Questions about your plan? Call us.
- How can I better understand my medical benefits?
Log in to My Health. Click on "Insurance," "Coverage," and "Coverage Plan." These documents show your copays, participating and nonparticipating benefits, out-of-pocket maximums, yearly deductible, and more. We are also happy to explain your benefits over the phone call Member Services at 800-538-5038.
- Who do I call if I have questions?
Our Member Services representatives are here during extended hours to answer questions and resolve concerns. We have a "One and Done" philosophy, with a goal to resolve any issue on the first call. To contact Member Services, call 800-538-5038 weekdays, from 7:00 a.m. to 8:00 p.m., and Saturdays, from 9:00 a.m. to 2:00 p.m. TTY/TDD users should call 711.
- How do I update my personal information or add a dependent to my policy?
Complete and submit a Change Form. If you are adding eligible dependents, you must do so within 31 days of the child's birthday, adoption, or adoption placement.
How do I find out how what I have paid toward my individual and family deductibles?
Note: Only the subscriber has access to the family's benefit details.
Log in to My Health. Under insurance, click “View All” then "Year-to-Date Totals."
- Do I have coverage for preventive care?
Yes. We cover most preventive services 100 percent. Your doctor must bill claims with preventive codes.
- How do I appeal a claim?*
We are committed to making sure that your insurance concerns are investigated and resolved as soon as possible. Most situations can be resolved informally by calling Member Services.
If you are not satisfied with the results of working with Member Services, you and/or your authorized representative may file a written formal appeal complete our Appeal Form or write to the Appeals department.
You must file any formal appeal within 180 days from the date you receive notification of any Adverse Benefit Determination or negative outcome of a Preservice Inquiry. Written, formal appeals should be sent to:
P.O. Box 30192
Salt Lake City, UT 84130-0192
Appeals may also be faxed to 801-442-0762. You may appeal an Urgent Preservice claim in writing or by calling 801-442-7829. For more information on appealing a claim, please refer to your Certificate of Coverage.
*Appeals processes may vary based on your plan. Contact Member Services for more information.
- How can I better understand my pharmacy benefits?
If your plan includes SelectHealth pharmacy benefits, you will be able to see them when you log in to My Health and click on "Pharmacy Tools." This will allow you to see your copays and if there are cheaper alternatives to what you may be taking. We are also happy to explain your benefits over the phone call Member Services at 800-538-5038.
- How can I request an exception for a medication not covered under my pharmacy benefits?
In some circumstances, we are able to make exceptions over the phone based upon information provided by you, your pharmacy, or the prescribing doctor. If it is determined that an exception cannot be made through this informal process, you or your provider can request an exception through the preauthorization process. Your doctor can submit a completed preauthorization form or Letter of Medical Necessity, or you can call us, submit a written request, or use My Health to send us a secure e-mail.
- What is the Plus Plan?
A Plus plan means you have the option to use nonparticipating providers and facilities or those providers and facilities that are not on your plan's network. To view your member materials and your nonparticipating benefit costs, log in to My Health ,
Note: If you are on a Plus plan, the logo on your ID Card will show a '+' symbol.
- What is COBRA coverage?
The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives you the option to continue coverage while you are searching for a new job or coverage. COBRA regulations apply to employers with 20 more employees.
The employer must notify employees about their rights and responsibility for continuation of coverage. For more information about your responsibilities as an employer, contact your broker/agent or visit the Department of Labor website.
- What services require preauthorization?
Preauthorization is required for all the following: inpatient services; maternity stays longer than two days for a normal delivery or longer than four days for a cesarean; certain durable medical equipment; home healthcare, hospice, and private duty nursing services; all services obtained outside of the United States unless a routine, urgent, or emergency condition; pain management/pain clinic services; certain injectable drugs and specialty medications; cochlear implants; organ transplants; and selected prescription drugs. If you fail to preauthorize these services when using a nonparticipating provider, your benefits may be denied or reduced by 50 percent and will not be applied to your out-of-pocket maximum.
- What should I do if I'm in an accident?
Call Member Services at 800-538-5038. To process your claims correctly, we need the details of your accident, including insurance information for the responsible party (e.g., auto or homeowner’s) and any injuries resulting from the accident.
We may need to coordinate benefits with other insurance payers through a process called subrogation. Our Subrogation Specialists will assist you in handling the various aspects of your accident and are experienced in sorting through the many details of settlements and claims payment. For subrogation questions, call 801-442-7415.
- Where can I find information about SelectHealth career options?
We are glad you are interested in joining our company. Click Here and learn more about what it’s like to work at SelectHealth and to search for Job Openings.
- Why was my claim denied?
There are many reasons why a claim may be denied, including insufficient information or the use of a nonparticipating provider or facility. If you have questions, call Member Services at 800-538-5038.
Log in to My Health
to view your claims and plan information.