Frequently Asked Questions

Q: How can I help get my claims processed quickly?
Promptly answer any letters received from Mutual Assurance Administrators, Inc. requesting additional information. The claim cannot be processed without the requested information. If you have any questions concerning the request, call Mutual Assurance Administrators, Inc. at 405.848.1975, or 800.825.3540 if calling from outside the Oklahoma City area.
Q: Why do you need an additional data form (or claim form)?
An Additional Data Form is required for each family once each year. This form will be distributed by your Benefits Department, can be downloaded from MAA Online at www.maa-tpa.com or by calling Mutual Assurance Administrators, Inc. at 405.848.1975, or 800.825.3540 if calling from outside the Oklahoma City area.
Q: How do I get a claim form or an Additional Data Form?
You can print a copy of the Additional Data Form or a Claim Form by logging in to MAA Online from this web site; you can contact the Billing/Eligibility Department at MAA (405.848.1975 or 800.825.3540) and they will mail you one; or they can be obtained from your HR Department.
Q: What do I need to do if I get married, have a new baby or adopt a baby?
You will need to complete a Service Request Form and return the completed form to your Employer. This form can be downloaded from MAA Online at www.maa-tpa.com.
Q: If I have an accident, what do you need to process my claim?
We need the full accident details including where, when, and how the accident happened. We also need to know if this is related to an on the job injury. In most cases, unless a third party is involved in the accident, this is all the information we will need in order to expedite your claim. We cannot begin to process your claim until we know the details of the accident. You can print a copy of a Claim form from MAA Online and an Accident/Injury Questionnaire from this web site to fill out and mail to MAA with the accident details.
Q: What is a PPO?
PPO stands for Preferred Provider Organization. A PPO is a managed health care network of medical providers who have contracted to provide their quality services to member patients. The Plan saves money when you use participating providers so these savings are shared with you by offering better benefits than if you use a Non-PPO provider. PPO providers include physicians, hospitals, outpatient facilities and other ancillary providers. You may access your PPO Providers here as well.
Q: How do I know if my doctor is a member of my PPO?
You may locate PPO directories several ways. Contact your HR department or reference MAA Online's directory of PPO Providers by simply locating the icon on the page that is listed on your ID card. Please remember that MAA does not maintain these web sites and is not responsible for their content or accuracy. If your PPO is not listed, please refer to the provider directory that was given to you to see if your doctor is a listed provider. If you do not have a directory, you can obtain one from your Human Resources Department at work. Depending upon the print date of the provider directory, you may want to contact the PPO network directly at the number listed on the directory to verify if your doctor is still a PPO provider. You may also want to ask your doctor if they are still participating in your PPO. It is a good idea to check the status of your doctor or hospitals participation in your PPO prior to each time you seek medical care.
Q: If you want a specific physician added to your PPO Network, who should you contact?
Please have your physician contact the PPO Network listed on the Identification Card.
Q: What is BabyLinks, and how do I enroll?
BabyLinks is an early prenatal care management designed to help promote the health and well-being of the mother and baby. Not all employers opt for this benefit. Please check with your employer prior to attempting enrollment to insure that you are in fact eligible for this enhanced benefit. Enrollment occurs when the expectant mother contacts Mutual Assurance Advantage (800-825-3540 ext. 2638) as soon as she is aware of the pregnancy. There is no additional cost for this service if your employer is an active participant.
Q: When do I need a Pre-Certification and how do I get one?
You or your doctor must call Mutual Assurance Advantage (800-777-2073 or 405-840-0882) prior to your admission to a hospital. This will take care of the Pre-Certification process. If you are admitted on an emergency basis the hospital needs to call within 2 business days following your admission. Once the admission has been approved and certified the nurses will continue with case management to determine if additional days are needed.
Q: What is case management, and how do I initiate the process?
After your hospital admission has been approved, Mutual Assurance Advantage will determine a target length of stay. MAA will follow-up with the hospital prior to your discharge date to verify whether complications have arisen and if your length of stay needs to be extended. This process helps to control the rising costs of medical coverage while being able to maintain the high level of benefits provided by your plan.
Q: What is COBRA?
The Consolidated Omnibus Budget Resolution Act provides for a continuation of your current benefits should you experience a loss of coverage due to a “qualifying event” such as loss of your employment.
Q: When my employment terminates, will I be able to continue my insurance coverage?
Yes, if your Employer is subject to COBRA. All employers with more than 20 employee are subject to COBRA. If MAA administers your Employer’s COBRA plan, you will receive a certified letter from MAA containing information on how to continue your coverage. When you receive this letter, indicate which dependent you want continued coverage for, sign the application and enclose a check for payment.
You will also receive a “Certificate of Credible Coverage” which indicates medical coverage dates and covered members of your family. You will need to give a copy of this letter to your new employer.
Q: What events constitute a COBRA qualifying event?
The qualifying events with respect to an employee who is a qualified beneficiary are:
  1. Termination of employment (for reasons other than the employee’s gross misconduct); and
  2. Reduction in the employee’s hours of employment.
With respect to an employee’s spouse or dependent child who is a qualified beneficiary, the qualifying events are:
  1. Termination of the employee’s employment (for reasons other than the employee’s gross misconduct)
  2. Reduction in the employee’s hours of employment
  3. Death of the employee
  4. Divorce or legal separation from the covered employee
  5. The employee’s entitlement to Medicare
  6. The employer’s commencement of a bankruptcy proceeding under Title 11 of the United States Code and
  7. The child’s ceasing to be a covered dependent child under the terms of the plan.
Q: What is HIPAA?
