Frequently Asked Questions

We update the FAQs regularly on our website, please keep checking back for new information! Here are some recently asked questions:

Similarly, for AlaskaCare covered dental services, you may prevent balance billing by verifying the provider is in the Moda/Delta Dental network.

How is the recognized charge amount determined?
The recognized charge for out-of-network medical providers is the 90th percentile of the prevailing charge rate for the geographic area where the service is furnished. The AlaskaCare plans establish the percentile (i.e., 90th percentile) to be applied to the prevailing charge rate; however, the prevailing charge rate is reported by FAIR Health, an independent not-for-profit corporation. FAIR Health collects charge data from claims received by insurance plans and health plan administrators across the country for charges billed by physicians, hospitals and other healthcare providers. Charges reported are the full fees that healthcare professionals report to insurers as part of the claims process—not the negotiated rates that apply when visiting a network provider. Charges reported are maintained by FAIR Health in its database, which is comprised of billions of claims for billed medical procedures from across the United States. New charge data is continually added to the FAIR Health database.

The recognized charge for out-of-network dental providers in the standard dental plan is 75% of the 80th percentile of the prevailing charge rate for the geographic area where the service is furnished. The recognized charge for out-of-network dental providers in the legacy dental plan is 100% of the 90th percentile of the prevailing charge rate for the geographic area where the service is furnished.

How does the plan know that FAIR Health's information is reliable?
FAIR Health has audit and validation programs in place to ensure the integrity of its data. Part of the validation process entails testing the data with statistical algorithms and examination by FAIR Health's in-house statistical and technology experts. A team of healthcare researchers from leading academic institutions advise FAIR Health on the best methods for analyzing its national claims data. FAIR Health is also advised by an independent Scientific Advisory Board of prominent researchers who review Fair Health's statistical methods and data. FAIR Health also seeks input from other stakeholders such as consumer and patient advocacy groups, healthcare providers, actuaries and federal officials.

How are the geographical areas determined?
FAIR Health organizes its data by geozip—a geographical area usually defined by the first three digits of the U.S. zip codes. Geozips may include areas defined by one three-digit zip code or a group of three-digit zip codes. Geozips generally do not include zip codes in different states.

The State of Alaska is currently defined into three geozips:

• 995 and 997: Including Anchorage, Bethel, Fairbanks, Kotzebue, etc.
• 996 and 998: Including Homer, Kodiak, Juneau, Sitka, etc.
• 999: Including Ketchikan, Prince of Wales, Wrangell, etc.

Where can I get more information about the two DVA plans?
You can find information about the two DVA plans online:

• 2020 Dental Benefit Comparison Guide
• 2020 Dental Benefit Enrollment Guide
• Draft AlaskaCare Defined Benefit Retiree Insurance Information Booklet (contains both the standard and legacy plan provisions)
• 2020 DVA Monthly Premiums

You can also call the AlaskaCare Member Services Contact Center toll free at (855) 821-2251, in Juneau at (907) 465-4460, or Delta Dental of Alaska at (855) 718-1768.

Can one person with two retirements choose both Dental plans?
If one person has two retirement accounts and would like to enroll in dental coverage, they cannot choose different plans for each retirement account. If a member and their spouse each have their own retirement plan and claim one another as dependents, one can choose the Standard Plan and the other can choose the Legacy plan. Each member would need to pay the appropriate plan premium.

Can I switch between the DVA plans?
Yes, for as long as the State offers two DVA plans, you will have an opportunity to change your dental plan selection during the open enrollment period. Outside of the open enrollment period, you will not be able to make changes to your selections unless you have a qualifying life event.

EGWP Enrollees: IRMAA Submission Reminder

Certain high-income retirees who are Medicare-eligible and enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP) pharmacy plan are required to pay a premium surcharge associated with Medicare Part D plans, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is required by Medicare and is the same type of surcharge that high-income enrollees already pay for a Medicare Part B plan. If you are an individual earning more than $85,000 per year or a married couple who earns more than $170,000 per year, you will be required to pay the IRMAA; retirees enrolled in EGWP and whose household income is below this threshold will not be subject to the IRMAA premium surcharge.

If you are required to pay the IRMAA premium surcharge, the Division will reimburse you for the amount you are charged each month through a tax-advantaged health reimbursement arrangement (HRA) account, so the EGWP plan has no additional cost to you!

Each November, Medicare-eligible individuals receive a letter from Social Security that outlines the Medicare premiums. Please submit the most recent letter you’ve received from Social Security that states you are subject to IRMAA surcharge for 2019, and at what amount, to the Division.

You can provide a copy of your letter to the division by:

• Emailing a copy or a photo of the letter to: drb.irmaa@alaska.gov
• Faxing a copy to: (907) 465-3086
• Mailing a copy to:
  Alaska Department of Administration
  Division of Retirement and Benefits
  P.O. Box 11023
  Juneau, AK 99811-0203

Once the Division receives a copy of your annual letter sent from Social Security, we will establish an HRA for you through PayFlex, Aetna’s subsidiary that administers the HRA on behalf of AlaskaCare. PayFlex will send you a letter that outlines how to access your HRA account information and how to set up claims for reimbursement. We encourage you to set up reimbursement on an automatic reoccurring basis, but you may elect to request reimbursement manually. Reimbursement can be made by check or through electronic funds transfer.