HELFO FAQ's

ELIGIBILITY

  1. Who is eligible for coverage through Equian?
  2. Insurance cards
  3. Will each family member receive an insurance card?
  4. Where do I obtain an enrollment form (svarskjema)?
  5. Coverage for dependents
  6. Termination of coverage for students
  7. Am I covered with Equian during my Optional Practical Training (OPT)
  8. How do I apply for voluntary membership?
  9. If I am a voluntary member, will I be covered through Equian?

 

POLICY INFORMATION

  1. What treatment or treatment categories are not covered?
  2. What is my deductible?
  3. Do I have to pay co-insurance?
  4. Is pre-existing conditions covered?
  5. Routine visits
  6. Well baby care
  7. Vaccinations
  8. Well baby care and vaccinations are covered in Norway, why is it not covered while I am in the US?
  9. Mammogram
  10. OB/GYN
  11. Maternity
  12. Abortion
  13. Infertility treatment
  14. Dental
  15. Physical Therapy
  16. Occupational Therapy
  17. Speech Therapy
  18. Psychotherapy
  19. Chiropractic treatment
  20. Prescription medication
  21. Supplies
  22. Durable Medical Equipment
  23. Vision
  24. Inpatient Hospital
  25. Surgery
  26. Ambulance
  27. Experimental treatment
  28. Death
  29. Repatriation/medical evacuation
  30. Lifetime/per illness maximum

 

CLAIMS PROCESSING

  1. While I am in the US, how will my claims be handled?
  2. How do I find a doctor?
  3. What is a Preferred Provider (PPO)?
  4. Why would I want to look for a PPO provider first?
  5. Do I need to pay at the time of service?
  6. The provider I contacted will not accept my insurance card, what do I do?
  7. Where do I send a payment for my deductible?
  8. I keep receiving bills in the mail, what do I do?
  9. What type of information do you need to be able to reimburse me for medical expenses?
  10. Where do I submit claims for reimbursement?
  11. I do not agree with the decision you have made on my claim, what do I do?
  12. How are claims payments made?
  13. What exchange rate will be used?
  14. What can I expect for turnaround time for claims payment?
  15. Where will my claim reimbursement and explanation of benefits (EOB) be mailed?
  16. Are claim submissions acknowledged?
  17. Can I see my claim reimbursement on the website?

 

OTHER

  1. What if I have other insurance?
  2. What do I tell the provider if I have insurance with two companies?
  3. I need to waive my school insurance, what do I do?
  4. I have old claims I would like to be reimbursed for, can I submit these to you?
  5. When do I need a referral?
  6. I have received an injury questionnaire, why?

 

ELIGIBILITY

  1. Who is eligible for coverage through Equian?

Compulsory members, such as:

  • Students
    A student is covered as long as he/she is a full time student and receives financial support from the State Educational Loan Fund (laanekassen) in Norway. Also, students without financial support from the State Educational Loan Fund have the same rights as mentioned above when studying abroad for a maximum of one year. It is presupposed that they are full-time students at an educational center abroad.
  • Consulates & Embassy employees
  • Military staff
  • Pensioners
  • Voluntary Members, Subject to approval from HELFO

 

  1. Insurance cards

Insurance cards are sent by Equian. Cards are automatically sent to Embassy staff and military members upon receipt of completed enrollment form.

All other members must contact Equian directly by phone or email (helfo@Equian.com) to advise of your US address. Cards can also be sent to Norway if you have not arrived in the US yet.

 

  1. Will each family member receive an insurance card?

Yes.

 

  1. Where do I obtain an enrollment form (svarskjema)?

Contact the Ministry of Foreign Affairs or click on the following links:

 

  1. Coverage for dependents

Any direct child of a member is automatically covered through Equian/HELFO upon receipt of the completed enrollment form.  They will be covered under the main member.  Please contact our office to register any newborn.  Spouse or dependents with common child is compulsory members as long as they are provided for and are Norwegian citizens. Please contact our office for information.

