Questions You Should Ask About Your Health Plan
We hope the following answers to some commonly asked questions will be helpful to you. Please call us at 1-800-962-9520. We are here to meet your needs!
Q. Can I change physicians and how?
A. You can go to any Contracted Participating Physician at any time. Verify that the physician you are going to see is still part of the network.
Q. Can I go to any hospital?
A. When you need covered hospital care, your participating Physician will arrange for your admission to a participating hospital that your physician admits to. Your Physician will also obtain a pre-authorization from your insurance company, if it is required.
This procedure helps keep your out-of-pocket costs down and helps the insurance company work with the hospital to make sure you do not receive any unnecessary medical bills. For covered hospitalizations, your hospital room, medical procedures and physician services are all included.
Q. What do I do in case of a medical emergency, while I am away from home?
A. You go to the nearest medical facility. You or a family member or a friend can notify your insurance company of the emergency. They will arrange for you to get the best medical care available.
Q, Can I go out of the network?
A. Yes. The out of network benefits will apply.
Q. Do all members of the family have to use the same physician?
A. No. Each member may go to a different participating Physician (Family Practice, Internal Medicine, Pediatrics etc.)
Q. Is preventive care covered?
A. Yes. The policy will provide coverage for those preventive items and services required to be covered by the Affordable Care Act and applicable regulations and will not impose any cost sharing requirements (for example, coinsurance, deductible, copayment) with respect to those items and services, when delivered by a participating/network provider.
Q. What about claim forms?
A. If you use a participating physician in the network, you do not need to fill out claim forms or wait for refund checks. If you use an out-of-network physician, you will need to fill out claim forms for out-of-network care.
Q. Where do I go to get prescriptions filled?
A. You may go to any participating major chain Pharmacy (Osco, Walgreens, etc.) in the country. A list of network pharmacies will be given to you.
Q. Is there a lifetime maximum coverage?
A. Benefits that are considered essential benefits (as that term is defined in the Affordable Care Act and applicable regulations) will not be subject to any lifetime limit on the dollar value of such benefits for any individual.