Questions

If your plan includes the Health Club Reimbursement benefit, you will see details in the “Supplemental Benefits” section of your SPD binder or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732.

The member and covered spouse are eligible to receive Health Club Reimbursement. Children and adult dependents are not eligible for this benefit.

The benefit is based on attending a gym an average of three times per week for a period of six months. The reimbursement is for $100.00 per individual after the completion of each six-month period. The entire six-month period must be while the member and/or spouse are enrolled in an Allegiant Care plan which covers the Health Club benefit.

At the end of the six-month period, complete the Health Club Reimbursement Form that was included in your SPD binder or you can find it under the “Forms” tab on the website.  The form must be completed in full, including dates of the six month period, a signature of a supervisor at the club, your signature and a print-out of your attendance.

The benefit is based on an average. This is why it’s important to include a print-out of the attendance. Most members will still receive their Health Club Reimbursement, even if they missed a couple of weeks of going to the gym.

You may contact Ann Simpson at Allegiant Care by calling (603) 669-4771 or 1-800-258-9732 Ext. 229.

Login to www.MyCigna.com or call Cigna at 1-800-244-6224.

Call Cigna at 1-800-244-6224. Have your card ready to provide your CIGNA ID, and know the date of service about which you are calling.

Under the CIGNA Open Access plan you do not need a referral. Keep in mind that sometimes having a referral from your PCP can help you to get an appointment with a specialist in a more timely manner. You will need to use an In-Network specialist in order to avoid being charged for deducible and coinsurance.

You may contact CIGNA by calling the Member Services Number on the back of your medical card. A customer representative will review the EOB (Explanation of Benefits) and advise you as to how and why the charges were processed. In some cases, the medical provider (doctor’s office) may have to be contacted to review the claim that was submitted to the insurance company.

Copays vary depending on the type of plan you have. Please refer to the medical section of your SPD binder or call Allegiant Care at (603) 669-4771 or 1-800-258-9732 if you have specific questions about your plan.

All scans/imaging must have pre-certification through CIGNA prior to the date of service. In order to receive the maximum benefit you should use a in-network imaging facility.

You should use an In-Network Urgent Care facility for non-life threatening illness or injury as the copay is less than had you gone to the emergency room for treatment. Visit www.cigna.com to locate In-Network Urgent Care facility in your area.

You only have your medical coverage through Cigna. If you have a separate vision benefit it is through EyeMed. If you have a separate dental benefit it is through Allegiant Care (unless otherwise specified). Prescription coverage is through Optum RX.

Vision services for medical conditions such as cataracts or diabetes will be billed under your medical benefit.

Effective 1/1/2023, Allegiant Care will offer a separate policy for dental or vision benefits. Contact us at 800-258-9732 ext. 235 for more details.

Yes, you must notify Allegiant Care immediately upon receipt of your Medicare cards and provide us with the effective date to ensure the proper processing of any claims.

Approximately 3 months prior to your 65th birthday you will receive a packet outlining your options when you turn 65.

Your spouse may continue on the Retiree coverage (subject to current eligibility rules) even if you do not elect any post-65 coverage with Allegiant Care.

You may enroll in Medicare Part A; however, you should defer your enrollment into Medicare Part B until you stop working. When you receive your Medicare cards you should contact the toll free number on the back and let them know that you are covered under an active group plan and will not be enrolling in Medicare Part B at this time.

S/he may enroll in Medicare Part A; however, s/he should defer enrollment into Medicare Part B until your group coverage ends. Once s/he receives his/her Medicare cards s/he should call the toll free number on the back and advise them that she is covered under an active group Plan and will not be enrolling in Medicare Part B at this time.

Call the Allegiant Care Dental department at (603) 669-4771 or 1-800-258-9732, select option 2.

You may see any licensed dentist in your area. Allegiant Care does not have a participating provider network for dental benefits. Please consult the Dental Fee Schedule 2024 for the maximum amounts paid for each service.

Neither. There is no network of dental providers; our members may go to any license dentist of their choice.

All the benefits are paid according to the Allegiant Care Dental Fee Schedule 2024. The fee schedule is the same for all four Allegiant Care dental plans. The member is responsible for any difference between the amount charged by the provider and the amount paid by Allegiant Care.

NOTE: Plan deductibles, calendar year maximums, and orthodontic maximums vary by plan.

Yes. To make an electronic claim submission use: Payer ID Number: 38238 and Group Number: R40.

The mailing address is: Attn: Dental Department, Allegiant Care, PO Box 4604, Manchester, NH 03108.

Call the Allegiant Care Dental department at (603) 669-4771 or 1-800-258-9732, select option 2.

