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Get to Know Your Plan

We Have You Covered

Depending on the type of plan you have, Traditional or Non-traditional, you may have coverage for these services:

  • Preventive care
  • Eye care
  • Labs and X-rays
  • Newborn care
  • Over-the-counter drugs

If you’re already a member and want to know more about what’s covered by your plan, log in to My Health. Even though some benefits may not be covered by Select Health Community Care, you may be able to get them through state Medicaid. These include mental health, dental, and chiropractic, and transportation services.

Your Rights and Responsibilities

You have rights to make sure you are treated fairly. You must also follow the rules of your plan.

We do not exclude because of current health issues, color, creed, age, national origin, handicap, religion, sex, or sexual orientation. If you have questions or you have not been treated fairly, call the Select Health Civil Rights Coordinator at 801-442-9950.

Get to know your rights and the rules of your plan.

 

Adverse Benefit Determinations, Appeals, and Grievances

Generally speaking, members are issued an Adverse Benefit Determination when a benefit is denied or coverage is rescinded. If you’ve received notice of an Adverse Benefit Determination, you have 60 days to ask for an appeal.

If you need help filing an appeal, please call the Appeals and Grievances department at 844-208-9012. Foreign language interpreters are available, and we offer assistance for those with hearing problems.

 

Understanding Adverse Benefit Determinations

An Adverse Benefit Determination is when Select Health:

  • Denies care or approves less care than you wanted
  • Denies a covered service you've had access to previously
  • Lowers the number of services you can get or ends previously approved service
  • Denies payment for care that you may be responsible for paying
  • Does not take care of an Appeal or Grievance as soon as we should

If you have a problem with an Adverse Benefit Determination, please call Member Services. They can help you work through most problems. If you still need help or have additional questions, you can file an appeal or grievance.

What is an Appeal?

An appeal is a request to review an Adverse Benefit Determination. Essentially, you ask that we double-check our decision to make sure we made the correct ruling on your claim. See our Appeal form.

What is a Grievance?

A Grievance is a complaint about anything other than an Adverse Benefit Determination. You can file a grievance at any time. Examples of grievances include:

  • The quality of care you received
  • A doctor was rude to you
  • Your rights were not respected by a Select Health staff member
  • A doctor won’t see you in a reasonable amount of time
  • You were not treated fairly, or you feel you were denied your rights or discriminated against

See our Grievance form or contact Member Services at 800-538-5038 to file a verbal Grievance.

Our mailing address:

Select Health Appeals
P.O. Box 30192
Salt Lake City, Utah 84130-0192

Fax: 801-442-0762
Email: appeals@selecthealth.org

 

 

 

Medicaid Handbook

Read more about your plan in the Medicaid Member Handbook. You’ll find phone numbers, information about programs we offer, details about what is—or isn’t—covered by your plan, and more.

Medicaid Member Handbook – English
Medicaid Member Handbook – Spanish
Integrated Care Handbook – English
Integrated Care Handbook – Spanish

Lost your paper copy or need this information in a different language? Member Services can help.