• Using Your Benefits

Questions about your plan? Call us.
801-442-5038
 Choose a section below:​


The following information is intended to give you a general idea of how to use your SelectHealth benefits. Your actual benefits are noted on your Member Payment Summary. This information is not all-inclusive and may vary by plan. To obtain more information on the coverage of services listed below, please refer to your Member Materials or call Member Services.

Where You Get Care

Primary Care Provider

We encourage you to maintain a relationship with a participating PCP. This type of doctor attends to your common medical problems, coordinates care, and provides preventive care and health maintenance. Carry your SelectHealth ID card with you and use participating providers and fa​cilities to ensure the highest possible benefits are applied to your claims.

Emergency Care

If you have an emergency, call 911 or go to the nearest hospital. Although your benefits copay and/or deductible are the same at all emergency rooms, you will save money on services by visiting participating hospitals.
 

Urgent Care

If you have an illness or injury that is not life threatening but needs medical attention within 24 hours, call a participating provider. You may use one of the following services:

  • Call Member Avocates​.They can help you get an immediate appointment with another provider
  • Go to an Intermountain InstaCare facility
  • Call an Intermountain KidsCare facility to schedule a same-day appointment or
  • If you are outside of the service area and need urgent care, go to any provider or hospital. You can save money on out-of-area services by using a MultiPlan provider. To find one, call 800-678-7427 or visit multiplan.com.​​

Out of Network Liablity

If you receive services from a provider that isn’t on your network, you may be responsible for more charges than had you received the same services from an in-network provider. Out-of-network providers may bill you directly for charges that aren’t covered by your plan. For more information related to out-of-network liability, click here.

Healthcare Management

We work hard to manage costs while protecting the quality of care. Our care managers review three aspects of medical care:

  • Is the care setting appropriate?
  • Are the services medically necessary?
  • Is the length of time spent in the hospital appropriate?​

By making sure your care is provided in the most appropriate manner, we can lower medical expenses for everyone and maintain reasonable premium rates.

Preauthorization

Approval from SelectHealth for certain services is called preauthorization. If preauthorization is not obtained when required, your benefits may be reduced or denied. Generally preauthorization is needed prior to receiving services. However, in some cases we may perform a post-service review to determine coverage. Please allow 14 days for preauthorization for non-admission-based procedures. For information on what services require preauthorization, click here​ and browse to “What services require preauthorization?” You may also request a list or speak to Member Services by calling 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 users please call 711. 

Concurrent Review

If you request more services—in addition to services already approved—we will work with you and the facility or providers to make sure that care is received in an appropriate setting. We will also help you plan for the return home or to another care setting. 

Claims Denials​ and Appeals

Claims

If you want to submit a claim to SelectHealth, rather than the provider submitting the claim for you, you may fill-out a claim form located here​Follow the instructions on page 2. Generally claims must be submitted within one year from the date of service, though longer time limits do exist in certain circumstances.


Retroactive Denials

If your policy is canceled due to nonpayment or for other reasons, claims submitted during the grace period, or before your plan is canceled, will be denied after SelectHealth receives them. You can prevent this by always paying your full premium. For more information about retroactive denials, click here. ​​ 

Appeals

You or your representative can appeal any decision. You may submit an appeal in writing to:

Attn: Appeals 
SelectHealth
P.O. Box 30192
Salt Lake City, UT 84130-0192

Pharmacy Benefits
 

SelectHealth Prescriptions

Pharmacy benefits are included with all of our Individual medical plans.
 

Individual Plans

All Individual plans include our RxCore formulary. A formulary is a list of covered prescription drugs. In an effort to help keep your costs as low as possible, RxCore excludes more expensive brand-name drugs when there is a lower-cost generic option or over-the-counter equivalent available. A generic drug is a medication with the same active ingredients, safety, dosage, quality, and strength as its brand-name counterpart. Providers and pharmacists agree that generic medications are as safe and effective as brand-name drugs.
 
Individual plan RxCore pharmacy benefits have four tiers (levels) of coverage. Each tier includes different drugs and copays/coinsurance. Tier 1 medications are available at the lowest cost. On some plans, the pharmacy deductible does not apply to these drugs.
 
