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Questions & Answers
Joining PTCQ: How do I become a member of the PTC?A: Employers of all sizes, including sole proprietorships are eligible for membership. Annual memberships are available for Technology, Support and Entrepreneurial members. Interested employers should contact the PTC Membership Department at 412-687-2700. 
Q: How do I become eligible for participation in the Council's Employee Benefits Group?A: Participation in the Council's Employee Benefits Group is an exclusive membership privilege for the Pittsburgh Technology Council. All members of the PTC are eligible to participate with the Council's Employee Benefits Group. Interested PTC members or prospective members should contact the Council's Employee Benefits Group at 1-800-517-5128.
BillingQ: When is my payment due?A: Payment is due by the end of the month prior to the coverage month (i.e. December 31 for January). Most invoices aren't mailed until the first or second week of the month prior to the coverage month.
Q: Is it required that I adjust my monthly premium payment to reflect the changes I am submitting?A: No. You can submit changes without adjusting the premium amount due. Your next invoice will indicate the credit or the back charges for the changes submitted.
Q: I have a new hire who needs to be added to the plan. Do I send the enrollment application with my premium?A: Yes. All enrollments, terminations and changes should be submitted with your monthly premium payment within 60 days of eligibility. Please ensure that the enrollment application is complete and that the correct group number and effective date are written clearly on the application. List all information on the Group Insurance Change Report.
Q: Is there a waiting period that must be satisfied before new employees can be added to the group plan?A: The Council's Employee Benefits Group does not impose a waiting period. Please be advised that coverage always begins and ends on the first of a month.
Policy AdministrationQ: Am I responsible for sending out Certificates of Creditable coverage in order to comply with the guideline of the Health Insurance Portability and Accountability Act (HIPAA)?A: Highmark Blue Cross or Blue Shield will issue Certificates of Creditable coverage when a member's coverage is terminated.
Q: Who is responsible for administering COBRA?A: Employers are responsible for notifying employees and qualified beneficiaries of their right to elect COBRA continuation coverage. Additionally, employers are responsible for notifying COBRA participants of benefit and rate changes and for monitoring the duration of benefits under COBRA. The Council's Employee Benefits Group can administer the premium billing for COBRA. Please refer to the COBRA Administration Web page for more detailed information on COBRA billing.
Q: Can an employee who declined a particular part of the benefit package at the time of hire elect to add the coverage at a later date?A: All elections made during the initial enrollment period must remain in effect until the next open enrollment period (January 1 – March 1) unless a qualifying event occurs.
Q. What is a qualifying event?A: An occurance entitling a person to change existing coverage or elect continuation outside of open enrollment. For example:
EligibilityQ: Who is considered a full-time student?A: A student must be taking at least 12 credit hours at an accredited educational institution to be considered as a full-time student. An individual can be considered a full time student up to the age of 25.
Q: How many hours must an employee work to be eligible for enrollment?A: Employee must be working a minimum of 20 hours and be considered full-time
employees by the company to be eligible for enrollment. Please refer to
the Eligibility Rules Web page for a
detailed description of eligible employees.
Q: Do all of my employees have to enroll in the health insurance plan?A: In general, a company must have at least 80% enrollment participation to be eligible for coverage. Credit toward the minimum 80% enrollment may be extended for those employees who have spousal coverage with certain health plans.
Q: Do any of the medical plans impose a limit for pre-existing conditions?A: No. The Council's Employee Benefits Group does not offer a medical plan that excludes coverage for pre-existing medical conditions. However, there are specific benefit limitations and exclusions applicable to each plan.
General IssuesQ: How do I change my PCP?A: A new PCP selection can be made by calling the Dedicated Customer Service Unit at 1 800 325-4560. If the change is made prior to the 15th of the month, the new PCP selection will be effective the first of the following month. If a change is made after the 15th, the change is made effective the first of the second following month.