Dental Fee Schedule 2024 It can also be found under “Forms” on the Allegiant Care website.

Dental Benefit Frequency Breakdown. It can also be found under “Forms” on the Allegiant Care website.

If you have CIGNA medical coverage through Allegiant Care, then you have access to the Health Education Reimbursement.

If you or a covered family member (including children) attends an approved Health Education class, you the covered family member can be reimbursed up to $100 per completed course with a limitation of 2 courses per year per individual. Reimbursement will go to the member if the claim is for a child under the age of 18, or if there is a note requesting that it should be paid to the member, not the child.

NOTE: You must attend at least 75% of the classes and successfully complete all class requirements to receive reimbursement.

There are over twenty Health Education courses eligible for reimbursement including: Cancer/Diabetes Education, CPR, Childbirth classes, Yoga, Babysitting, Weight Watchers^®, Smoking Cessation and Nutrition to name a few. The complete list can be found on the Health Education Reimbursement -CIGNA.

Yes. Just save your receipts until you have reached a $100.00, and mail them in with the completed Health Education Reimbursement -CIGNA to Allegiant Care; Attn: Health Promotion Department; P.O. Box 4604; Manchester, NH 03108

You can find the Health Education Reimbursement -CIGNA under the “Forms” tab of the website website or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732 Ext. 229 and request the form.

NOTE: The form cannot be completed online. You must print the form, and mail it to Allegiant Care; Attn: Health Promotion Department; P.O. Box 4604; Manchester, NH 03108.

You would contact Ann Simpson at Allegiant Care by calling (603) 669-4771 or 1-800-258-9732, extension 229.

You may change your primary care physician by calling the number on the back of your medical card or going logging into your account at www.mycigna.com.

You should always notify Allegiant Care of an address change. You may call Allegiant Care at 1-800-258-9732 or you may complete the Demographic Update Form and upload to www.myallegiantcare/send/.  You must also notify your employer of the change.

You should always notify Allegiant Care of an address change as soon as possible.

You can find applications packets for Short Term Disability Application under the “Forms” tab on the Allegiant Care website or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732 Ext. 211 and request the form.

NOTE: The form cannot be completed online. You must print the form, and mail it to Allegiant Care; Attn: Liz Macedo; P.O. Box 4604; Manchester, NH 03108.

Yes. With Short Term Disability you must be receiving medical attention by an MD. The doctor must complete an initial medical report and provide updates when requested in order for you to continue to receive the benefit while you are out of work.

No, you must contact your employer to file a Workers Compensation claim.

A FMLA (Family Medical Leave Act), if approved, helps maintain your job position and contributions will be sent from your employer to Allegiant Care for Health & Welfare benefits in order to stay eligible. Short-Term Disability is for Wage Replacement while out on a Medical Leave.

Apply for FMLA with your Human Resource Department and Short-Term Disability with Allegiant Care.

You can find applications packets for Short Term Disability Application under the “Forms” tab on the Allegiant Care website or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732 Ext. 211 and request the form.

NOTE: The form cannot be completed online. You must print the form, and mail it to Allegiant Care; Attn: Liz Macedo; P.O. Box 4604; Manchester, NH 03108.

The weekly benefit is payable after the first week has been withheld (seven calendar days from the date medical care was sought).  Payment on an approved short-term disability claim will begin on day 8.  The weekly benefit is payable for a maximum period of 26 weeks for all members.

No. Weekly reports are sent to your employer and your employer will include these amounts on the W-2 they issue to you.

No. We allow claims to be processed within a maximum of 60 days from the date of illness or injury for which you first sought medical attention.

Yes, you will need to update the address and phone number for yourself and your spouse (if known) as well as any children on your plan.

Yes. You will need to update the address and phone number for yourself and your spouse (if known) as well as any children on your plan. You will need to send in a copy of your finalized Divorce Decree as soon as it is available to you. You may fax it to 603-666-4477 or mail a photocopy to Allegiant Care; PO BOX 4604; Manchester, NH 03108.

Contact Allegiant Care at 1-800-258-9732 and update the address and phone number for yourself and your spouse (if known) as well as any children on your plan. You will need to send in a copy of your Divorce Decree as soon as possible. You may fax it to 603-666-4477 or mail a photocopy to Allegiant Care; PO BOX 4604; Manchester, NH 03108.

NOTE: If a member does not notify us of the divorce and claims are incurred, the member will be responsible to reimburse Allegiant Care for any claims paid after the divorce.

No, Allegiant Care does not cover stepchildren after a divorce. If a member does not notify us of the divorce and claims are incurred, the member will be responsible to reimburse Allegiant Care for any claims paid after the divorce.