 

  1. Termination of coverage for students

Generally you have full coverage until the first Sunday in the month following your last exam.  After this you have reduced coverage through HELFO directly.  This means that you have to pay all charges after this period yourself and submit to HELFO for consideration.  However; if you start working you are no longer covered, but can apply for voluntary membership.

 

  1. Am I covered with Equian during my Optional Practical Training (OPT)

No. As soon as you start working, you are no longer covered with Equian/HELFO.  However, you can apply for voluntary membership in which you will be covered through HELFO directly.

 

  1. How do I apply for voluntary membership?

Go to www.HELFO.no and find detailed information about voluntary membership.  Click here to find the application.  This is to be sent directly to HELFO.  For further information contact HELFO directly.

 

  1. If I am a voluntary member, will I be covered through Equian?

Maybe. HELFO will determine if voluntary members may be covered through Equian.

 

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POLICY INFORMATION

  1. What treatment or treatment categories are not covered?

 

Acupunture Regular dental work/School dental service
Aromatheraphy Routine check-ups
Homeopathy Infant welfare
Naprapath Vaccinations
Optician Experimental treatment
Osteopath Medical certificates
Cosmetic treatment

 

Please note that this list is not complete.

 

  1. What is my deductible?

The deductible is $263.17.  This is taken in 25% increments.  Children under 16 years of age have no deductible. Please note that the amount of the deductible changes each year.

 

  1. Do I have to pay co-insurance?

No, unless specifically stated otherwise.

 

  1. Is pre-existing conditions covered?

Yes.

 

  1. Routine visits

Not covered, except annual well woman examination (including pap smear and mammogram).

 

  1. Well baby care

Not covered.

 

  1. Vaccinations

Most vaccinations not covered.

 

  1. Well baby care and vaccinations are covered in Norway, why is it not covered while I am in the US?

When you travel abroad, the coverage is not always the same as if you were in Norway.  Well baby care and vaccinations are not governed by “trygdeloven” when you travel abroad, and are therefore not covered.  As an example, schooling is free in Norway.  However, when you travel abroad you will no longer have this right.  The same is for well baby care and vaccinations.

 

  1. Mammogram

Covered.  25% deductible will apply if not already met.

 

  1. OB/GYN

Covered. 25% deductible will apply if not already met.

 

  1. Maternity

Covered.  No deductible.

 

  1. Abortion

Covered. No deductible.

 

  1. Infertility treatment

Coverage is available.  Please contact our office for details.

 

  1. Dental

Treatment of tooth decay and cleaning is not covered. Impacted wisdom teeth are covered with reimbursement of fixed amounts that are approved in Norway; this includes x-rays and anesthesia.  Gum disease (periodontal disease)/braces might be considered.  Other oral surgical treatment may also be considered.  Please contact our office for information.

 

  1. Physical Therapy

A referral from a Medical Doctor is needed.  24 sessions each 6 months period is covered and a total of 48 sessions a year.  If you need more PT than this, please have the treating physician send us medical records to approve further sessions.   Physical therapy is covered at 75%.  If physical therapy follows surgery therapy is covered at 100% for six months.

 

  1. Occupational Therapy

Not covered.

 

  1. Speech Therapy

Coverage is available.  Please contact our office for details.=

 

  1. Psychotherapy

Psychotherapy must be performed by a psychologist (PhD) or psychiatrist (MD).  If you are seeing a PhD, a referral from an MD is needed. In serious cases of mental disturbance please contact our office.

 

  1. Chiropractic treatment

Limited coverage.  Please contact our office for details.

 

  1. Prescription medication

Please pay prescription medication up front and submit the original receipt to Equian for consideration.  The receipt must include the name of the doctor who prescribed the medication, the date it was prescribed, the name of the drug, and the total charges.

Only Blue Card prescriptions are covered.

Blue Card prescriptions are drugs for chronic conditions (ex. Diabetes, heart, depression etc). This is applied towards the ded of $263.17, but taken in 38% increments. After deductible is met, Blue card is covered at 100%

If you have questions whether the drug you are using is a blue card or white card prescription, please contact our office.

