Member FAQ
Member Frequently Asked Questions
Click the links below for answers to frequently asked questions about Today's Options® HMO.
Q: When can I start using my plan?
Once your enrollment application is processed, you will receive an Acknowledgement Letter. This letter will inform you to begin using the plan on your Effective Date, which is typically the first day of the month following the date you submit your application.
If you enrolled in a 2012 plan during October 15, 2011 – December 7, 2011, your coverage will be effective on January 1, 2012.
Q: When will I receive my ID card?
You should receive your ID card no later than 10 calendar days from when you receive confirmation of your enrollment from the Centers for Medicare & Medicaid Services (CMS), or by the last day of the first month of your enrollment, whichever comes first.
Q: How will I make my premium payments for my plan? Can I change how I pay my bill?
You can make a premium payment in one of three ways:
- You can arrange for an automatic bank withdraw from your checking or savings account, or
- We can send you a monthly bill, and you send us back a check or money order, or
- You can sign up for automatic deduction from your Social Security check. This process can take up to 90 days to become effective, and you are responsible for paying any premiums during this time.
If you want to change how you pay your bill, we can accept a verbal request to change your method of payment over the phone for direct bill or Social Security Administration (SSA) deduction. You must submit a signed request in writing, either by sending a fax or a letter through the mail, if you are changing to automatic bank withdraw from your bank account. You will need to submit a copy of a voided check.
Q: Will I receive a coupon booklet to send in my monthly premium payments?
If you choose to pay your bill monthly through a check or money order, you will receive a monthly premium notice, but you will not receive a coupon booklet. If you pay your premium by automatic bank withdraw, you will not receive a monthly premium notice.
Q: I've heard I'll need a Primary Care Physician (PCP). What does that mean?
As a Today's Options HMO member, you are required to select an affiliated Primary Care Physician (PCP) to help manage your healthcare. Your PCP will collaborate with you, your pharmacist and various medical specialists and professionals to help manage your medical care.
Click here to use our Provider Search tool to locate your physician.
To make PCP changes, call us at: 1-866-802-8571, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.
Q: How can I find out if my physician is in my plan’s provider network?
To check if your physician is in the Today's Options HMO provider network, use our Provider Search tool or refer to the Today's Options HMO Directory of Physicians and Healthcare Providers page.
To make PCP changes, call us at: Today's Options HMO, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 8:00 a.m. to 8:00 p.m..
Q: How do I see a specialist?
When specialty services are medically necessary, your PCP will direct you to a specialist (routine OB/GYN care does not require PCP direction).
Q: What about emergency services?
Your plan includes coverage for emergency services. You are covered anywhere in the United States. Simply go to the nearest emergency room or call 911 for assistance.
If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card or contact your Primary Care Physician (PCP).
Q: Can I continue to see my original physicians?
With Today's Options HMO, you will choose a doctor from our broad network to coordinate your care.* If you wish to change your doctor, also called your Primary Care Physician (PCP), you may do so at any time. Your PCP is your health advocate - he or she will send you to specialists or hospitals when you need additional care.
Please note that with an HMO plan, you must use providers in the network. You will be responsible for any fees or services provided by doctors or hospitals out of the network. Providers in the network can change at any time.
*You must use plan providers except in emergency or urgent care situations (or for out-of-area renal dialysis). If you obtain routine care from out-of-network providers neither Medicare nor Today's Options HMO will be responsible for the costs.
Q: I am a Member but have not received approval for medical services. What should I do?
Questions regarding approval for services should be referred back to the doctor who ordered the services. Or, you can call us at 1-866-802-8571, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.
Q: What is an EOB?
If you've visited your doctor or pharmacist, or if you’ve received some type of medical care, you have probably received an Explanation of Benefits (EOB). This statement is from your plan about health services you’ve received. This statement provides complete information about the health services you’ve received, payments, and any charges you are responsible for. It is important to remember that the EOB is not a bill. This information is provided for your convenience.
If you have questions about how much you owe your provider, you should contact us at: 1-866-802-8571, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.
Q: What if my prescription medicine is not on the formulary?
If your specific medicine is not on our formulary, there may be a similar, high-quality medicine available that offers the same benefits. We’ll work with you and your doctor to find a covered medicine that best suits your condition. You may also request a formulary exception.
If you have questions about your prescription medicine, you should contact us at 1-866-802-8571, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.
Q: Does
Today's Options HMO have materials that are in Spanish?
Yes, Today's Options HMO offers materials in Spanish that are available upon request. You may request Spanish materials by calling 1-866-802-8571, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week. A Today's Options HMO representative will be happy to help you.
We also offer materials in other alternate formats, such as Braille or large print. Materials may also be available in a non-English language. For additional information, call us at the phone number listed above.
Q: How do I report suspected fraud, waste, and abuse?
Allegations can be reported to the Fraud, Waste, and Abuse hotline at 1-866-684-0595 or by email to Fraud@UniversalAmerican.com. All calls and emails are confidential and may be anonymous. For more information please visit the Fraud, Waste, and Abuse section
of the website.
Primary Care Physician (PCP)
A doctor that a member chooses to coordinate their healthcare with specialists and other providers. A PCP acts as the manager of your healthcare and can assist you in finding the right specialists when necessary. He or she is available to patients 7 days a week, 24 hours a day through regularly scheduled appointments or by other doctors providing "on-call" back up coverage. Most Health Maintenance Organization (HMO) plans require you to see your PCP before you see any other healthcare provider.