If you Plan covers ex-spouses, s/he may be covered only if there is language in the Divorce Decree stating that you must provide coverage.  (You will need to confirm with your employer whether or not they will cover an ex-spouse.)

If you Plan covers ex-spouses, s/he may remain covered until one of you remarries, until s/he becomes eligible for Medicare, until s/he becomes eligible under another group plan, or in accordance with any state laws or statutes named within the Divorce Decree.

Your natural and/or adopted children may remain covered after a divorce.  You will be asked to provide an updated Coordination of Benefits  so that we are able to determine if Allegiant Care coverage will be primary or secondary.  Step-children are not eligible for coverage after a divorce.

We must have an official document to indicate a divorce has occurred and whether or not a member is responsible to provide coverage for the ex-spouse and/or provisions for children covered under the Plan.

We allow a 60-day grace period to send appropriate documentation. If you do not notify Allegiant Care of the divorce in the required time frame and claims are paid for an ineligible ex-spouse or ineligible step-child, you will be required to reimburse the cost of those claims. Furthermore, Allegiant Care may retract any outstanding claims and seek restitution, including legal expenses needed to obtain repayment.

An ex-spouse may elect to be covered through COBRA at their expense. It is the member’s responsibility to provide contact information for the ex-spouse.

If the ex-spouse has other coverage or becomes eligible for other coverage s/he is not eligible to be covered by Allegiant Care.

If the ex-spouse has Medicare or becomes eligible for Medicare, s/he is not eligible to be covered by Allegiant Care.

You should contact the Allegiant Care at 1-800-258-9732 as soon as your divorce becomes final so that we can update our records and mail a COBRA package to the member loosing coverage. Please review the COBRA Continuation Coverage document for more information regarding COBRA.

If you have medical coverage through Allegiant Care, then you have access to Hearing Aid reimbursement. The benefit covers the member and eligible dependents over the age of 19. You may find more details in the “Supplemental Benefits” section of your SPD binder.

The child’s medical provider must contact CIGNA with the procedure and diagnosis codes to verify coverage for those codes. If the charges are approved, the medical provider will submit their claims to CIGNA as Durable Medical Equipment. The member will be responsible for any applicable copays or coinsurance, dependent upon the facility used for evaluation.

You will be reimbursed 75% of the total cost up to $1500.00 for testing and/or hearing aids. The benefit is payable once every five (5) years.

The Hearing Aid reimbursement is 75% of the total charge, up to $1,500.00 no matter where you choose to go for treatment. You may also choose to go to an Epic Hearing Healthcare provider. Their hearing aid prices are discounted before you purchase them, eliminating the need to submit for reimbursement. Contact Epic Hearing directly at 1-866-956-5400 for names of specific network providers in your area.

After paying the provider in full, you should submit a copy of the itemized, paid receipt to Allegiant Care for reimbursement. Attn: Hearing Department; Northern New England Benefit Trust; PO Box 4604; Manchester, NH 03108.

A member receives a Pay-in when they do not meet the minimum required monthly hours to maintain their coverage. The Pay-in amount is calculated by multiplying the number of hours the member is short for the month by the employer’s current hourly rate.

At this time, we are only able to accept check or money order mailed to Northern New England Benefit Trust; Attn: Pay-In; PO Box 4604; Manchester, NH 03108. Cash and charge cards are not accepted.

Any disputes must go through your employer. We are only able to confirm what hours were remitting by your employer each month.

Allegiant Care’s I.T. systems and data protection protocols exceed the requirements laid out by the government to protect member information. We utilize enterprise level encryption, continuous monitoring, NextGen security software, and third party audits. In addition, our staff is regularly trained regarding best practices for protecting your data. While no entity can ever provide a 100% guarantee, we are extremely security-driven and will continue to adapt and implement the latest software and methodologies to stay at the forefront of cyber security.

If you choose not to pay in, your coverage will terminate on the date indicated on your Pay-in Notice. The only way you can be reinstated once your coverage terminates (and the due date for the Pay-in option has passed) is by meeting the reinstatement requirements (see your Plan’s eligibility rules for reinstatement requirements ).

NOTE: there is no Pay-in option for reinstating your coverage once you allow your coverage to terminate, so it is possible that you could remain ineligible for an indefinite period of time if you continually work fewer than the minimum required hours to reinstate.

The minimum work hours required to become eligible for benefits is determined by your employer and is listed on your Pay-in Notice.

