Group Health Benefits: Frequently Asked Questions

Click on each item for additional information.

How do I make changes to my enrollment (address, add/remove dependent, beneficiary, etc.)?

Please complete a new enrollment card (click here). Please provide this signed form to your employer – they may also need to know about important changes to your status and benefits enrollment. They will forward your completed form to us for handling.

How do I get another ID card?

You may contact us or request through HealthView.

If I don’t have a family doctor, can I go to the emergency room?

The hospital emergency room is not the best place to seek routine health care. We encourage everyone to establish a relationship with a doctor before you need care and to schedule regular preventive visits. Your family physician is most qualified to provide you and your family with personalized health and wellness care.

As a reminder, most CGF plans include NurseLine, a toll-free hotline where you can speak with a nurse any day, all day, every day of the year. The toll-free number is located on your identification card.

Can you help me find a doctor?

Yes, please contact us and we can prepare a list of physicians and/or hospitals near you. You may also search for providers using the links below or through HealthView.

 

California: Anthem Blue Cross:How to search for Anthem Providers

Instructions

  1. Select Provider network
  2. Scroll about 1/3 down to Medical, Employer Sponsored
  3. Choose Blue Cross PPO (Prudent Buyer) Large Group

Outside of California: First Health

If I need a medical procedure, what will it cost?

This depends on many factors, including the medical plan deductible (the amount you pay before benefits begin) and coinsurance (your share of costs). Please contact our office to speak directly with a customer service representative about benefits covered under your company’s plan.

What is the status of my medical claim?

Claims are typically processed within 30 days. Occasionally claims are delayed for more insurance information, physician records, or other reasons. Please contact us to research the status of any pending medical claims. Claims status is also available on the HealthView site.

Can you explain the statement I received from Western Growers Assurance Trust (WGAT)?

The Explanation of Benefits (EOB) statement confirms that WGAT received your medical claim, and how that claim was processed. The EOB should match any invoices you receive from your medical care provider. Please contact us if there are discrepancies or if you have other questions about this statement. We always suggest keeping your statements on file in case you need it in the future (How to Read Your Explanation of Benefits).

You may also receive EOBs via email by registering on HealthView.

Why is my medicine so expensive?

Prescription drugs may be available at four different price points:

  1. Generic drugs typically cost the least and are prescribed the most.
  2. Name Brand drugs are more expensive and your co-pay will be higher. If there is no generic medication available, your doctor may prescribe a brand-name medicine to treat a condition.
  3. Non-Formulary Drugs are particular medicines that are not approved under your medical plan. Non-Formulary prescriptions tend to have higher copayments.
  4. Specialty drugs are for the specific treatment of certain debilitating and life-threatening conditions. Patients must receive authorization from Acaria Health Specialty Pharmacy (link) before specialty medication can be dispensed. A copayment based on a percentage of the drug cost is required for specialty medications.

Can I save money on my medications?

If you are prescribed regular medication(s), our convenient mail order program makes it easy to get refills. By using mail order, nyou can receive a 90 day supply of prescription drugs delivered to your home address. Save a trip to the pharmacy, and save money on nyour Rx co-pay!

The Health Management Program is also a way to qualify for free or discounted prescriptions and is designed to help patients with asthma, diabetes, high blood pressure, and high cholesterol. The Health Management Program also includes free health coaching for anyone wishing to quit smoking or lose weight!
Health Management Program (English)

Health Management Program (Spanish)

How do I add our newborn baby?

Congratulations! We need to update our records to add your new child to the health plan. Please complete the attached enrollment card and return to our office within 31 days of the date of birth.

When can I add family member(s) to my medical plan?

Coverage is typically offered: a) for new hires and, b) during the annual open enrollment period. Employees may be allowed to enroll themselves and eligible dependents (if applicable) if they experience a “qualifying event” during the Plan Year.

Qualifying events that may be allowed include:

  • Change in legal marital status including: marriage, death of a spouse, divorce, legal separation or annulment.
  • Change in the number of dependents, including: adoption or placement for adoption, birth, death.
  • Change in employment status of the employee, or the employee’s spouse or dependent.
  • Change in coverage of a spouse or dependent under another employer’s plan.
  • Change of residence for an employee or retiree, or their spouse or dependent; and the current carrier is not available.
  • COBRA-qualifying event.
  • Dependents who are no longer eligible because of age, marital status, or other similar circumstances.
  • Entitlement to Medicare or Medicaid.
  • Family Medical Leave Act (FMLA) leave.
  • Health Insurance Portability and Accountability Act (HIPAA) special enrollment rights for new dependents, and in the case of loss of other insurance coverage.
  • Judgments, decrees, or orders.
  • Loss of coverage under the group health plan of a governmental or educational institution.
  • Situations in which the group health plan is required by the applicable federal or state law to allow a change in coverage.

Is my privacy protected?

Your privacy is a serious matter and we take extra care to ensure that the personal and private data you share with CGF is protected. All account information is respected as confidential. We do not release private information to any person or entity without approval. If you wish to authorize CGF to release your private information, you may use the Protected Health Information form, click for English or Spanish. Your healthcare information is also protected by WGAT. To view WGAT’s privacy practices, click here.