Transparency in coverage
Find information about claims, billing, coverage decisions, appeals, reviews, and your rights as a health plan member–for 2027 Select Health plans.
Claims and billing
Learn how claims are processed, how billing works, and what to do if you receive care from an out-of-network provider.
Out-of-network cost responsibilities
Learn about your financial responsibility when receiving care from providers outside your plan's network, including protections related to balance billing and out-of-network charges.
Enrollee claim submission
Find out how to submit a claim when you've paid for covered healthcare services and need reimbursement from your health plan.
Explanation of benefits (EOB)
Learn how to read your Explanation of Benefits (EOB), including services received, payments made, and any remaining member responsibility.
Coordination of benefits (COB)
Understand how claims are processed when you have coverage through more than one insurance policy.
Recoupment of overpayments
Review how overpayments are identified, corrected, and recovered when premium payments exceed the appropriate amount.
Coverage decisions
Understand how coverage determinations are made and what factors may affect approval of services, treatments, and medications.
Premium grace periods
If a premium payment is missed, you may qualify for a grace period. Coverage may end if past-due premiums aren't paid, and some claims may be delayed during that time.
Prior authorization
View services and medications that may require approval before treatment and learn how authorization decisions are made.
Retroactive claim denials
Understand the circumstances that may lead to a previously paid claim being reviewed and denied after payment.
Pending claims
Learn how claims may be handled during premium payment grace periods and what this means for coverage and reimbursement.
Appeals & reviews
If you disagree with a coverage decision, learn about available review options, timelines, and submission requirements.
Medication exception review process
Understand the process for requesting an exception when a medication is not covered or has coverage restrictions.
Submission instructions
Find the forms, documentation requirements, and instructions needed to submit appeals and review requests.
For over 40 years, we’ve been committed to helping our members and communities live the healthiest lives possible. We’re a Utah-based nonprofit with offices in Colorado, Idaho, Nevada, and Utah. When you call us, you’re talking to a real person, who is familiar with your community.