Retired State Employees Association of Texas

Frequenty Asked Questions


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AMBA


Who is AMBA?

AMBA stands for Association Member Benefits Advisors. We administer benefits for your association. Think of us as your main hub for your associations benefit program.

How can I reach AMBA? / Contact Us:

AMBA can be reached by phone Monday-Friday from 8am-5pm CT by calling 1-800-258-7041. Our member services team is here to serve you!

Billing & Existing Account Questions: 1-866-615-4051

Customer Service: 1-800-258-7041
Monday-Friday from 8am-5pm CT

Cancellations: Cancellations@amba.info

Dental Claims – Ameritas – 1-888-239-3336

Vision – VSP: 1-800-877-7195

All other questions: inquiries@amba.info

Enroll Online or View Benefit Information: www.myambabenefits.info

Request a call back or send us your question by completing the Review Your Benefits form.

Mailing Address:
AMBA
6034 West Courtyard Dr. STE 300
Austin, TX 78730
Fax: 512-772-5795

Dental


How can I find out what is covered & locate a network dentist?

You can call Ameritas at 1-888-239-3336 for coverage information. To locate a network dentist, call Ameritas or visit them at www.findproviders.net. Once you’re ready to enroll, call AMBA at 1-888-698-0972.

Can I use my current dentist?

Yes! One of the best features of this plan is that you have the freedom to use your current dentist. You also have the option of selecting an Ameritas network dentist, from anywhere in the U.S. to receive excellent discounts on covered services.

Will I have waiting periods?

When members enroll during open enrollment, members have their waiting periods waived for covered services! Our plans cover preventive services, such as annual dental exams and cleanings, at 100% when visiting a network provider. Enjoy no waiting periods for covered services when you apply during open enrollment.

How Does the Dental Rewards® Feature Work?

This feature rewards members who care for their teeth by filing at least one claim during the calendar year but use less than the threshold amount of benefits. This feature solves the “use it or lose it” problem many dental insurance plans have. For example, if you visit the dentist at least once but use less than $500 in annual benefit you may roll over $250 to the next plan year!

How can I save the most money with this plan?

Dentists in the Ameritas network have agreed to charge you 20-40% less than their regular rates. Many of them also offer discounted fees on noncovered dental services as allowed by state law.

How will I know that you accepted my application?

We never deny enrollment, so if you apply and include a payment option and all necessary information your coverage will become active. Our Processing department will contact you by phone if there is an issue with your application.

When will my coverage begin?

If we receive your application in our office before the final week of the month your coverage will become effective the 1st of the following month.

Will I get dental ID Cards? /How do I tell my Dentist know that I am covered?

You will receive dental ID cards and Certificate of Coverage 2-3 weeks after your application arrives in our office. Please note: that this packet will be arriving from Ameritas in Lincoln Nebraska and not from AMBA or your Association. Keep in mind that you do not need ID cards to visit a dentist. You can simply tell your dentist to contact Ameritas for details of your coverage, just provide them with the phone number 1-888-239-3336.

Do I have to file the dental claims?

No, there is no need to for you to file claims with Ameritas. This plan is a PPO so your dental office can file the claim directly with Ameritas.

Can my disabled child remain on my plan?

Disabled dependent children, that are over the age of 26, can remain on your plan if they are legally disabled and you are their primary financial caregiver. Please contact AMBA if your dependent qualifies so we can send the necessary paperwork to you to get them covered. AMBA can be reached at 1-800-258-7041 Monday – Friday 8am -5pm CST.

Can dependent children be on my plan?

Dependent children can remain on your plan up until their 26th birthday. We will automatically remove dependent children at the end of the month of their 26th birthday. Children over the age of 26 are eligible to be covered under their own plan.

Can I add my parents/siblings/relatives to this plan?

No. Spouses and children under the age of 26 are the only ones who qualify as dependents. The good news is that your relatives can request to join the association and obtain benefits under their own plan. Please contact AMBA for more details 1-800-258-7041

If I’m on Medicare can I keep this plan?

Yes. You can remain on this plan even after you enroll in Medicare.

Can I cancel this coverage? How?

We encourage members to maintain their plan so that they can maintain their oral and visual health, but if you are truly unhappy you are able to cancel your coverage. We require a written request to terminate the coverage and we need requests by the 15th of the prior month to stop any future payments.

Vision


How can I save money with VSP?

With VSP you’ll save money on exams, lenses, frames and more. VSP’s comparison of national averages shows exams can cost over $150, and frame and lens costs can be well over $200. In addition, VSP provides discounts on lens options like scratch resistance, UV protection, antiglare, and impact resistance.

Is the vision program easy to use?

With VSP, you’ll receive services at rates well below walk-in prices, and you don’t even need an ID card — any VSP doctor can access your plan coverage. All you have to do is make your appointment, get your exam, select your frames and lens options, and the doctor’s office will take care of the rest. You pay any copays or overage right there at the doctor’s office, and you’re done. It’s that simple.

