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Many more answers to your frequently asked questions are located in your Fundamenal Care account, login now.
Fundamental Care>Member Resources>FAQ
I requested an ID card. How long will it take to receive it?
Is Fundamental Care a major medical plan?
What rules govern my medical expenses?
Who is the insurance company behind Fundamental Care?
Who pays the claims?
What kind of medical benefits are covered under the plan?
I have a medical condition. How does that affect my Fundamental Care coverage?
My wife is pregnant. How does Fundamental Care pay for maternity services?
What is an accidental injury?
What is emergency care?
If I leave my job, can I keep my insurance?
What dental expenses will be covered under this plan?
How do I file a dental claim?
I requested an ID card. How long will it take to receive it?
You will receive your ID cards by US Mail approximately 7-10 days after the request has been submitted and received.
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Is Fundamental Care a major medical plan?
No, Fundamental Care is not a major medical plan. Fundamental Care provides dependable coverage for more than the most common medical expenses. The benefit limits are lower compared to a comprehensive medical plan, but our research shows that these are the benefits employees use the most*.
*According to Milliman Health Cost Guidelines more than 80% of health care expenses fall into the medical expense categories covered by Fundamental Care plans.
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What rules govern my medical expenses?
In order for expenses to be covered under your plan, your medical expenses must:
Be administered or ordered by a licensed physician;
Be medically necessary for the diagnosis and treatment of the sickness or injury, and;
Not be excluded by the plan.
Who is the insurance company behind Fundamental Care?
Fundamental Care is underwritten and administered by Connecticut General Life Insurance Company.
Claims are paid by CIGNA HealthCare , the administrator for the Fundamental Care plan, based in Phoenix, Arizona.
What kind of medical benefits are covered under the plan?
Expenses resulting from sickness and off-the-job accidents including:
Outpatient Care
• Physician Office Visit
• Wellness Benefit
• Diagnostic, Lab, X-Ray Facility
• Emergency / Urgent Care
• Durable Medical Equipment
Inpatient Care
• Room and Board
• Hospital Intensive Care Unit
• Hospital Critical/Coronary Care Unit
• Maternity
• Ancillary Services
Surgery
• Inpatient/Outpatient Surgery Benefit
• Facility/Surgical Rooms
• Anesthesiologist
Prescriptions
• Generic/Formulary/Non-Formulary
I have a medical condition. How does that affect my Fundamental Care coverage?
If you recently had other group insurance, ask your prior insurance carrier to send you a Certificate of Creditable Coverage (CCC) and submit it with your first claim to Fundamental Care Claims Department. A CCC may reduce or eliminate the Pre-existing Condition Limitation on your policy. Submitting the CCC with your first claim will also decrease the time it takes to process your claim. If you did not have prior group insurance, you may be subject to the Pre-existing Condition Limitation Clause.
My wife is pregnant. How does Fundamental Care pay for maternity services?
The pre-natal, labor, delivery and post-delivery care charges for her pregnancy are billed by the doctor under a packaged procedure code. Your doctor will bill Fundamental Care for these charges after the birth of your baby.The Fundamental Care Claims Department will review the package after your baby is born. Please note that the initial office visit, pregnancy test, lab work and ultrasound services can be submitted to Fundamental Care Claims Department when the services are received. You do not need to wait until your baby is born to submit these charges.
To qualify, an injury must occur while covered under the plan. An Accidental Injury is a non-work related bodily injury that is sudden, unexpected and unforeseen as the result of an identifiable event producing objective symptoms of an injury. Only charges incurred within 90 days of the accident will be eligible to be paid under the Accident Medical Benefit.
"Emergency care" is defined as medical care and treatment provided after the sudden onset of a medical condition manifesting itself by acute symptoms, including severe pain, which are severe enough that the lack of immediate medical attention could reasonably be expected to result in any of the following:
the patient's health would be placed in serious jeopardy;
bodily function would be seriously impaired;
there would be serious dysfunction of a bodily organ or part.
If I leave my job, can I keep my insurance?
Yes, as part of the COBRA law, you have the option to keep your group health coverage, regardless of whether you are terminated or leave your position voluntarily. You will be notified within 60 days of your last day of employment of your option to enroll in COBRA. The group health coverages, by law, must be identical to the coverages provided to you while employed. You will be responsible for the full monthly premium amount.
If I selected the Dental Plan, what expenses will be covered under this plan?
If the dental insurance is offered by your employer, and you have enrolled in the plan, expenses listed in the "List of Covered Dental Procedures" will be covered up to the Maximum Covered Charge. Only charges incurred while insured under the Dental plan will be covered.
The policy requires your claim to be filed within 90 days of the date of service. All dental offices have a supply of the "Universal Dental Claim Form" that can be mailed directly to CIGNA HealthCare (the claims payer) by your Dentist. Dental claims should be sent to:
CIGNA HealthCare
P.O. Box 30870
Phoenix, AZ 85046
This claim form will be accepted by your Fundamental Care Dental Plan as proof of claim. The Fundamental Care Dental Plan allows you complete freedom to obtain care from the Dentist of your choice. If your dentist does not file insurance forms for you, please make certain that they give you a completed "Universal Dental Claim Form" to submit to CIGNA HealthCare for reimbursement.