Benefits » Health Insurance » EPO
The LANS/LANL Select Exclusive Provider Organization (Select EPO) medical insurance plan provides you access to a national network of medical care providers and plan coverage for a broad variety of health care needs. The Select EPO network ensures you and your eligible family members access to less expensive network services, both at and away from home, including medical care for children at college. As a member, you must use network providers for covered benefits but may self-refer to network specialists and other network providers. Once you pay the $20 copayment for a network provider's service, that provider handles all claim form submittals and reimbursement issues.
The Select EPO plan has a $150 calendar-year deductible. This plan is a good one for members who use in-network care and are concerned about the premium cost. It covers costs with a 90/10 split, and members must use an in-network provider. (Only emergency care is covered under this plan if out of network.)
You first must choose a primary care physician from the list of physicians in the network. Your primary care physician serves as a guide in coordinating your health care and, when necessary, can recommend other medical specialists. You may also self-refer to specialists.
The Select EPO plan requires you and your family members to choose a PCP. A primary care physician (PCP) is the doctor who oversees your regular medical care and can suggest a specialist, if needed.
You can change your PCP by logging into your account on the UnitedHealthcare Web site. Once in the site, you can run a customized search by provider name, location, and/or specialty or find guidance on choosing a physician or facility, definitions of medical specialties, and a useful hospital-comparison tool to learn more about the quality of care provided by a facility.
The Benefit Eligibility Level Codes (pdf) for Select EPO are 1, 2, and 3. The areas covered are restricted to zip codes in New Mexico, Washington, D.C. and Nevada Test Site.
New Mexico does not recognize "common law" marriages; therefore, only a legal spouse or eligible domestic partner may be enrolled in LANS sponsored health and welfare plans.
You may enroll yourself or an eligible family member in a LANS-sponsored medical plan if you are a newly-hired employee, have a qualified change of status, or during Open Enrollment, which is held at the Lab each November, with coverage effective January 1st of the following year.
If you are newly hired, you have a period of initial eligibility (PIE) during which you may enroll yourself and your eligible family members. Your PIE starts the day you become eligible—usually on your date of hire—and ends approximately 31 days later.
To enroll, submit a completed insurance enrollment form (pdf) to the Lab’s Benefits Office within 31 days of your PIE.
You may become eligible for LANS-sponsored benefits if you change employment status (e.g., change from contractor to LANS or limited benefits to full benefits). When this happens, contact the Lab's Benefits Office immediately by calling 505-667-1806 or e-mail the Benefits Office to determine when your PIE begins and to register for a benefits presentation. You will have a 31-day PIE from the date your employment status was changed
Families change and grow due to marriage, birth or adoption of children, and other events. If enrolling in a medical plan because of a family status change (e.g., marriage or birth of a child), you must request enrollment within 31 days from the date of the qualifying event (e.g., date of marriage or date of the child's birth).
To enroll, contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office.
If you are not enrolled in a medical plan, you and your eligible family members may enroll during Open Enrollment, which is usually held in November for coverage effective January 1st of the following year.
If you and/or an eligible family member involuntarily lose other employer-sponsored medical insurance coverage, you may enroll in one of LANS’s medical plans. A new PIE starts the day you lose coverage. You must furnish proof that other employer group coverage was lost.
To enroll e-mail the Benefits Office or call 505-667-1806.
If you are going on or returning from a change of station or extended travel and will be moving in or out of a service area, you may be able to change your insurance plan. Contact the Lab’s Benefits Office at 505-667-1806 or e-mail the Benefits Office about this change.
If you missed your PIE, you can still enroll in medical coverage at any time by submitting an enrollment form to Benefits; however, your medical coverage won’t go into effect for 90 calendar days from the day you submit your form.
LANL employees enrolled in a UnitedHealthcare plan can now easily access information on claim status. This on-line service is provided by UnitedHealthcare and allows you to:
Insurance card. If you don’t receive your UnitedHealthcare card within several weeks of enrollment (45+ days) contact UnitedHealthcare directly at 1-800-603-3816.
Contact customer service. To change your PCP, inquire about claims or covered services contact the UnitedHealthcare LANL representative.
Dispute with UnitedHealthcare. You should first contact UnitedHealthcare customer service directly at 1-800-603-3816 to resolve the issue. If you are unsuccessful in resolving the issue through this route, you can meet with the LANL UnitedHealthcare representative.
This is only an overview of the Select EPO medical insurance plan. For full details, refer to the Select EPO Summary plan description (pdf) for Los Alamos National Laboratory.
Questions? Contact the Lab's Benefits Office at 505-667-1806.