Additional Information

Frequently Asked Questions

    • Only the name of the Member (sometimes referred to as the “policyholder”) will appear on the ID card. Crossroads supplies up to 2 ID cards per eligible member and his/her dependents.
    • At the current time, the provider networks contracted with your health fund do not provide ID cards.
    • A PPO, or Preferred Provider Organization, is a managed care organization of medical providers, such as physicians, hospitals, and other facilities, that is contracted with your health fund to provide healthcare services at reduced rates to health fund members.  Physicians, hospitals, and other facilities that are a part of the PPO, or sometimes referred to as the Provider Network, are considered In-Network providers.  Those that are not a part of the PPO are considered Out-of-Network.


    • The Plan of Benefits is an employee welfare benefit plan established, maintained, and amended from time to time, by the Board of Trustees of your health fund.  The Plan of Benefits determines the types of services that are covered by the plan and those that are not covered.


    • For services that are covered by the plan and performed by an In-Network provider, there is little or no cost to the patient.  For services that are either not covered by the plan, or performed by an Out-of-Network provider, there is typically an out-of-pocket cost to the patient, which can be very costly.
    • A COB form, or Coordination of Benefits form, is a form that must be completed and signed by all eligible members in order for their claims to be processed and paid correctly.  The primary purpose of this form is to determine if your health fund should be the primary or secondary payor of medical claims for a patient who has coverage from more than one health insurance policy.


    • There are many instances where two Group Health Plans or a Group Health Plan and a homeowner’s, automobile, general or other liability insurance policy may be available or may pay benefits for you.  For that reason, the Plan has rules which may affect the benefits payable.  These rules are called Coordination of Benefits.  With Coordination of Benefits, if you are also covered for health benefits under any other group plan or program, the total payment from all sources combined may not exceed one hundred percent (100%) of the Allowable expenses.  Allowable expenses are any necessary, reasonable and customary services or treatments, at least a part of which is eligible for reimbursement by the Plan or any group health plan or homeowner’s, automobile, general, or other liability insurance policy that covers you.  On the COB form, you must report any of the following coverage and any changes to that coverage:
      • Group health benefits provided by any other employer or organization; or
      • Healthcare benefits provided under homeowners, automobile, general, or other liability insurance policy; or
      • Governmental programs including Medicare or Medicaid; or
      • Coverage required or provided by law.


    • The Coordination of Benefits rules apply whether or not you file a claim under the other plan.  Your health fund may require written documentation regarding the existence of, or changes to your other insurance coverage.
    • An Accident Injury Inquiry form asks how, when, and where an injury occurred and if it was caused by a third-party.  The primary purpose of this form is to determine if your health fund should be the primary or secondary payor of medical claims resulting from the injury.  This is a system-generated form based on the diagnosis codes provided by your doctor or as a part of the case management protocol.  In all instances, this form must be completed, whether you suffered an injury or not, in order for all claims related to the injury or incident to be paid.
    • If you’ve been injured in a motor vehicle accident, the medical claims related to that accident must be submitted to your state’s No Fault Insurance carrier.  For all motor vehicle accident scenarios, your state’s No Fault Insurance carrier is the primary payor on all related medical claims and your health fund is secondary.
    • Even if you have Medicare parts A or B, as long as you are an active, eligible member of your health fund, the health fund will be your primary coverage for medical claims.
    • Most elective procedures require Authorization in order for the claims resulting from that procedure to be paid. To determine whether the procedure requires Authorization, please refer to your Summary Plan Description and call the Case Management Department of Crossroads at the designated toll-free number for your health fund.