Submitting a claim Utilization management and financial compensation Covered and excluded benefits How we evaluate new technology Precertification. Finding a Provider Primary and specialty care Non-participating provider care Finding a Pharmacy Behavioral health and substance abuse services. Quality improvement strategy We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing. We work with groups of doctors and other health professionals to make health care better. Our clinical activities and programs are based on proven guidelines. We also give you and your doctors information and tools that may help you make decisions.
Enrolling in TCC. It explains what you have to do to enroll.
Alternatively, you can buy coverage through the Health Insurance Marketplace where, depending on your income, you could be eligible for a new kind of tax credit that lowers your monthly premiums. Visit to compare plans and see what your premiums, deductible, and out-of-pocket costs would be before you make a decision to enroll. Finally, if you qualify for coverage under another group health plan such as your spouse's planyou may be able to enroll in that plan, as long as you apply within 30 days of losing FEHB coverage.
Converting to individual coverage You may convert to a non-fehb individual policy if: Your coverage under TCC or the spouse equity law ends If you canceled your coverage or did not pay your premium, you cannot convert ; You decided not to receive coverage under TCC or the spouse equity law; or You are not eligible for coverage under TCC or the spouse equity law.
If you leave Federal or Tribal service, your employing office will notify you of your right to convert. You must apply in writing to us within 31 days after you receive this notice.
See the full list of Qualified Health Plans (QHP) available on airmax95billig.com Altius Health Plans Inc. Bronze Peak Preference HSA Eligible, Bronze, HMO, NO. 1 review of Altius Health Plans "Pretty dissatisfied with my Altius Health Plans fully insured commercial employer groups, self funded organizations, Federal. Important Notice from Altius Health Plans About Our Prescription Drug Coverage and Medicare FEHB is the Federal Employees Health Benefits Program.
However, if you are a family member who is losing coverage, the employing or retirement office will not notify you. You must apply in writing to us within 31 days after you are no longer eligible for coverage.
Your benefits and rates will differ from those under the FEHB Program; however, you will not have to answer questions about your health, and we will not impose a waiting period or limit your coverage due to pre-existing conditions. We require you to see specific physicians, hospitals, and other providers that contract with us.
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These Plan providers coordinate your health care services. The Plan is solely responsible for the selection of these providers in your area.
Contact the Plan for a copy of their most recent provider directory. HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury.
Our providers follow generally accepted medical practice when prescribing any course of treatment. When you receive services from Plan providers, you will not have to submit claim forms or pay bills.
You can find more information in the Federal Plan brochure. What are the advantages of the Altius Health Plan High and Standard? The Altius Health Plan High. View your claims, explanations of benefits (EOBs) and benefit usage details Did you know that Coventry Health Care is part of the Aetna family? As we work to.
You pay only the copayments, coinsurance, and deductibles described in this brochure. When you receive emergency services from non-plan providers, you may have to submit claim forms.
You should join an HMO because you prefer the plan s benefits, not because a particular provider is available. You cannot change plans because a provider leaves our Plan.
Most services provided by physicians and other health care professionals, including physician services that are provided while you are in a hospital, may be subject to a copayment or coinsurance. Comprehensive dental coverage is included in our High Option. The Standard Option does not include dental coverage except for dental services that are necessary as a result of an accidental injury to sound, natural teeth. We protect you against catastrophic out-of-pocket expenses for covered services.
This means you can receive covered services from a participating provider without a required referral from your primary care physician or by another participating provider in the network. How we pay providers We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure.
We compensate contracted providers by either discount fee-for-service fee schedules or capitation agreements. It is your responsibility to verify that the provider you use is a Plan provider. Except for emergency and out-of-area urgent care, we will not pay for care or services from non-plan providers or facilities unless it has been authorized by us. If you use a non-plan provider or facility without authorization from us, you may be responsible for all charges.
This means the doctors provide care in contracted medical centers or in their own offices. Approximately 2, Primary Care Physicians and 3, specialists participate in this Plan.
However, we recommend that you select a PCP to coordinate all of your medical care. You are responsible for making sure that a provider is a Plan provider. Should you have any questions, please contact out Customer Service Department at oror visit our website at Altius Health Plans 13 Section 1. Please see below for more information about these savings features.
Preventive care services Preventive care services are generally covered with no cost-sharing and are not subject to copayments, deductibles or annual limits when received from a network provider.
Annual deductible The annual deductible must be met before Plan benefits are paid for care other than preventive care services. Health Savings Account HSA You are eligible for an HSA if you are enrolled in an HDHP, not covered by any other health plan that is not an HDHP including a spouse s health plan, but does not include specific injury insurance and accident, disability, dental care, vision care, or long-term coveragenot enrolled in Medicare, not received VA or Indian Health Services IHS benefits within the last three months, not covered by your own or your spouse's flexible spending account FSAand are not claimed as a dependant on someone else's tax return.
