Q: What is UMR and what do they have to do with Palm Beach County Firefighters Employee Benefits Fund.
A: UMR is an affiliate of United Health Care and is the Funds Third Party Administrator (TPA). The TPA handles all payments to physicians and administers the plan as set forth by the Board of Trustees. They are also your first level of an appeal should need to appeal a claim. Click here for a brochure on How UMR Processes a Claim
Q: What is that paper that UMR sends me each time I visit a medical or dental provider and how do I understand it.
A: The paper you receive in the mail from UMR after you visit a medical or dental provider is called an EOB (Explanation of Benefits). This EOB explains how your claim was processed. Things like services billed, discounts, copays and if other information is needed before the claim can be processed. Click on this link for a short brochure on how to read the EOB. How to read my explanation of benefits
Q: When is Notification required?
A: Notification is required for all in-patient hospital admissions and for all out-patient surgeries performed in an ambulatory surgery center, out-patient surgery center or hospital setting, skilled nursing facility, home-health care, durable medical equipment over $500 per month for rental or $1500 for purchase, prosthetics over $1000; organ and tissue transplants, inpatient behavioral health, mental health, substance abuse, and dialysis. An emergency non-scheduled in-patient hospital admission must be pre-certified within 48 business hours or two (2) business days of the admission.
Q: What is meant by a PPO?
A: A Preferred Provider Organization (PPO) is a network of individual physicians and hospitals that discount fees in exchange for an anticipated increased volume in patients. The PPO used by the Fund is United Healthcare Choice-Plus (UHC). If you do not have access to a PPO Provider within 30 road miles of your home, covered expenses received from a non-PPO Provider shall be payable at the PPO benefit level provided you have sought notification from UMR (see Section 5).
Q: Why should I use a Panel Provider?
A: Because Panel Providers have made agreements to reduce their fees, you and the Fund save money.
Q: What if I have questions about my benefits or a claim payment?
A: Contact UMR, Inc. (UMR) at 1- (877)-210-1840. If you have a problem with the way your claim was paid. After discussing it with UMR, if your issue has not been resolved you can call the Fund Office at (561) 969-6663.
Open Enrollment Checklist
Q: I’m a current Palm Beach County Fire Rescue employee, which forms do I fill out to start or change my coverage?
Q: I’m a retiree with current coverage and I would like to change my coverage, which form do I fill out?
Q: I would like to change my beneficiary, which form do I fill out?
Q: When do the forms need to be turned in by?
A: Status Change Forms: By the close of the last business day in November.
Beneficiary Forms: ASAP anytime a change is requested. Original form or color copies only in blue ink.
Q: When do my changes take effect?
A: January 01 after open enrollment.
Q: If I have any questions, who can I call?
A: Call Customer Service at the Benefits office, 561-969-6663. We are open from 8-5 Mon-Fri excluding County holidays.
Page Last Updated: Nov 05, 2013 (07:14:27)