Certain medications are not covered. If you have questions before applying for coverage or using your pharmacy benefits, call Member Services or visit
the Pharmacy section of our website. You may also search our list of covered medications online or call to request a copy.
 

Drug Exceptions

If you need a prescription for a medication that is normally not covered under your plan, you may ask for an exception to your plan’s prescription drug coverage. Obtaining an exception decision takes between 24 (emergent) and 72 hours (standard)​. Many requests can be handled over the phone by calling 800-538-5038, or by filling out the Exception Request Form​. Some requests may need to be submitted by your physician. If the exception is denied, you have the right to appeal that decision as with any other denial.

Pharmacy Networks

Access your prescription drug benefits conveniently through a network of more than 39,000 pharmacy locations nationwide, with 400 locations in Utah. Most of our partner pharmacies are national chains, so you are covered while traveling.

90-Day Prescriptions

Pick up a 90-day supply of your maintenance medications at participating Retail90 pharmacies or by mail order through Intermountain Home Delivery. This program offers both convenience and cost savings. Register for Intermountain Home Delivery.

Individual Plans and Premiums

Grace Periods 

If you receive an Advanced Premium Tax Credit (APTC) to assist in paying your monthly premiums, you will receive a 3-month grace period in the event that you become delinquent in payment. In the event that claims are submitted for services received during the second or third months of the grace period, they will be pended (held without final determination or payment) until you pay your portion of premium or are terminated for nonpayment. For more information, click here

If you do not receive financial assistance for your coverage, premiums are due the first day of the month your coverage begins. If you do not pay your premium in full by the last day of the month, your coverage will be terminated the first day of that month.​

Recoupment of Overpayments

If you pay too much (overpay) toward your premium and your policy is still active, we will apply this overpayment to the next month’s premium. If your policy has been terminated, the overpayment will be refunded—unless benefits were used after the termination date, in which case, the refund will be offset by the benefits used and we will refund any remaining amount. If you have questions, please call Accounts Receivable at 844-442-4106, option 1.

Explanation of Benefits (EOB)

An EOB explains what services have been paid for by your plan and what services you will be responsible for. SelectHealth sends EOBs to members after claims are received and processed. For more information on how to read and understand an EOB, click here to see a sample.

​​
Coordination of Benefits (COB)

COB occurs when a member is enrolled in more than one plan and is used to determine which plan processes claims first. For more information about coordination of benefits, click here​


 

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Log in to My Health to view your claims and plan information.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Cerrar

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 。


退出

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Thoát

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. 번으로 전화해 주십시오.


종료

ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । SelectHealth Advantage: 1-855-442-9900 (TTY: 711)/ SelectHealth: 1-800-538-5038 मा फोन गर्नुहोस्।


बाहिरनिस्कनुहोस्

FAKATOKANGA’I: Kapau ‘oku ke lea fakatonga, ko e kau fakatonu lea te nau tokoni atu ta’etotongi, pea te ke lava ‘o ma’u ia. Telefoni ki he SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Hū‘anga ki tu‘a

ОБАВЕШТЕЊЕ: Ако говорите српски језик, услуге језичке помоћи доступне су вам бесплатно. Позовите Select Health Advantage: 1-855-442-9900 (TTY- Телефон за особе са отежаним говором или оштећеним слухом: 711)/Select Health: 1-800-538-5038.


IZLAZ

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Isara

ملحوظة: إذا كنت تتحدث العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل بشركة SelectHealth Advantage: 1-855-442-9900 (رقم هاتف الصم والبكم: 711) / SelectHealth: 1-800-538-5038.


خروج

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


Beenden

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги переводчика. Позвоните SelectHealth Advantage: 1-855-442-9900 (телетайп: 711) / SelectHealth: 1-800-538-5038.


выйти

សម្គាល់៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ សេវាជំនួយផ្នែកភាសា ដោយមិនគិតថ្លៃ គឺអាចមានសំរាប់ អ្នក។ សូមទូរស័ព្ទមក SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038 ។


ចាកចេញ

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。SelectHealth Advantage: 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038. まで、お電話にてご連絡ください。


終了

ATTENTION : si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Contactez SelectHealth Advantage au 1-855-442-9900 (TTY: 711) / SelectHealth: 1-800-538-5038.


fermer