Is the VSP Network large?

VSP gives members access to over 34,000 in network doctors. Visit https://www.vsp.com/findeye-doctors.html to locate a doctor!

Do I have to use one of your Optometrists?

It is highly recommended that you stick with a VSP provider, but you do have coverage if you go out of network. When you visit a VSP network provider you receive full benefits. If you go out of network you will need to pay out of pocket and request reimbursement from VSP, keep in mind that reimbursement amounts are often lower than in-network benefits. You can find a VSP doctor by calling 1-800-877-7195.

Does this plan cover ophthalmologists?

This plan is meant to assist with the costs of general optometry procedures such as glasses, contacts, and eye exams. Some coverage may be available if your ophthalmologist is in the VSP network please contact VSP for more details doctor by visiting irspa.vspforme.com or call 1-800-877-7195.

Does this vision plan cover cataract surgery?

This plan does not cover cataract surgery. AMBA suggests reviewing your current medical plan to see if it offers any coverage for cataract Surgery.

Will I get Vision ID cards? / How do I let my eye doctor know I am covered?

VSP does not Issue ID cards but you will not need one to visit a provider. If you visit a VSP network provider, they can easily verify your benefits online. Just tell your providers office you are covered with VSP, then verify your name, date of birth, and last 4 of social security number. They will take care of the rest. If your provider is out of network, that’s OK! You will need to pay out of pocket and request reimbursement with VSP by calling them at 1-800-877-7195. Please note that reimbursement amounts may be lower than in-network benefits.

Do I have to file the vision claims?

If you visit a VSP Network doctor they will take care of the claims for you. If you visit an out-of-network provider, you will have to pay out-of-pocket and request the claims be reimbursed by VSP 1-800-877-7195.

Why is vision health important?

You only get one set of eyes. Take care of them. Your eyes not only affect how you see, but how you feel. Caring for your vision can lead to a better quality of life, including fewer headaches, less computer eye strain, and more effectiveness with work or hobbies. It all starts with an eye exam.

Can my disabled child remain on my plan?

Disabled dependent children, that are over the age of 26, can remain on your plan if they are legally disabled and you are their primary financial caregiver. Please contact AMBA if your dependent qualifies so we can send the necessary paperwork to you to get them covered. AMBA can be reached at 1-800-258-7041 Monday – Friday 8am -5pm CST.

Can dependent children be on my plan?

Dependent children can remain on your plan up until their 26th birthday. We will automatically remove dependent children at the end of the month of their 26th birthday. Children over the age of 26 are eligible to be covered under their own plan.

Can I add my parents/siblings/relatives to this plan?

No. Spouses and children under the age of 26 are the only ones who qualify as dependents. The good news is that your relatives can request to join the association and obtain benefits under their own plan. Please contact AMBA for more details 1-800-258-7041.

Can I cancel this coverage? How?

We encourage members to maintain their plan so that they can maintain their oral and visual health, but if you are truly unhappy you are able to cancel your coverage. We require a written request to terminate the coverage and we need requests by the 15th of the prior month to stop any future payments.

Long Term Care


Who Needs it?

No one knows what the future holds in store. As people age, they may need help with things they once were able to do for themselves. Accidents and injuries mean younger people need long-term care services, too.

Where are Services Provided?

Long-term care doesn’t mean you have to go to a nursing home. Services are available in a variety of settings:

  • Home
  • Community
  • Assisted Living Facility
  • Nursing Home
Why it’s Important

A long-term care insurance policy may be an important component of your overall plan for retirement.

  • Pays a portion of your long-term care expenses
  • Helps protect your retirement assets
  • Allows you to spend your retirement the way you planned
How Will You Pay?

You could purchase a long-term care insurance policy,and...

  • Supplement your out-of-pocket expenses with policy benefits to help pay your long-term care expenses
  • Protect a portion of your assets so you can use them as planned
  • Stay connected to the things that matter most

Short Term Care / Home Health Care


How much does Home Aide generally cost?

On average home health aide cost about $46,332 per year based on 44 hours per week for 52 weeks.

Does Medicare cover all recovery period costs?

No, Medicare has restrictions and limitations on what it will cover for skilled home care assistance. Unfortunately, seniors mistakenly believe that Medicare covers the entire recovery period at home. Out-of-pocket costs can be expensive for accidents or illnesses with long recovery times.

How are HHC benefits paid?

Benefits paid directly to you and you decide how to spend the benefits. Or payments can be made to a medical provider that you designate, and are paid in addition to any other health care coverage, including Medicare.

Did you know?

Your insurance may pay different coverage amounts based on the type of stay in the hospital. This policy could help cover unexpected expenses.

What are the main causes of the need for Home Health aide?

