The Insurance Department routinely conducts new employee orientations as there are approximately 350+ full time regular employees working for the Hoopa Tribe throughout the year; however, that number can jump up to 700+ during peak seasons. Usually during a new employee orientation there are a few forms each employee must complete including updates to employee status if necessary, changes in health coverage if previously employed or if new dependents need to be added, Consolidated Omnibus Budget Reconciliation Act or COBRA notification, notification to Tribal Fiscal Department, and finally the review of the Health Plan Document which is also referred to as the Summary of Benefits Pamphlet.
          Sign up at www.anthem.com, or click on the anthem logo below 
     to review your benefits and see your medical insurance information online.

 


24/7 NurseLine

Your plan includes 24/7 NurseLine, a 24-hour nurse assessment service to help you make decisions about your medical care. When you call 24/7 NurseLine toll free at 1.800.700.0197, be prepared to provide your name, the patient’s 
name (if you're not calling for yourself), the beneficiary’s identification number, and the patient’s phone number.

In addition to providing a nurse to help you make decisions about your health care, 24/7 NurseLine gives you free unlimited access to its Audio Health Library featuring recorded information on more than 100 health care topics. To access the Audio Health Library, call toll free 1.800.700.0197 and follow the instructions given. We have made arrangements with an independent company to make 24/7 NurseLine available to you as a special service. It may be discontinued without notice.
Note: 24/7 NurseLine is an optional service. Remember, the best place to go for medical care is your physician.
Participating Providers
The claims administrator has established a network of various types of "Participating Providers". These providers are called "participating" because they have agreed to participate in the claims administrator’s preferred provider organization program (PPO), which is called the Prudent Buyer Plan. They have agreed to provide our members with health care at a special low cost.

All care must be provided, or coordinated by, a participating provider physician.
A directory of participating providers is available upon request. The directory lists all participating providers in your area, including health care facilities such as hospitals and skilled nursing facilities, physicians, laboratories, and diagnostic x-ray and imaging providers. You may call the customer service number listed on your ID card and request that a directory be sent to you, or you may search for a participating provider using the “Provider Finder” function on the claims administrator’s website at www.anthem.com/ca.
Non-Participating Providers
Non-participating providers are particular providers included in the Prudent Buyer network that have not agreed to participate in the Prudent Buyer Plan network. They have not agreed to the negotiated rates and other provisions of a Prudent Buyer Plan contract. Benefits are provided for them under the plan only for an emergency or for urgent care.

In addition, if you are a new beneficiary who enrolled in this plan as a result of the plan administrator changing health plans, and you are receiving services for an acute, serious, or chronic mental or nervous disorder from a non-participating provider, you may be able to continue your course of treatment with the non-participating provider for a reasonable period of time prior to transferring to another provider who participates in the Prudent Buyer Plan network. To request this continued care or to get a copy of the claims administrator’s written policy for this continued care, please call the customer service telephone number listed on your ID card.

Indian Health Service
Expenses for services or supplies which can be received or are received by an Indian Health Service provider will NOT be considered eligible under this plan. Expenses for services or supplies which are received from a referral by an Indian Health Service provider will NOT be considered eligible under this plan. Note: K’ima:w Medical Center is an Indian Health Service provider and any claim for services or supplies will be denied under this plan. Any claims denied to non-eligible Indians for services rendered at an Indian Health Service provider can be submitted for reconsideration to the plan administrator on a case by case basis.


The Hoopa Valley Tribal Council Employee Benefit Plan is a self-insured health plan funded by the Hoopa Valley Tribe. The United States, an Indian Tribe, or a Tribal Organization is prohibited from seeking reimbursement from a self-insured health plan funded by a Tribe or Tribal Organization for providing Health Services. See 25 U.S.C. § 1621. Based on the foregoing statements, the expenses incurred by the United States, an Indian Tribe or a Tribal Organization in providing health services to covered eligible Indians shall not be recoverable from the Employee Benefit Plan. Moreover, the Hoopa Valley Tribal Council has deemed that the Employee Benefit Plan is not an alternate resource for the purposes of the Indian Health Services payor of last resort rule pursuant to 42 C.F.R. § 136.61. Based on the foregoing statements and consistent with Congressional intent, any submissions to the Benefit Plan for reimbursement for direct care to covered eligible Indians are prohibited and shall be denied.

Vision
Along with Health Services, the Health plan covers Vision, Dental, and Prescription based services although they may be through seperate managing agencies. Vison services are covered under Guardian, which can be visited   at 
www.guardiananytime.com, or by clicking on the Guardian logo below.


Employees can sign in as a member on the website to see current actions on their account. Be sure to have your card available, or at least your Member ID (the subscriber's social security number) and Plan Number (G-00408520). The Plan Holder is the Hoopa Valley Tribal Council.
 Employees can visit vsp.com, or click on the VSP logo below to access the Vision Service Plan(VSP) provider listing online, or click here » VSP Participating Providers.pdf  for a list of local Vision Service Plan Participating Providers in our area.

                                   
Have questions about Guardian's VisionGuard Program? Please click here for a copy of the Benefit Summary for vision » Benefit Summary.pdf, or call Member Services at 1.877.814.8970.


The Hoopa Tribal Insurance Department is able to answer any questions you may have regarding your health insurance, as well as other facets of our health insurance program. Please click on the contact us link at the top of the page to view our employee directory.

Our goal is to ensure exess loss coverage is in place, reinsurance and excess policies are valid and in place, and that life insurance policies are maintained and premiums paid. We also initiate reimbursement when individual and aggregate stop loss is penetrated. It is necessary to monitor large claims management. We review montly premium statements for accurace. Our accountant prepares and monitors fund transfers for payment of claims. Additionally, we ensure and review the actuarial report before renewal to prepare for anticipated fund changes.