By law we must include COBRA information with your Pay-in Notice. For some members who are not returning to work, this may be a more financially suitable option as it is tiered (based on the number of dependents). You may contact Jacky at Allegiant Care (1-800-258-9732 Ext. 235) if you would like to discuss these options further.

Pay-in due dates are firm and the envelope must be post-marked by the Post Office no later than the due date to be considered on time. Always refer to the Pay-in Notice for the proper due date.

Coverage will term if payment was not received by the due date. However, if your payment arrives with a postmark on or before the due date, your coverage will be reinstated retroactively. Please allow 5 to 7 business days to process your payment.

Hours worked this month provide eligibility for insurance coverage in three months. For example: June work hours will determine eligibility for coverage in the month of September. The pay-in is applicable to the employment period and coverage month listed.

Your SPD binder outlines which benefits your Plan includes, or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732.

In order to receive the maximum vision benefit, you should use a EyeMed Provider. You can search for in-network providers by visiting https://www.eyemed.com/en-us and clicking the “Find an eye doctor” in the top banner.

You can search for in-network providers by visiting https://www.eyemed.com/en-us and clicking the “Find an eye doctor” in the top banner.

For member/spouse and adult dependents age 19 and over, the benefit may be used once every 24 months. For children age 18 and under, the benefit may be used once every 12 months.

No. EyeMed does not require that you use your vision benefits only on the day of your exam. The waiting period will reset at 12 or 24 months, depending on your plan, for each portion of the vision benefit (i.e., exam, glasses, frames or contacts). Be sure to register an account on EyeMed Website to review the specifics of your plan and see when you are eligible to use your vision benefits.

Qualifying Event can be any of the following:

• Change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.
• A change in the number of dependents, including birth, death, adoption and placement for adoption.
• A change in employment status of the member’s dependent spouse and/or adult dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in work site, or a change in employment status which results in a change in benefits s/he receives or is eligible to receive.
• A change in the employment status of the member’s adult dependent child that results in loss of access to employment-based group insurance.
• A dependent’s loss of eligible status.
• A change in the place of a dependent’s residence making the current Plan unavailable.
• Open enrollment under the Plan available through the dependent spouse’s employer.
• Judgments, decrees or orders.
• Significant cost or coverage changes under the member’s Plan.
• Entitlement to Medicare or Medicaid.

Step-children can be added to your policy as long as Allegiant Care receives all the required documentation.  You should download and complete the Enrollment Form and forward to Allegiant Care with all required documentation within 30 days of the Qualifying Event. Dependents will not be added unless all required documentation is received.   If you have questions about completing the form, please contact Allegiant Care at 1-800-248-9732.

You should download and complete the Enrollment Form and forward to Allegiant Care with all required documentation within 30 days of the Qualifying Event. Dependents will not be added unless all required documentation is received. If you have questions about completing the form, please contact Allegiant Care at 1-800-248-9732.

You should notify Allegiant Care within 30 days of the Qualifying Event using the Dependent Termination Form.  If you have questions about completing the form, please contact Allegiant Care at 1-800-248-9732.

No. Your Plan with Allegiant Care does not cover extended family. However, a dependent would be covered if you are able to provide court documentation indicating that you and/or your spouse are the appointed legal guardian(s) in the relationship.

No. Your Plan with Allegiant Care does not cover extended family.

No. Your Plan with Allegiant Care does not cover significant others.

You should download and complete the Coordination of Benefits.  If you have any additional questions regarding this form, please contact Allegiant Care at 1-800-258-9732.

You may enroll in Medicare Part A; however, you should defer your enrollment into Medicare Part B until you stop working. When you receive your Medicare cards you should contact the toll free number on the back and let them know that you are covered under an active group plan and will not be enrolling in Medicare Part B at this time.

Under current laws, a dependent may remain covered under your Plan until the end of the month in which s/he turns 26.

Please contact Allegiant Care at 1-800-258-9732.

You can add or remove qualified dependents from your Plan any time there is a Qualifying Event (i.e., birth, death, marriage, divorce, gain or loss of other coverage) or during an annual Open Enrollment period (if applicable).

To add a dependent, please complete the Enrollment Form.  You must return all required documents before your dependent(s) can be added.  You should also notify your employer of any changes.  If you have questions about completing the form, you may contact Allegiant Care at 1-800-248-9732.

You must notify Allegiant Care within 30 days of the Qualifying Event.  Please complete the Enrollment Form.  You must return all required documents before your dependent(s) can be added.  You should also notify your employer of any changes. If you have questions about completing the form, please contact Allegiant Care at 1-800-248-9732.

You may contact Marcia Frappier at Allegiant Care: (603) 669-4771 or 1-800-258-9732 extension 221

If your plan includes the benefit, you will see details in the “Supplemental Benefits” section of your SPD binder or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732.