 

  1. Supplies

Generally not covered.  Contact our office for details. 

 

  1. Durable Medical Equipment

Generally not covered.  However, please forward medical records and/or doctor’s prescription to our office for consideration. 

 

  1. Vision

Coverage is available for the eye exam.  However; glasses or contact lenses are not covered.  Exams by an optician are not covered.

 

  1. Inpatient Hospital

Necessary inpatient services in hospital in a semi-private room are covered in full, including psychiatric hospitals and maternity clinics.  Necessary laboratory tests, x-rays, pathology, anesthesiology, etc. relating to the hospitalization dates are also covered in full.

 

  1. Surgery

If your medical doctor recommends a surgery, please contact our office for approval.

 

  1. Ambulance

Covered.  No deductible.

 

  1. Experimental treatment

Not covered.

 

  1. Death

Necessary funeral expenses abroad are covered in full.  Transportation expenses of cinerary urn or bier to Norway are also covered in full.

 

  1. Repatriation/medical evacuation

May be considered on a case by case basis; if medically necessary and approved by the Norwegian government then the reasonable charges are covered. Medical evacuation is never requested or required by Equian/HELFO.

 

  1. Lifetime/per illness maximum?

Unlimited

 

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CLAIMS PROCESSING

1.      While I am in the US, how will my claims be handled?

HELFO will administer services and claims in the US through Equian.

 

2.      How do I find a doctor?

The first option is to use the Equian website to find a Preferred provider.  The site is www.equian.com.  The site has an online, searchable physician and provider lookup, and other information.

The second option is to look for an out-of network provider.  In this case, you can use any physician of your choice.

 

3.      What is a Preferred Provider (PPO)?

A PPO is a group of hospitals, physicians and other health care providers who agree to provide health care services at pre-negotiated rates to plan participants.  These providers must all meet strict credentialing and re-credentialing requirements in order to be admitted and stay in the PPO Network.

 

4.      Why would I want to look for a PPO provider first?

Your per time deductible will be less.  Also, because we are in network with these providers, you should not have any problems with them arranging direct billing with our office.

 

5.      Do I need to pay at the time of service?

Equian has in place direct billing arrangements with a number of medical providers, and will set up others, when requested and if possible.  When arranging care with the medical provider, please present your insurance card.  This card details the information necessary to do direct billing.  If the provider does not accept the insurance card you can request Equian to set up direct billing so you do not have to pay at the time of service.

 

6.      The provider I contacted will not accept my insurance card, what do I do?

It is very likely that the provider has not heard of Equian before.  However, when presenting your insurance card, they will see the different PPO networks that we are affiliated with.  If the provider is affiliated with the same networks they should be able to bill us directly.

However, if the provider is not affiliated with any of the same networks as our office, they most likely will not accept your insurance because they think you do not have out of network benefits.  This is incorrect.

Therefore, if you have any problems with the provider not accepting your insurance, please either contact our office or have the provider contact our office so we can verify your coverage and arrange for billing.

 

7.      Where do I send a payment for my deductible?

Upon completion of processing your claim, we will send a check and an EOB (“Explanation of Benefits”) to the provider.  An EOB for this payment will also be sent to you if we have your U.S. address.  This will explain how we have processed your claim and will tell you what your responsibility is.  The provider will then bill you for what you are responsible for and you should submit a payment directly to them.

 

8.      I keep receiving bills in the mail, what do I do?

The billing practices in the US are quite different, thus, we would like to advise you that it is not uncommon for the hospital and physicians to bill you at the same time they bill our office.  As well, there also may be medical providers that have not sent the bills to our office, expecting that you will forward them to us.

In case you do receive bills from the hospital or doctor’s office, please forward them to our office together with a copy of your insurance card.  However, please note that the bill may also be for your deductible, and therefore be your responsibility.  If you are unsure if this is something you need to pay or not, please contact our office for information.

