|
This section of your online member
handbook explains:
Your ID card How long will it take to get my ID card? What if I have to see my doctor before I get my ID card? Your coverage documents What is a Certificate of Coverage (COC)? How do I find out what's covered under my plan? Your provider directory What information is available in the Provider Directory I got from Priority Health? What hospitals and pharmacies can I go to under my plan? Where can I go for medical supplies? Other benefit information What is an Explanation of Benefits (EOB)? What if I'm covered by more than one health plan? How can I be sure coordination of benefits (COB) is being applied to my claims? Q: How long will it take to get my ID card? After Priority Health receives your eligibility information from your employer or you order a new ID card here online (you need to log in to do this!), you should receive it within 10 days. Back to top Q: What if I have to see my doctor before I get my ID card? A copy of your enrollment form is proof of insurance and can be used as a temporary ID card. Still, you may have to pay for services up front, then print, fill out, and submit a claim form (100KB PDF*) to Priority Health. Your Primary Care Physician or other health care provider also can contact Priority Health Customer Service to verify your coverage. Back to top Q: What is a Certificate of Coverage (COC)? When you have PriorityHMOSM, PriorityEPOSM, or PriorityPOSSM coverage, your COC is your contract with Priority Health. PriorityPPOSM members have an insurance policy instead. Either one will tell you which health care services are covered or not covered under your plan. It also shows who is eligible to be enrolled in your plan. Back to top Q: How do I find out what's covered under my plan? Since every employer's health plan is slightly different, you need to check your coverage documents, either a Certificate of Coverage (COC) if you have PriorityHMO, PriorityEPO, or PriorityPOS, or a policy if you have PriorityPPO. You'll also need to check any "riders," which explain what coverage your employer may have added to or deleted from the standard COC or policy, to find out the exact terms of your plan. Call Customer Service if you have questions about your plan and can't find the answer in your coverage documents. See the standard coverage documents. Back to top Q: What information is available in the Provider Directory I got from Priority Health? It tells you which doctors, mental health professionals, hospitals, pharmacies, medical supply providers and other health care providers participate in your health plan. The same information is available here at priorityhealth.com in the Find a Doctor tool - and the online version is usually more up-to-date. Back to top Q: What hospitals and pharmacies can I go to under my plan? Use the Find a Doctor tool to find the doctors, mental health professionals, hospitals, pharmacies, medical supply providers and other health care providers covered by your health plan. Back to top Q: Where can I go for medical supplies? Use the Find a Doctor tool online to search for Medical Supplies Providers. Back to top Q: What is an Explanation of Benefits (EOB)? An Explanation of Benefits (EOB) is a statement that Priority Health mails to you with details of health care services you've received. It is not a bill, it's a statement of the amount your provider (specialist, hospital or other health care professional) billed Priority Health and the amount we paid or denied. It does inform you of any amount that you are responsible for, which your doctor or provider may then bill you for. You can also see this information when you log in to your personal account here at priorityhealth.com and go to "View Claims." Back to top Q: What if I'm covered by more than one health plan? Coordination of Benefits (COB) is the system we use to determine how benefits are paid when you are covered by more than one health care plan. If you and your spouse work for different employers you may be covered by more than one health plan. That is called "dual coverage." If you have dual coverage, one company is the primary payer and the other is secondary. The primary plan is responsible for paying the full benefit amount allowed by the member's contract. The secondary plan is responsible for paying up to that plan's benefit level. When a claim is filed for a member or dependent who has dual coverage, we work with the other plan to coordinate benefits. We make sure that the maximum payments are made for all allowable expenses. We also coordinate benefits for claims covered by auto insurance plans. If you are covered by another plan but did not list it on your enrollment form, please let us know by calling our Customer Service Department. To learn more about coordination of benefits, see your online Certificate of Coverage (COC) or insurance policy. See the standard coverage documents. Back to top Q: How can I be sure coordination of benefits (COB) is being applied to my claims? For Priority Health to coordinate our coverage with coverage from other group health plans, be sure that you:
Back to top You'll need Adobe® Acrobat software to view and print PDF files. Download it free now! 
Last modified
10/21/08
|
