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Know Your Plan

Get to Know Your Plan

Find out what is covered by your health insurance plan and learn about your rights.

Questions? Call us at 855-442-3234.

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 SelectHealth 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 SelectHealth Civil Rights Coordinator at 801-442-9950.

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

 

Actions, Appeals, and Grievances

You’ll have 60 days from the date we take action to ask for an appeal. If you need help filing an Appeal, call the Appeals department at 844-208-9012. We have interpreters and help for those with hearing problems.

If you have a concern or complaint, you can file an action, appeal, or grievance. Read more about each one to decide which one best
meets your needs.

What is an Action?

An Action is when SelectHealth:

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

If you have a problem with an Action we have taken, call Member Services. They can solve most problems. If you are unhappy with how things work out with Member Services, you can file an Appeal or Grievance.

What is an Appeal?

An Appeal is when you write and ask us to review an Action we have taken to see if we made the right ruling on your claim. See our Appeal form.

What is a Grievance?

A Grievance is a complaint about anything other than an Action. Some Grievances are:

  • The quality of care you received
  • A doctor was rude to you
  • Your rights were not respected by a SelectHealth 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 member rights or discriminated against

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

Our mailing address:

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

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

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