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Frequently Asked Questions

How do I request a replacement insurance card?


Login to HMA member portal and you may make a request to have one sent to you.

 

What is an Explanation of Benefits (EOB) statement?


An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment. The EOBs are not bills. For an example of an EOB, Click Here

 

What's the difference between a deductible and copayment?


Both are medical charges you must pay out of your own pocket, even if you have insurance. Your deductible is the initial amount you must pay each year for covered health services before your insurer will start to chip in. A copayment is a fixed amount you pay toward each medical service.

 

What is covered under the Plan?


Navajo Nation Plan offers medical, prescription drug, dental, vision and short-term disability benefits. Election of coverage for an employee includes medical, prescription drug, dental, vision and short-term disability. Election of coverage for dependent(s) includes medical, prescription drug, dental and vision only.

 

When can I enroll a dependent to my policy?


Please refer to page 17 of the Plan document. There are some instances where there are Qualifying Events and other instances that might have to wait until our annual open-enrollment period, which is October - November of each year. However, Qualifying Events such as recent marriage, birth of a child, adoption, establishment of legal guardianship, medical child support court order, loss or denial of other health coverage are all grounds to add a dependent to your insurance if you notify our Benefits office within 31 days.

 

How do I submit for reimbursement when I paid cash out-of-pocket for health services?


You may download the Out-Of-Pocket Reimbursement Form (OOP) and submit in a timely manner. We suggest that you submit within 30 days from the date of service to allow sufficient processing time to complete your claim. For the OOP form,Click Here

 

How can I see if a claim has been processed by the health plan?


You may find this information on the HMA Member portal. You will need to register in the HMA member portal if you have not already done so in order to view your benefit claims.

 

How do I know if my health plan pays first or second for my children when they have more than one health insurance coverage?


Please refer to page 24 of the Plan document for detailed information pertaining to the Coordination of Benefits.

 

What benefits are covered and by my Medical Plan? What benefits are non-covered?


For all your Medical benefit questions, please refer to page 31 of the Plan Document where you will find information of what services are covered and not covered. If your inquiry is not in the document, you may all HMA directly at (480) 921-8944.

 

What benefits are covered by my Dental Plan? What benefits are non-covered?


Dental benefits can be found on page 63 of the Plan Document.

 

What benefits are covered by my Vision Plan? What benefits are non-covered?


Vision benefits can be found on page 70 of the Plan Document.

 

What benefits are covered by my Pharmacy Plan? What benefits are non-covered?


Pharmacy benefits can be found on page 58 of the Plan Document.

 

If your question is not listed here, you may find a more detailed answer when you refer to our Plan Document. Click Here

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