CLAIMS

Most Planstin-managed health plans do not use a provider network . That means you are free to work with any provider with out fear of any out-of-network penalties. Very few Planstin-managed health plans still use a provider network. In this case, your health plan uses the PHCS network of providers. Fair-priced healthcare & care coordination The majority of Planstin-managed health plans use an innovative healthcare pricing strategy called fair-priced healthcare. This strategy does not require the use of a provider network, and instead relies on a care coordination team to help you work with your provider, make appointments, and locate providers that work well with your benefits. To learn more about fair-priced healthcare, click here . To learn more about care coordination click here .

All Planstin-managed health plans now feature care coordination services as a part of a fair-price healthcare strategy. The Planstin Care Coordination team will help match members with providers that work best with their plan.

Fair-price healthcare is a no-network, proactive pricing strategy that relies on a care coordination team to match members with providers that work best with their plan. If your health plan uses fair-priced healthcare, it will try to determine what the most fair price is for a service in any given area by examining average prices, cash prices, or using other reference points, such as the Medicare rates. 

Maybe. Preventive Basic, Preventive HSA, and Preventive Copay plans do not cover maternity. However, all Care+ health plans do include coverage for maternity care. Additionally, many members with a preventive health plan also become Zion HealthShare members. A Zion HealthShare membership is designed for larger, medical needs like maternity.

No. Instead, if you have a health plan, you will be issued an ID card for medical services, and separate ones for dental and vision. Both digital and physical copies of these cards will be sent to you—the digital copies via email and the physical ones via mail. When you visit a doctor's or dentist's office, you should present the appropriate ID card. The healthcare provider will then bill us directly. There is an exception for vision care. In most cases, vision service providers may ask you to pay up front. If you do pay out-of-pocket for vision services, your plan can reimburse you upon submission of an itemized receipt. This receipt needs to include the patient's name, member number, group number, the date of service and/or purchase, and the billing codes.