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FAQs

Timing of Benefits Enrollment/Changes

Q. Why can’t I enroll in or drop coverage at any time?

A. Full-time associates are able to pay for certain benefits (medical, dental, vision, FSA) on a pre-tax basis. In exchange for this benefit, the IRS places certain restrictions on when associates can enroll in and drop coverage. You are able to change your benefit elections if you experience a qualified change in status, such as marriage, divorce or the birth of a child. Benefits paid for on an after-tax basis can be dropped at any time. You are also allowed to change your benefit elections during the Company’s Annual Benefits Enrollment period.

Q. When can I add or delete a dependent?

A. Any change you wish to make to your benefit elections must be consistent with your change and affect eligibility for coverage. For example, if you have a baby, you may enroll your new baby in the plan and drop coverage for your spouse because you had a change to the number of dependents eligible. These changes include:

  • A change in legal marital status, including marriage, death of a spouse, divorce, legal separation or annulment.
  • A change in the number of dependents, including birth, adoption, placement for adoption, death, marriage, divorce
  • A change in employment status, including termination or commencement of employment by the associate, spouse or dependent
  • A change in work schedule, including a reduction or increase in hours of employment by the Associate, spouse or dependent, including a change from full-time to part-time status or vice versa, a strike or lockout or commencement of return from an unpaid leave of absence
  • A change that causes a dependent to satisfy or cease to satisfy the eligibility requirements for coverage under the Payless plan such as the attainment of age.
  • A change in the place of residence or work site of the associate, spouse or dependent that results in a change in plan eligibility
  • A court order that requires coverage of an eligible child
  • Entitlement to Medicare or Medicaid
  • A significant change in the cost or coverage of the Company’s medical or dental plan, subject to certain limitations
  • A significant change in the cost or coverage of a spouse’s medical or dental plan, attributable to the spouse’s employment.
  • A significant change in the cost of dependent care.

NOTE: All election changes must be made within 30 days of the event (birth, marriage, etc.).  Elections for medical, dental, vision and pre-tax savings plans are made at https://payless.benefitsnow.com. Life and disability elections as well as beneficary designations are made at www.mypayless.com.

Benefits Billing/Claims

Q. If I have a question about how a claim was paid, who do I call?

A. Always start by calling the number on the back of your ID card. If you are unable to get resolution from the carrier, contact the Payless Benefits Center at 1-855-564-6152 between the hours of 9 am to 6 pm Eastern (associates in all 50 states).

Q. What do I do if I receive a bill for services covered by the plan?

A. If you live in a network plan area, and use a network provider, your provider will bill the services directly to the medical plan. You are responsible only for your deductible, co-pay or co-insurance at the time of service. If you are in a plan where no network is available or you are in a network plan but choose not to use a network provider, you will be responsible for the full cost at the time of service. Check the cost with your doctor before you receive care. Check with your carrier to confirm what portion of the cost you will be responsible for.

Health Plan Terminology

For more information and information specific to your health plan, refer to the Summary Plan Descriptions.

Q. What is a Deductible?

A. A deductible is an amount of money that you pay before your medical plan starts contributing to the cost of your medical services. For example, if the plan’s deductible for individual coverage is $2,000, the plan will start paying a percentage of your benefits after you have paid for $2,000 of covered expenses during a calendar year.

Q. What is Co-insurance?

A. Co-insurance is the fixed percentage of eligible expenses you pay, after you’ve paid the deductible. For example, if the plan pays 80% for a service after you’ve paid the deductible, you are responsible for paying the remaining 20%, which is your co-insurance (80% is the plan’s co-insurance).

Q. What is a Co-pay?

A. A co-pay is a set dollar amount you pay for specified services covered by the plan. For example, if your co-pay for an office visit is $20, you will pay this amount at the time of service.