You may use the money in your HSA to pay all or a portion of the annual deductible, copayments, coinsurance, or other out-of-pocket costs that meet the IRS definition of a qualified medical expense. Distributions from your HSA are tax-free for qualified medical expenses for you, your spouse, and your dependents, even if they are not covered by a HDHP.
In addition, you the account holder may contribute your own money to your HSA up to an allowable amount determined by IRS rules. Your HSA dollars earn tax-free interest. You may allow the contributions in your HSA to grow over time, like a savings account. An HRA does not earn interest. An HRA is not portable if you leave the Federal government or switch to another plan.
Health education resources and accounts management tools We make available a wide variety of self-service tools and resources to help you take personal control of your health. Below is a list of some of these tools and resources, many of which are available through our website at Health education resources preventive guidelines, patient safety tips, wellness and disease information, prescription drug interaction, pricing tools, and newsletters Account management tools online claims payment history and HSA or HRA balance information Consumer choice information online provider directory and health services pricing tool Altius Health Plans 14 Section 1.
You may get information about us, our networks, and our providers. Some of the required information is listed below. Altius Health Plans has been in existence for more than 30 years. If you want more information about us, call oror write to Altius Health Plans, Attn: Customer Service Department, South Jordan Gateway, SuiteSouth Jordan, UT You may also contact us by fax at or visit our website at Your medical and claims records are confidential We will keep your medical and claims records confidential.
Please note that we may disclose your medical and claims information including your prescriptions drug utilization to any of our treating physicians or dispensing pharmacies. Service Area To enroll in this Plan, you must live in or work in our service area.
This is where our providers practice. If you receive care outside our service area, we will pay only for urgent or emergency care benefits. We will not pay for any other health care services out of our service area unless the services have prior plan approval.
If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents live out of the area for example, if your child goes to college in another stateyou should consider enrolling in a fee-for-service plan or an HMO that has agreements with affiliates in other areas.
If you or a family member move, you do not have to wait until Open Season to change plans. Contact your employing or retirement office Altius Health Plans 15 Section 1. Changes for Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 Benefits. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.
See page How you get care Identification cards We will send you an identification ID card when you enroll. You should carry your ID card with you at all times.
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You must show it whenever you receive services from a Plan provider or fill a prescription at a Plan pharmacy. Until you receive your ID card, use your copy of the Health Benefits Election Form, SF, your health benefits enrollment confirmation letter for annuitantsor your electronic enrollment system such as Employee Express confirmation letter. If you do not receive your ID card within 30 days after the effective date of your enrollment, or if you need replacement cards, call us at or You may also request replacement cards through our website: Where you get covered care Plan providers You must receive care from Plan providers and Plan facilities.
This plan is Open Access which means you may receive covered services from any participating provider without a required referral from your primary care physician. Some services may require prior approval from the Plan. Plan providers are physicians and other health care professionals in our service area that we contract with to provide covered services to our members. We credential Plan providers according to national standards. We list Plan providers in the provider directory, which we update periodically.
The list is also on our website. If you have questions about Plan providers, call us at or or visit our website at Plan facilities What you must do to get covered care Primary care Plan facilities are hospitals and other facilities in our service area that we contract with to provide covered services to our members.
We list these in the provider directory, which we update periodically.
See reviews for Altius Health Plans in South Jordan, UT at S Jordan fully insured commercial employer groups, self funded organizations, Federal. Altius Health Plan - Standard, Code, Non-Postal, Postal 1, Postal 2 For specialty drug information, see the federal plan brochure.* Your plan requires the use. We are working hard to improve the service, quality and safety of health care. come from plan sponsors, federal and state regulators, or accrediting groups.
If you have questions about Plan providers, call us at or or visit our website at www. It depends on the type of care you need.
You and each family member are encouraged to choose a primary care physician. It is important to establish a relationship with a physician who will provide most of your health care. Your primary care physician may also assist in arranging other services, such as diagnostic tests or specialty care. Your primary care physician will provide most of your health care. If you want to change primary care physicians or if your primary care physician leaves the Plan, call us at or and we will help you select a new one.Compliancedashboard - Compliance software for HR, HIPAA and ACA
Specialty care Although we encourage you to select a primary care physician PCPyou do not need a referral or approval from your PCP to see one of our Plan specialists.
Here are some other things you should know about specialty care: If your current specialist does not participate with us, you must receive treatment from a specialist who does for services to be covered. Generally, we will not pay for you to see a specialist who does not participate with our Plan. If you need to see a specialist frequently because of a chronic, complex, or serious medical condition, your specialist will develop a treatment plan for you.
