Member FAQ
Member Frequently Asked Questions
Click on the questions below to find answers to frequently asked questions.
Q: When will I receive my ID card and be able to start using my Plan?
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.
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: 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 withdrawal, you will not receive a monthly premium notice.
Q: Can I choose my doctors?
Yes. Today's Options® PPO gives you the freedom to choose which doctors, specialists, and hospitals you visit. You may pay less for services received from healthcare providers who are in our broad network. You may see a specialist without a referral. And, there is no limit on covered office visits so you can see your doctor as often as you choose. Providers in the network can change at any time.
Q: How can I find out if my physician is affiliated with my health plan?
To see if your physician is in the Today's Options PPO provider network, review the Today's Options PPO Directory of Physicians and Healthcare Providers or click here to use our Provider Search Tool to locate your physician.
Q: Why do I need a Primary Care Physician (PCP) assigned to me?
You are not required to select a PCP, but we recommend it. The best way to meet your total healthcare needs is to have your care coordinated by one physician who knows you and your health history.
Your 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.
Q: What happens if I go to a doctor who is not in the network?
You can go to doctors, specialists or hospitals in or out-of-network. Our plan gives you the freedom to choose which doctors, specialists, and hospitals you visit. You may pay less for services received from healthcare providers who are in our broad network. You may see a specialist without a referral. And, there is no limit on covered office visits so you can see your doctor as often as you choose. Providers in the network can change at any time.*
*With the exception of emergencies or urgent care, it may cost more to get care from out‐of‐network providers.
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: What is an Explanation of Benefits (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 costs you are responsible for paying. 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: 1-866-422-5009, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-877-907-2985) 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.
If you have questions about your prescription medicine, you should contact us at: 1-866-422-5009, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-877-907-2985) 7 days a week.
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.