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    Using Your Benefits

    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 Certificate of Coverage or call Member Services.
     

    Using Your Benefits

    Carry your SelectHealth ID Card and use participating providers and facilities to ensure the highest possible benefits are applied to your claims. We also encourage you to maintain a relationship with a participating Primary Care Provider (PCP). This type of doctor attends to your common medical problems, coordinates care, and provides preventive care and health maintenance.
     
     

    Emergency Care

    If you have an emergency, call 911 or go to the nearest hospital. Though your copay is 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. If the provider is unavailable, you may use one of the following services:

    • Call Member Advocates. 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.

    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?​
    So how does this benefit you? 

    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. To see a list of all services that require preauthorization or to request it, call Member Services at 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 should 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. 

    Filing an Appeal

    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.
     

    RxCore

    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.
     

    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.​
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    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.


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