Medical necessity and prior authorization timeframes and enrollee responsibilities
Enrollee claims submissions
Enrollee recoupment of overpayments
Machine readable information
About benefits
Coordination of benefits
If you have coverage from more than one health plan, coordination of benefits helps determine which plan is primary and pays first and which plan is secondary.
Explanation of benefits
We send you an an EOB statement with details about what medical treatments/services we've paid for you and what you will have to pay, according to your policy.
Additional resources
Grace period and claims pending
Medical necessity and prior authorization timeframes and enrollee responsibilities
Out-of-network liability and balance billing
Retroactive denials
This information pertains only to our QHP (Qualified Health Plan) plans.
