Frequently Asked Questions

Blue Shield, CVS/Caremark and Guardian will send you an ID card upon enrollment.  The ID cards are printed in the name of the member only.  Please note that it may take a few weeks after you turn in your paperwork to receive your ID cards.  You can always call the carrier directly to obtain your account numbers, should you need them before you physically receive your cards. 

VSP does not issue ID cards.  You will need to provide your social security number to the provider, who will have access to check your benefits.

CVS/Caremark provides the pharmacy benefits for all plans other than the Pine HSA plan.  If you are on the Pine plan, your ID card will be provided by Blue Shield of California.

The most up-to-date list can be found in the provider directory on each carrier’s website (see the Contacts tab).  Once on the website, you can login to your account and use the provider search tool.  Blue Shield and VSP will automatically link you to the correct provider list.  For Guardian, there are two network lists.  The first can be found on their website under DentalGuard Preferred.  The second is a custom directory just for NCSMIG members, which is available from your district benefits coordinator.  These providers only contract with Guardian for members of NCSMIG.  While these are the most recent versions of the contracted providers, for all carriers, it is your responsibility to double check their contract status before obtaining services.

Open Enrollment is the set time each year when you may change your Medical plan or add dependents that weren’t added during their initial enrollment eligibility period.  Open Enrollment is held during the month of May each year.  All change requests, including required official documentation, must be received by NCSMIG during the Open Enrollment period.  Any requests received after that time will not be processed. 

The new plan will be effective on July 1^st, with any accrued deductible amount automatically applied to the new plan.  You will NOT have to restart a new deductible.  Although, if the new plan has a higher deductible than the prior plan, there may be an additional amount that needs to be met before the new plan begins paying claims.

Any changes, including, but not limited to, addresses, phone numbers or addition or deletion of dependents, must be initiated at your district office.  The district will provide you with a change form, review it for completeness and forward it to NCSMIG for processing.  NCSMIG does not accept any applications or changes that have not first been initiated at the district level.

You may add eligible dependents to your plan during their initial eligibility period or during the annual Open Enrollment period.  In very limited circumstances, there may be other times where a loss of alternate coverage may trigger a special enrollment period.  There are very specific timelines for enrolling your eligible dependents.  If you don’t properly enroll your dependents and you miss your deadline, you must wait until the next Open Enrollment period. 

Please note that in California it is your responsibility to obtain paperwork, such as a birth or marriage certificate, from the County office of Vital Records where the birth or marriage took place.  They are not automatically sent to you; you are responsible for requesting them.  Please check with the County that holds your records for their process on how to request your information. 

If a provider is contracted for services, they are required by the terms of that contract to timely submit your bill directly to the carrier for payment. Once that payment is processed, you should receive an Explanation of Benefits (EOB) from the carrier and a bill from your provider for any amount that is remaining.  It is strongly suggested that you save your EOBs and match the payment amounts to your provider’s bill before remitting payment.

Occasionally procedures are billed incorrectly or have payment rejected due to missing information from the provider.  If you have questions about an EOB or bill, please contact the provider or carrier directly to verify claim payment information.  If you are still in need of help after contacting the carrier, please feel free to contact our office for assistance at 707-445-7126.

Registered participants have access to U.S. licensed doctors 24/7.  Doctors can diagnose, treat and prescribe medications when needed for non-emergency conditions by phone, web or Teladoc app. Set up your account today so when you need care, a Teladoc doctor is just a call or click away!  Please see the Medical tab at the top of the page for more information on Teladoc services and how to register.  It’s quick, easy, and free for members of the Oak, Spruce or Maple plans! (Per IRS guidelines, members of the Pine plan must meet their annual deductible before the plan will pay for any claims, including prescriptions and Teladoc visits). 

Teladoc can be reached at 1-800-835-2362.  If you have not set up your account before calling, your first visit may require a short enrollment process.  Save time before your appointment by visiting teladoc.com/bcs and register today!  You may request an appointment via the website, app or by phoning Teladoc. 

Registered participants 13 years and older can receive mental health care by appointment 7 days a week, 7am – 9 pm Pacific time, from a psychiatrist, psychologist, licensed clinical social worker or therapist.

Teladoc does not offer a crisis hotline, appointments must be scheduled online.

Teladoc is a supplemental service that is not intended to replace care from your physician or mental health professional.

If you see an out-of-network provider, it is your responsibility to seek reimbursement directly from Blue Shield as your provider will bill you at the time of service.  The provider should give you a detailed receipt that includes their information, the date of service, a diagnosis code, a procedure code, detailed charges and more. You can submit this receipt, along with a claim form, directly to Blue Shield.  More information on how to get reimbursed can be found under the Medical tab at the top of the page.

If you are enrolled in a NCSMIG medical plan, then you have prescription drug coverage through either CVS/Caremark (Oak, Spruce, Maple plans) or through Blue Shield of California for Pine plan participants.  Please see the Medical plan comparison chart for a SUMMARY of basic benefit details, this is not a complete list and is used as a guide only, please consult your plan Summary Plan documents (SPD) or CVS/Caremark (for Pine plan participants only, Blue Shield of CA) for specific coverage information.