 

9.      What type of information do you need to be able to reimburse me for medical expenses?

We need an original itemized bill that indicates the following:

  • Provider’s name and tax identification number
  • Date of service
  • Charges
  • Diagnosis (ICD-9 codes)
  • Procedures (CPT codes)

For prescription we need the original prescription receipt that includes the patient’s name, the name of the drug, the name of the doctor who prescribed it, the date it was filled, and the total charges.

 

10.  Where do I submit claims for reimbursement?

You can send any correspondence and/or claims to be refunded to our physical address at: Equian, 5975 Castle Creek Parkway, Suite 100, Indianapolis, IN 46250.

However, for claim submission by providers, use the address of Equian, P.O.Box 91250, Milwaukee, WI, 53209

 

11.  I do not agree with the decision you have made on my claim, what do I do?

If you do not agree with the decision of how your claim was processed, we encourage you to send an appeal or complaint.  You may appeal against any decision you disagree with.  The appeal must be presented within six weeks from the day you received notification of the decision.  Please write the appeal in English.  You can address this to Equian.  HELFO will then review for possible reconsideration.

 

12.  How are claims payments made?

Normal payments is by check

 

13.  What exchange rate will be used?

The exchange rate for 2014 is $1 = NOK 6.  Please note that this is updated annually.

 

14.  What can I expect for turnaround time for claims payment?

From the time a clean claim (A claim where all the information is available for processing. If we do not have all the required information, we will request this either from you or directly from the provider.) is received, the average turnaround time is eight days.  From the time we have processed your claim, it generally takes 7-10 days before a check/EOB is sent out from our office.  Click here to see the claim flow for HELFO.

 

15.  Where will my claim reimbursement and explanation of benefits (EOB) be mailed?

Checks and EOBs will be mailed directly to the address that you have informed us of.  Therefore, you must ensure that Equian has your correct address.

 

16.  Are claim submissions acknowledged?

No.

 

17.  Can I see my claim reimbursement on the website?

At this time you are not able to see your claim reimbursement on our website.  However, we are working on creating this service for you.

 

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OTHER

  1. What if I have other insurance?

If there is another possible liable party (other insurance), in order to expedite the processing of your claim please advise our office of any known relevant information.

If your insurance is through an American insurance company, such as Aetna, Blue Cross Blue Shield etc., HELFO/Equian is secondary and will pay covered expenses not payable by your primary insurance.

However, if your other insurance is through Norway, such as Gjensidige and Ansa, HELFO/Equian will be your primary insurance.

 

  1. What do I tell the provider if I have insurance with two companies?

If the other insurance is through an American insurance company, such as Aetna, Blue Cross Blue Shield etc, inform the provider that they are your primary insurance and that Equian/HELFO is your secondary insurance.  This will prompt the provider to send bills to the correct place and will speed up the processing time.

 

  1. I need to waive my school insurance, what do I do?

Your university may ask you to complete a form ensuring that your coverage meets the insurance requirements defined by the university.  If required, please fax or email (helfo@equian.com) that form to our office to complete the specifications of your policy.  We also have standardized letters about your policy coverage that we can send to your university.  This may prevent demands from your university to purchase additional coverage.

 

  1. I have old claims I would like to be reimbursed for, can I submit these to you?

We must receive the first notification of a case within six months after the treatment for it to be covered.  Please note that even though you might not have notified us, we might have received bills or correspondence from the provider directly regarding your case.  Therefore, we recommend that you send all claims to us so we can review for coverage.

 

  1. When do I need a referral?

Your insurance policy requires you to have a referral from a Medical Doctor for physical therapy and for psychotherapy (see details above).

If you are seeing a specialist other than what is noted above, your insurance policy does not require you to have a referral from a Medical Doctor.  However, please note that the specialist may be the ones that require that you have a referral.

 

  1. I have received an injury questionnaire, why?

If the claim we receive indicates that you were treated for an injury, we will send you an injury questionnaire for you to fill out.  Since we are secondary to all other liable parties, we want to investigate possible other insurance regarding your injury.  Please note that we are not trying to put blame on anyone who may have caused the injury, but simply to find out if other insurance is available.

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