Q: Do female SelectBlue/KeystoneBlue/CommunityBlue subscribers need a referral from a PCP to see network obstetricians/gynecologists?A: No, a female can self refer to a network obstetrician/gynecologist of her choice at any time without the need for a referral from their PCP. This includes the annual, routine gynecologist exam, sick visits and maternity visits.
Q: Are you required to get a referral for follow-up visits to a Specialist?A: For most types of specialty care, the referred Specialist can provide care for up to 60 days from the date of the referral, if needed, without an additional referral. This should be verified with the PCP.
Q: Whom do I contact for Mental Health and Substance Abuse Network Services?A: To access mental health and substance abuse services, and to receive the highest level of benefits available, you must call the confidential 24-hour, toll-free help line, 1 800 258-9808 before seeking inpatient or outpatient treatment. Representatives are available 24 hours a day, 7 days a week. They will provide you with information and referral sources for inpatient and outpatient care.
Q: Am I covered for medical treatment away from my residence?A: If you are traveling or are on vacation and are injured or suffer a sudden and acute illness, you should contact your PCP or the Dedicated Customer Service Unit number located on the back of your medical identification card. The customer service unit or your PCP may be able to refer you to a local network provider. If the injury is life or limb threatening you should seek immediate treatment from the nearest facility. In order for these emergency services to be paid at the coordinated care level, you must contact your PCP within 48 hours of the emergency treatment.
Q: Do employees need to inform their doctors if they are on a plan that has a drug formulary and supply limitation?A: Yes. It is important for all members to communicate prescription drug benefit information to their doctors. Sharing this information with the Doctor helps to eliminate confusion or member inconvenience at the pharmacy.
ID CardsQ: When will members receive their ID cards?A: ID cards will be sent to the member’s home address within 7-10 business days from the time the coverage is added into Highmark’s system. Please allow 10-15 days for employees residing outside of western Pennsylvania.
Q: I have not received my medical cards and I need to see a doctor. Will my services be covered?A: The employee copy of your enrollment application acts as a temporary identification card. Most providers do accept the application, but in the case that a provider would not, the member could pay for the service and file a claim for reimbursement.
Q: What happens if an employee needs a prescription and they have not received their ID cards?A: The employee will be responsible for paying for the prescription and filing a prescription drug reimbursement claim form once their enrollment application has been processed by Highmark Blue Cross Blue Shield. If the application is processed within 14 days from the date of purchase, an employee may return to the pharmacy and obtain a refund. Please note refunds are issued according to the pharmacy’s refund policy.
Dental/ VisionQ: Is there a list of participating dentists that my employees must use for Dental?A: In order to obtain benefits at the highest level, we encourage employees to use dentists that accept United Concordia or participate in the DentalPlus network (depending on the dental plan). Employees can call United Concordia at (800) 332-0366 to obtain a listing of participating dentists or visit their website at www.ucci.com. Employees enrolled in the DentalPlus network can call Pennsylvania Blue Shield at 1-800-772-1919.
Q: Do I have to request a benefit form before making my eye appointment under the VBA Vision plan?A: Yes. Members should either submit a benefit request card to VBA, call VBA’s Customer Service Department at 1-800-432-4966, or request online at www.visionbenefits.com before making an eye appointment. VBA will determine if the member is eligible for the benefit at that time. If so, a precertified VBA benefit form and current list of Participating Providers will be sent directly to the member’s home, generally within a week. Members should select a provider from the list and make an appointment. In order to take full advantage of the benefits available, members must present the precertified VBA Benefit form to the VBA provider on the first visit. Failure to do so will result in higher charges.
Q: Are OptiChoice members required to select a Preferred Provider or Contracting Supplier to receive benefits?A: No. Members who receive services or products from Preferred Providers and Contracting Suppliers within the network will have all or most of their services covered in full with no out-of-pocket expense. However, by going to an out-of-network provider or supplier, members are responsible for whatever portion of the bill is not covered by Highmark Blue Cross Blue Shield / Pennsylvania Blue Shield. This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.
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