Prior authorization may be required for certain services. In some situations, you may receive services from your current specialist until we can make arrangements for you to see someone else. If you have a chronic and disabling condition and lose access to your specialist because we: - terminate our contract with your specialist for other than cause; - drop out of the Federal Employees Health Benefits FEHB Program and you enroll in another FEHB program plan; or - reduce our service area and you enroll in another FEHB plan; You may be able to continue seeing your specialist for up to 90 days after you receive notice of the change.
Contact us at or or, if we drop out of the Program, contact your new plan. If you are in the second or third trimester of pregnancy and you lose access to your specialist based on the above circumstances, you can continue to see your specialist until the end of your postpartum care, even if it is beyond the 90 days. Hospital care If you are hospitalized when your enrollment begins Your Plan primary care physician or specialist will make necessary hospital arrangements and supervise your care.
This includes admission to a skilled nursing or other type of facility. Please note: It is your responsibility to verify that your physician has arranged and received prior authorization for your care in a Plan facility and.
We will not pay for services provided by a non-plan facility without our prior authorization. See Services requiring our prior approval in this section. We pay for covered services from the effective date of your enrollment. However, if you are in the hospital when your enrollment in our Plan begins, call our Customer Service Department immediately at or If you are new to the FEHB Program, we will arrange for you to receive care and provide benefits for your covered services while you are in the hospital beginning on the effective date of your coverage.
If you changed from another FEHB plan to us, your former plan will pay for the hospital stay until: you are discharged, not merely moved to an alternative care center; the day your benefits from your former plan run out; or the 92 nd day after you become a member of this Plan, whichever happens first.
These provisions apply only to the benefits of the hospitalized person. If your plan terminates participation in the FEHB Program in whole or in part, or if OPM orders an enrollment change, this continuation of coverage provision does not apply. In such cases, the hospitalized family member s benefits under the new plan begin on the effective date of enrollment.
You need prior Plan approval for certain services Since our Plan does not have a primary care physician requirement, you may need to obtain our approval before you receive certain services. The pre-service claim approval processes for inpatient hospital admissions called precertification or prior authorization and for other services, are detailed in this Section.
A pre-service claim is any claim, in whole or in part, that requires approval from us in advance of obtaining medical care or services. In other words, a pre-service claim for benefits 1 requires precertification, prior approval or a referral and 2 will result in a denial or reduction of benefits if you do not obtain precertification, prior approval or a referral Altius Health Plans 18 Section 3.
Union Health Service www. Kaiser Foundation Health Plan, Inc. Coventry Health Care www. Coventry Health Care of Louisiana, Inc. Group Health Cooperative www. KPS Health Plans www. Health Net of Arizona, Inc. Physicians Plus Insurance Corporation www.
This plan's health coverage qualifies as minimum essential coverage. SelectHealth Plan selecthealth. Blue Care Network www. Blue Cross and Blue Shield of Illinois www.
Coventry Health Care of Kansas, Inc. MVP Health Care www. Humana Health Plan, Inc. Humana Benefit Plan of Illinois, Inc. Dean Health Plan, Inc. Health Net of California www. You must live or work in. Foreign Service Benefit Plan www. Humana Health Plan of Texas, Inc. This plan's health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits.
Aetna Open Access www. This plan's health coverage qualifies as minimum essential coverage and meets the minimum value standard. You must live or work. Compass Rose Health Plan www. Enrollment in this plan is limited. You must. Government Employees Health Association, Inc. Benefit Plan www. Government Employees Health www. Health Alliance HMO www. United States Office of. You must live or work in our geographic. Research health. We are providing. Eligibility for this program will be determined.
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Altius Health Plans. Customer Service Size: px. Start display at page:. Download "Altius Health Plans. Vernon Nichols 3 years ago Views:. Finding a Provider Primary and specialty care Non-participating provider care Finding a Pharmacy Behavioral health and substance abuse services. Quality improvement strategy We are working hard to improve the service, quality and safety of health care.
One way we do this is by measuring how well we and others are doing. We work with groups of doctors and other health professionals to make health care better. Our clinical activities and programs are based on proven guidelines. We also give you and your doctors information and tools that may help you make decisions. NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.
We asked members how satisfied they are with Coventry, and we continued to implement actions to improve member satisfaction. We surveyed members in the Case Management Program. They are overall satisfied with the program, and noted improvement in nurse effectiveness in coordinating care. Overall satisfaction with the program remains strong. They told us that the services helped to follow the treatment plan given by their doctor, and that the services helped to improve their health.
Educated members and providers about patient safety efforts, and provided information to help make informed health choices. It's how we show our commitment to improving your quality of care, access to care and member satisfaction. Preventive care guidelines Fraud and Abuse Notice. Our local members have access to a strong regional network of providers who have met our stringent credentialing requirements.
If you have a medical emergency, get the treatment you need right away. Emergency services outside the service area will be covered. If you are away from home and need urgent care, call your primary care physician. He or she will tell you if you should seek treatment right away or if you can wait to get care when you return home.