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.
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.
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.
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.
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.
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.
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:
P.O. Box 30192
Salt Lake City, UT 84130-0192
SelectHealth Prescriptions pharmacy benefits are included with all of our Individual medical 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.
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.
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