The Health Insurance Portability and Accountability Act, otherwise referenced to as HIPPA, was enacted on August 21, 1996. The main intent of HIPPA is to improve the portability and continuity of health care coverage in the group and individual insurance markets and group health plan coverage provided in connection with employment.
Q: What is “Reasonable and Customary” (R&C) and how is this determined?
This term refers to the designation of a charge as being the usual charge made by a physician or other provider that does not exceed the general level of charges made by other providers rendering comparable care within the same geographical area. MAA utilizes a national company to provide our R&C data.
Q: What is an Explanation of Benefits?
The Explanation of Benefits is an explanation of how your claim was processed. It will include the total charge submitted by the Provider and will identify any ineligible charges, discounts, amounts applied to the deductible and the patient responsibility. Any amounts shown as “patient responsibility” should be paid directly to the physician, hospital or other service provider. You can view and/or print this information from the Online Benefits link in this web site after signing up for this feature. You can also contact the claims department at MAA. (405-848-1975 or 1-800-825-3540) for an original copy.
Q: What is a “Pre-Existing Condition”?
A Pre-Existing Condition is a physical or mental condition for which medical advice, diagnosis, care or treatment was recommended or received within a defined time period to the Enrollment date. The time period is specified in your Plan Document.
Q: What is an “Incidental Procedure” and how is this determined?
An incidental procedure is a procedure that is performed in conjunction with a major procedure and should not be billed separately. MAA utilizes a Claims Edit System in our claims payment process to identify these procedures.
Q: Are work-related injuries covered under the Medical Plan?
No. Any charges arising out of, or in the course of any occupation for wage or profit, or for which the person is entitled to benefits under any Workers’ Compensation or Occupational Disease Law is considered work-related and is not eligible under the Employer Health Benefit Plan.
Q: What recourse is available to an employee who has a disputed claim?
If an employee does not agree with a decision made on any claim, s/he has the right to appeal. The employee should write a request for appeal within 180 days from the date of the Explanation of Benefits. He should specify the reason for the appeal and provide any additional information that might alter the original decision.
Q: What are “Pre-Existing Condition Exclusions”?
Under HIPPA, a group health plan or a health insurance issuer offering group health insurance coverage may impose a pre-existing condition exclusion with respect to a participant or beneficiary only if the following requirements are satisfied:
  1. A pre-existing condition exclusion must relate to a condition for which medical advice, diagnosis, care or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date.
  2. A pre-existing condition exclusion may not last for more than 12 months for new or special enrollees, or 18-month for late enrollees, after and individual’s enrollment date. This 12 or 18 month period will be reduced by the n umber of days of the individual’s prior credible coverage, excluding coverage prior to any break in coverage of 63 days or more.
Q: What is a co-payment?
Many plans offer prescription drugs for a co-payment. A co-payment is typically a flat dollar amount or percentage of the cost of a prescription that you pay each time you buy medications. Most plans also offer a reduced co-payment when you purchase generic drugs instead of brand name drugs. Choosing generic drugs or from the Preferred Drug List used by your plan can reduce the amount that you pay for your prescription medications.
Q: Why should I use a generic over a brand name drug?
As consumers, we may be suspicious of generic products, but for medications it’s a different story. A generic drug is chemically identical to its brand name counterpart. The FDA goes through the same approval process for generic medication as it does for brand name drugs. The generic drug manufacturer has to prove that the drug is the “bioequivalent” of the brand name drug and provides the same results. Generic drugs are usually sold at a price 20-80% less than the brand name product. On most plans, you have the choice to continue to use a brand name medication but your co-payment will reflect a greater share of the cost.
Q: What is a Preferred Drug List?
The Preferred Drug List or formulary brand names vary from plan to plan. The drugs on every plan's Preferred Drug List have been evaluated by physicians and pharmacists and determined to be the most effective for the most number of patients. Because new drugs are constantly being introduced, the Preferred Drug List is frequently reviewed and updated. If more effective or safer drugs are reasonably priced appear on the market, they may be added to the list. By using a generic or preferred drug, you will save money over the brand, save your employer money and continue to receive the same high quality of care.
Q: What if I am currently taking a prescription for a drug that is not on the Preferred Drug List?
If you are now taking a brand name medication not on your Preferred Drug List, you may choose to continue the drug at a higher co-payment, or you may ask your physician to change your medication to a generic or preferred drug from the list. Either you or your pharmacist can arrange this with a simple phone call to your physician.
Q: What if my doctor prescribes a drug that is not on the Preferred Drug List?
We suggest that you carry a Preferred Drug List with you when you see your doctor so that he or she may prescribe drugs from the list whenever possible. It may be necessary for your treatment that you use the brand name drug in which case you will be responsible for sharing in the cost of the drug by paying a higher co-payment. However, if a non-preferred or generic drug is available; your in-network pharmacist may contact your doctor to see if you can be switched to the generic or formulary.
Q: What can I do to reduce the amount I have to pay when filling my prescriptions?
  • Choose generic drugs whenever possible.
  • Carry your Preferred Drug List with you when you see your doctor so they may prescribe from it whenever possible.
  • Use mail order pharmacy services whenever possible. Some plans may require the use of mail order for refill prescriptions. Mail order is easy, convenient and provides a 90-day supply of most medications. With all of our pharmacy benefit partners, you can even order your refills online!