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United Service Workers Union 138-50 Queens Boulevard
Briarwood, NY 11435
Tel: (718) 658-4848
Fax: (718) 523-5722
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Oxford Health Insurance

In this section will we do our best to answer any questions relating to your Oxford Health Insurance. If you still require assistance, please do not hesitate in contacting our office at (718) 658.4848.

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Are prescription drugs covered?”

Oxford offers various prescription drug benefit programs to help defray the rising costs of prescription drugs. Check your Summary of Benefits or contact your Benefits Administrator for details about the plan for which you may be eligible.

Do I need to submit claim forms?”

Members do not need to submit claim forms for in-network services. However, you must submit claim forms for out-of-network services in order to receive payment, subject to deductible, coinsurance and Usual, Customary and Reasonable (UCR) charges limitations.

What if I want to see a doctor who's out-of-network?”

Visits to out-of-network physicians will be subject to deductible, coinsurance payments and Usual, Customary and Reasonable (UCR) charges limitations. You also need to submit claim forms. However, when visiting an in-network physician, Members are only subject to a copayment for most covered services.

If I need to see a specialist, will I need a referral?”

To visit an in-network specialist and be eligible for in-network coverage, your PCP or OB/GYN will need to electronically submit a referral. Please note that paper referrals are no longer acceptable and only electronic referrals will be processed. With an authorized referral, your visit will require only a copayment for most covered benefits.

To visit an out-of-network specialist, you will not need a referral, but will be required to pay a deductible and a portion of the specialist's fee, as defined in your Summary of Benefits. You will also need to submit a claim form.

What if I need to be admitted to the hospital?”

All inpatient hospital stays require precertification. If you are admitted to the hospital as a result of an emergency room visit or by your PCP or Oxford specialist, you do not need to fill out any claim forms or satisfy any deductible, and your hospital expenses will generally be completely covered (some plans require a copayment). If you are admitted by an out-of-network doctor, you are responsible for obtaining precertification, paying any deductibles, coinsurance and are responsible for Usual, Customary and Reasonable (UCR) charges limitations.

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