The member and covered spouse are eligible for Massage Reimbursement. Children and adult dependents are not eligible for this benefit.

You can go to any licensed massage therapist that you choose.

Massage Therapy Reimbursement  It is also found under “Forms” on the Allegiant Care website; or you may call Allegiant Care at (603) 669-4771 or 1-800-258-9732, extension 221 and request the form

NOTE: The form cannot be completed online. You must print the form, and mail it to: Attn: Massage Department, Northern New England Benefit Trust, PO Box 4604, Manchester, NH 03108.

You will need to submit a completed Massage Therapy Reimbursement to: Allegiant Care, Attn: Massage Department, Allegiant Care, PO Box 4604, Manchester, NH 03108. The massage therapist will need to complete and sign the bottom section of the form. Up to five sessions will fit on one form.

The Massage Reimbursement is $50.00 for each visit. The maximum amount of reimbursement per calendar year is $1,650.00 per covered member or spouse.

Allegiant Rx at 1-866-888-0103

You should present your Medco/Express Scripts card that carries the Allegiant Rx logo to the pharmacy to fill a prescription. If you do not have a card or are unsure if you have the correct card, please call Allegiant Rx at (866) 888 0103.

Login to www.AllegiantRx.com  or call Allegiant Rx at 1-866-888-0103.

Your plan benefits limit you to a 30 day supply or a quantity of 100 doses, which ever is less, at your retail pharmacy. However, for greater benefit to you, a 90 day supply is available by mail order for all of your maintenance medications.

NOTE: If you are an Anheuser Busch member, you can fill your maintenance medications 3 times at the retail pharmacy. After 3 fills, you must fill your 90 day supply prescription at mail order in order to avoid paying the entire cost of your prescription at retail.

You can log in to www.myallegiantrx.com utilizing your Allegiant Rx ID # to create a user logon to register for mail order, add billing, verify shipping information. Your physician can fax your 90 day prescription to (800) 837-0959 or your physician can call in your prescription to (888) 327-9791. You may also call Allegiant Rx at (866) 888-0103 for more information.

Yes. If you are a Northern New England Retiree, you must contact Allegiant Rx at 1-866-888-0103 before filling your prescription at your retail pharmacy. Copay will depend on if member is in a grandfathered or non grandfathered plan.

Yes. If you are a Northern New England Retiree, you must contact Allegiant Rx at 1-866-888-0103 before filling your prescription at your retail pharmacy. Copay will depend on if member is in a grandfathered or non grandfathered plan.

Yes. Test strips and lancets are covered through mail order only. If you purchase them at a retail pharmacy, you are responsible for the entire cost. Check with your physician to see if they have any samples you can use until your mail order prescription arrives.

If you are a member electing COBRA you will not see a change to your ID numbers. If you are a dependent electing COBRA on your own you will receive new ID cards and will need to update this information with your providers.

Your doctors will not see a change in your coverage; you do not have to tell them that you are on COBRA.

No, your first payment is due no later than 45 days after the post-mark on your election form. Once we receive your election form we will send you a packet which will tell you when your first payment is due.

No, we do not bill for COBRA. You will receive payment slips once you have elected and activated your COBRA account. You are responsible for making sure that your COBRA payment is received on time.

No. Payments must be check or money order made payable to Allegiant Care; PO BOX 4604; Manchester, NH 03108.

If you do not make your payment prior to the start of the coverage month your coverage will be terminated until payment is received.  A 30-day grace period allows your coverage to be reinstated retroactively to the first of the coverage month provided payment is post-marked no later than 30 days after the start of the coverage month.

Eligibility files are run electronically on a weekly basis. Payment for the following month should be received by the 23^rd in order to avoid a break in coverage.

COBRA is very expensive and typically a last resort for many. You should check with your State in regards to what might be available to you for premium assistance or State health coverage. www.healthcare.gov is a resource available to assist you in finding individual policies in your State.

Yes, your eligibility for Medicare serves as a second qualifying event for your spouse. S/he will be eligible to remain on COBRA for a total of 36 months (less what has been used while covered under your COBRA policy). For example: if you and your spouse have been on COBRA for 9 months, when you become eligible for Medicare your spouse will be eligible for 27 remaining months of COBRA on his/her own.

You may simply stop paying your COBRA premium and your policy will term naturally.

A Health Club Reimbursement Form  was included in your SPD binder or you can find it under the “Forms” tab on the website. You can also contact Ann Simpson at Allegiant Care by calling (603) 669-4771 or 1-800-258-9732 Ext. 229.