We’re here to help you to take full advantage of your health benefits.
Have a question about what’s covered? Want to check up on a claim? Need to find a doctor? Whatever your question or concern, we’re here to help.
We’ve got you covered.
We know that your health insurance plan is among the most important factors of your compensation package—and that it can also be the most confusing.
Your employer wants to make sure you’re satisfied with your healthcare plan—and that’s why they’ve partnered with us to help manage your benefits.
We’re here whenever you have a question or concern about your plan—from finding a doctor to questions about claims and benefits. We’re here to be your advocates to make sure you receive the benefits promised to you. Most importantly, we’re here to inform and empower you to take control of your health—and save money, too.
24/7 SELF- SERVICE MEMBER PORTAL
YOUR QUESTIONS RESOLVED – IN ONE CALL
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AFFORDABLE, QUALITY HEALTH BENEFITS
With our secure member portal, navigating your healthcare benefits has never been easier. Log in securely to:
Access your Virtual ID Card
View claims activity and plan information
Communicate with our member support team
Our helpful and knowledgeable member support team is available by phone or by chat 24/7. We know you’re time is valuable, and we resolve 90% of member questions on the first call.
None of our plans require referrals to see the doctor of your choice.
Worry less about paying high out-of-pocket costs that aren’t covering you sufficiently. Our plans are designed to be cost effective while giving you the coverage you want.
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an innetwork provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact The Department of Health and Human Services at (800) 985-3059.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Not sure where to start?
Just Follow These 3 Simple Steps:
1. Call us 24/7 or sign into your secure member portal to file a claim, check your eligibility, or ask a question about your coverage.
2. A member of our expert team will help you understand your health benefits and ensure you receive the care as promised in your plan.
3. Take full advantage of your employer health programs and benefits, and be empowered to take control of your health and wellness.
or call 877-435-2063