Almost a quarter of all seniors visit the emergency room due to these top 10 conditions:

  1. Injuries and accidents
  2. Heart disease
  3. Chest pain
  4. Adverse effects and complications of medical treatment
  5. Abdominal pain
  6. Chronic obstructive pulmonary disease
  7. Pneumonia
  8. Urinary tract infection
  9. Stroke
  10. Spinal disorders

Medical Transportation


Do I have MASA benefits if I am at home?

Yes! MASA will be there for you if you become ill or get injured and require local transportation by ground ambulance or helicopter or if you need to be transferred by air ambulance to an upgraded medical facility. Your MASA membership will also get you specialized medical care that is not available locally.

Do I have MASA benefits if I am at home?

Yes! If you get sick or injured and require hospitalization, MASA can get you back home for treatment and recuperation. And if you require an air ambulance, MASA will even send a relative or friend with you so you do not have to be alone. Plus your membership can return a stranded vehicle back to your home by a bonded driver.

Who decides if I am going to be transported by an air ambulance?

Your attending physician and MASA’s medical director determine when and where you will be flown. MASA takes care of all the details and the transportation.

What do I do in an emergency?

If you are in the U.S., call 911 first as you would normally do. Once you are safe and in stable condition, call MASA and they will take care of everything.

If you are overseas, use the emergency services available in your area and then contact MASA.

What happens if I pass away while away from home?

MASA will cover the air waybill for returning the member’s remains to the airport nearest the member’s permanent address.

When do my MASA benefits start?

Your benefits start immediately once we receive your completed application.

Medicare Solutions


Does it have Low Out-of-pocket Costs?

Every year, your Medicare supplement insurance policy benefits coordinate with your Medicare benefits to help you meet your eligible health care expenses, depending on the plan you choose. What’s more, you can be sure your benefits won’t decrease.

Can you choose your doctors and hospitals?

With your Medicare supplement insurance policy, you alone select all your health care providers to use whenever and wherever you choose. You don’t have to worry about your doctor or hospital leaving a provider network at any time.

Is coverage guaranteed renewable?

Your Medicare supplement insurance policy cannot be cancelled. It will be renewed as long as you pay the premiums on time and make no material misrepresentations.

Whole Life Insurance


Is everybody between age 45-85 guaranteed acceptance for this protection at affordable rates?

Yes! Acceptance is guaranteed for those between age 45 and 85.

Can I be turned down because I have health problems?

You cannot be turned down for any health reason. Your acceptance is guaranteed. (Each insured may have a combined maximum of $25,000 coverage of this type from United of Omaha Life Insurance Company.)

Will my rate always be exactly the same?

There is absolutely no way that your rate can be increased. The affordable rate you start with is the rate you stay with – for life. You’ll never pay any more.

You say “no obligation.” Please explain.

Just fill in the pre-approved application form and mail it in the postage-paid envelope with your payment. You will be billed your premiums and you’ll receive your policy. If you are not 100% satisfied, just return your policy to us within 60 days and your money will be refunded.

Can I be canceled for any reason?

You cannot be canceled for any reason as long as your premiums are paid when due.

Term Life Insurance


Can help pay off debts if they die

In the event of death, provides cash that may be used to pay off debts, enabling the surviving spouse and children to keep the current lifestyle.

Can help provide income for mortgage payments if they become disabled

In the event of a covered disability, this rider provides cash that can be used to make mortgage payments for either 18 or 30 months, after a 90-day* elimination period.
*In MD – 120-day elimination period.

Residential Damage Rider

If the primary residence sustains $25,000 or more of damage, this provision allows the monthly base premiums and riders to be waived for one six-month period.

Waives premiums if they become unemployed

In the event of qualifying unemployment, provides for premiums to be waived for one six-month period.

Refunds all premium paid

At the end of the policy term, this provision provides for a refund of all premiums paid if the life insurance is no longer needed.

Disability


How does disability income insurance work?

Disability insurance provides supplementary income in the event an illness or accident results in a disability. Benefits are usually paid monthly so the insured can maintain a comparable standard of living and pay recurring expenses.

What do disability insurance policies usually cover?

Disability insurance may cover everything from total disability to rehabilitation and even the short period after you recover from your disability.

Hearing


How long can you test the hearing aids?

You have 60 day trial period

What if my battery dies?

You will receive up to a 3 year supply of batteries. That's 40 cells per hearing aid.

Accident


I also have disability coverage. Isn’t that enough?

Ideally, you'd have both, because your disability coverage may not provide you a lump-sum payment to help you to take care of day-to-day living expenses and still have money for your recovery. Accident coverage can pay a lump-sum benefit in addition to any disability coverage you may have. Also, most disability plans provide a reduced monthly benefit, and many are valid for just a limited time.

Will my premiums increase in the future?

Your premiums are group premiums designed to make this coverage affordables.

What is covered?

Covered losses range from loss of hearing to more serious injuries, such as paralysis and brain damage.