Group Health Care Program

Nationally, the trend in the cost of providing health insurance has been increasing, and the greatest challenge for the Cultural Alliance is to offer plans suitable for our members at affordable rates. To meet that challenge we have partnered with Potomac Companies, Inc to provide a solution.

Cultural Alliance of Greater Washington is pleased to be able to offer a suite of affordable healthcare options. Eligible members may apply for coverage from UnitedHealthcare, the nation's largest managed healthcare company, Denex Dental, whose in-network dentists meet strict credentialing standards and Advantica EyeCare, who boast a national network of providers that includes over 10,000 vision care professionals. Some features of our program and plans are:

• Choice of coverage plans
• Annual opportunities to change
• No limits on the number of times you can see a provider
• No pre-authorization of services
• In and out-of-network coverage

Our health insurance year begins in May and extends to the end of April of the following year. Members may enroll in the program at any time during their membership.

CAGW is a non-profit arts and cultural organization, not an insurance company. Members are responsible for their own decisions regarding their own healthcare. You must review each plan carefully and decide what works best for you. CAGW cannot make any representation about the suitability or sufficiency of health insurance for any member.


Open Enrollment

This year Open Season occurs in April of the plan year. All participants who have not continued enrollment in the program will be terminated effective May 1st. To reinstate coverage please contact the CAGW Healthcare Administrator.

Open Enrollment Meetings

April 16, 2008 8:30 AM Click here for meeting information

April 21, 2008 1:30 PM Click here for meeting information

Plans and Rates
Contact Information
Enrollment and Change Forms


Eligibility Requirements

CAGW members are entitled to enroll themselves and their qualified dependents (spouse and/or dependent children up to age 19) in the CAGWHP as long as all eligibility requirements listed below have been met. A Student Certification is required for dependent children ages 19-23 who are fulltime students at an accredited school or college.

Enrollees must be:

• CAGW members in good financial standing
• Current dues-paying CAGW individual members
• CAGW member for 90 days (to participate in any insurance plans; no waiting period for discount or service plans). Former members, whose CAGW membership has expired less than 6 months, can rejoin the CAGW and enroll immediately in the CAGWHP. The 90 day waiting period applies to all members who rejoin the CAGW after a 6 months lapse.
• Members must be US citizens or hold a permanent visa.
• Employees of CAGW member organizations, who are eligible to participate in the CAGWHP and enroll in any insurance plan when the organization meets the 90 day membership requirement. The member organization must agree not to offer any competing health plan other than the CAGWHP to their employees. No waiting period applies if an organization wishes to enroll employees in a discount or service plan.

Click here for a printable copy of CAGW's policies and procedures.


Benefits Administration

Potomac Companies is one of the premiere brokers in our region. Established in 1990, Potomac Companies has a staff of 20 that services the metropolitan Washington area.

In addition to standard benefits management, Potomac Companies provides dedicated staff persons that will work with members on claims, eligibility issues, and carrier service related inquiries.

Sample Customer Service Issues Include:

• Denied claims
• Claims paid incorrectly
• Employee & dependent eligibility
• Medical/dental/vision care cards not received or lost
• Plan coverage of specific services
• Service providers not submitting claims correctly or at all
• Service providers balance-billing when not appropriate
• Non-network provider negotiation of service costs
  

Forms

ENROLLMENT

New Program Participants: Please download the applicable form to request participation in the CAGW Healthcare Program. Next download the form for the plans that you wish to enroll in from the Forms section.

Individual Members

Group Members

CHANGE OF PROGRAM PARTICIPATION STATUS

Individual Members

Adding/ Changing/ Terminating Coverage

Terminating Participation from the CAGW Healthcare Program

Group Members

Adding New/ Changing Coverage/ Terminating Participants

Terminating Participation from the CAGW Healthcare Program

CARRIER FORM

UnitedHealthcare Enrollment/ Waiver Form

Denex Dental Enrollment/ Waiver Form

Advantica Eye Care Enrollment/ Waiver Form

Update or Change Contact/ Payment Information

To download forms, you must have the free Adobe Reader software.


Questions/Contact Information

New Program Participants/ Program Eligibility/ Billing Inquiries/Terminations / Reinstatement:
Taisha Parrott, Healthcare Administrator
202-638-2406 extension 18
202-638-3388 (Fax)
tparrott@cultural-alliance.org

Coverage/ Claims:
Fred Smith, Customer Service Manager
(800) 230-0770
(301) 840-0770 extension 107
fsmith@potomacco.com

Change in Enrollment/ Adding New Enrollments:
Sandra Nnaji, Customer Service Assistant
301-840-0770 extension 101
301-840-9607 (Fax)
sandra@potomacco.com

Policies and Procedures Manual

Provider Contact Information:

UnitedHealthcare 1-866-425-2323
http://www.myuhc.com

Allied EyeCare 1-800-336-8467
http://www.AlliedEyeCare.com

Denex Dental 1-866-433-6392
http://www.denexdental.com/members.htm