There are many reasons why a prescription may be initially denied at the pharmacy.  The most common reason is that your prescription ran out of renewals, and you need your provider to write you a new prescription.  Other reasons may be that your requested medication isn’t standardly covered on our plan, may require prior authorization from CVS/Caremark or Blue Shield in order to be processed or is a maintenance medication that requires the use of mail order (unless you have opted out of the mail order program). 

If you are having problems, your pharmacist should contact the Customer Service number listed on the back of your ID card for help.  If they are unable to help you, please feel free to contact our office for assistance at 707-445-7126.

Using the mail order program for your prescriptions can save you a considerable amount of money by providing you with a combined three-month prescription instead of paying each month.  Some specialty medications may not qualify for the reduced copay.  In order to facilitate enrollment, you will first need to have your provider write you a prescription for a 90-day supply with 3 refills, as opposed to the standard retail 30-day prescription with 11 refills.  This prescription must be provided to CVS/Caremark to initiate the program.  You will order your refills via the CVS/Caremark website. 

Alternatively, you may choose to have your medication sent to your local CVS Pharmacy where you can pick it up at your convenience.  To get started with mail order, please contact CVS/Caremark at 800.552.8159 or use the main customer service number listed on the back of your ID card.

Livongo is an innovative Diabetes management program that provides eligible members with:

• Access to certified diabetes educators
• A connected blood glucose meter that offers automatic data uploading, real-time insights and feedback on your readings
• Unlimited test strips and lancets that can be ordered from your glucose meter to be delivered to your door

Dental is a defined benefit plan.  This means you are allowed certain percentages for treatment, such as basic or prosthodontics procedures.  You are also allowed a maximum for annual payments, as well as a lifetime maximum payment for orthodontic work.  Please contact your district benefits representative for more information on your specific plan.

To incentivize members to proactive good oral preventative maintenance, we will pay up to 100% of the allowed amount for most services, just so long as you have at least one dental bill processed per calendar year.  The first year you are in the program, you will have your bills processed at 70% and will increase 10% each year you utilize services, until you reach 100%.

If you miss a year, you will drop down by 10%.  However, if you go again, you will go back up 10% the following year.  Your incentive level will remain the same if you transfer employment between other districts insured through NCSMIG.  Incentive levels are tracked individually for each member of your family, not for the plan as a whole.

Dental benefits are on a January through December, or calendar year, benefit period.  Please note that each plan has an annual maximum of $1,500, $2,000 or $3,000 per calendar year, as well as certain sublimit categories and lifetime maximums.

The plan covers two exams and two cleanings per year.  You are responsible for any exams or cleanings beyond the two covered by the plan.

Orthodontic coverage varies per plan.  Every plan has a lifetime maximum that is payable, per person, for orthodontic coverage.

You can easily check your vision benefits online at www.vsp.com.  You can see the benefits available to you, as well as the timeframe in which you can next receive covered services.  Unlike Medical and Dental, Vision benefits are payable every 12 to 24 months, not on a calendar year basis.  You are responsible for any amount above the coverage limit listed under your plan benefits.

Eyeconic is an online service provided by VSP that provides frames and lenses that will be delivered directly to you.  If you are not satisfied with your purchase, simply return it for a full refund.  Eyeconic allows you to upload a photo of your face to your account and “virtually” try on different styles and colors of frames.  Please see www.eyeconic.com for coverage options and limitations.

Contracted providers will gladly bill VSP for you and are able to see your benefits online at VSP’s website.  Other providers who are not contracted with VSP will charge you upfront and will provide you with a detailed receipt you can use to submit to VSP for reimbursement.  See the Vision tab for more detailed information on how to seek reimbursement from VSP.  A list of contracted providers in your area can be found at www.vsp.com.

All retirees have the right to stay on any or all of the NCSMIG plans after you retire.  However, if you decline benefits when you retire, you will not be able to return to the program(s) you declined. Please feel free to call NCSMIG at 707-445-7126 to discuss your eligibility after you retire.

It is your responsibility to notify NCSMIG, through your district benefits coordinator, when you or your dependents are first eligible for Medicare due to age or disability.  If you fail to timely notify your district, or enroll in Medicare, you are responsible for any premiums or surcharges that assessed once your enrollment status is corrected.  This can add up very quickly, so please make sure you stay on top of the process.  Please feel free to call NCSMIG at 707.445.7126 to discuss your enrollment timeframe and the steps you need to take to properly enroll or if you meet the criteria for delayed enrollment.

HICAP stands for the Health Insurance Counseling and Advocacy Program and is run by the California Department of Aging.  HICAP is a government-funded resource to help you navigate the intricacies of understanding and enrolling in Medicare.  They provide free one-on-one Medicare counseling services.  It is highly recommended you contact HICAP for a counseling appointment at least 90 days prior to your initial Medicare eligibility, due to either age or disability.  To find the HICAP office closest to you, please visit www.cahealthadvocates.org.