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EGWP’s or Employer Group Waiver Plans are Medicare Advantage plans offered by employers or unions to their retirees. The plans are provided and managed by private insurance companies. These plans are exempt from certain rules that apply to individ...
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What Happens After I Get Care? After you go to the doctor, how does the doctor get paid? How do you know if your visit was covered? What if you owe more for the service? We can help make sense of what happens next. After You Go to the Doctor ...
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We know employees get sick or hurt, and when they do, they need health care. They can’t always avoid the bad stuff life throws at them, but it’s nice to help them through it. That’s why we’re here–to give them insurance for real life. We explain ...
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Last Updated: 02/24/2021
in Medicare Your Account How do I order a new ID card? How can I check my claims? How can I see my preauthorizations? How to file a grievance or appeal a coverage decision? Where can I get an Appointment of Representative form? How do I authorize release o...
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Additional Terms and Definitions A Accreditation Shows that a health plan meets standards set by an official review committee or organization. Acute Care Short-term care for an illness or health problem. Adjudication The process of paying ...
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Last Updated: 12/11/2024
in Medicare Your Pharmacy Info Better therapeutic outcomes for members with multiple conditions Our Medication Therapy Management Program (MTMP) is focused on improving therapeutic outcomes for Medicare Part D members. To qualify for MTMP, a member must meet all of the following...
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Plan Types What is an HMO? An HMO (Health Maintenance Organization) plan gives you personal care from a set network of doctors and hospitals. Out-of-Network care is still covered in urgent or emergency situations or with an approved prior author...
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Medicare Part D adds prescription drug coverage. You can buy Part D from insurance companies to go with your Original Medicare coverage or your Medicare Supplement coverage, or you can choose a Medicare Advantage plan that includes Part D prescripti...
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What Is a Monthly Premium? Your monthly premium is the set amount you pay each month to have your plan. You pay it even if you don’t receive any medical care that month. Like other bills, this premium can rise when it’s time to renew your plan fo...
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Clinical Review Criteria Clinical Review Criteria are available here Useful Websites American Academy of Pediatrics National Heart, Lung, and Blood Institute United States Preventive Services Task Force UpToDate Alcohol and ...