A GUIDE FOR
YOUR COVERAGE
SO YOU HAVE HEALTH INSURANCE.
NOW WHAT?
Call us at 1-800-851-3379 or visit YourHealthAlliance.org
Introductions.
What’s the
Health Alliance story?
We’re a 30-something-year-old insurance company
that grew up in the cornfields of East Central Illinois
to become a company that now offers health care
coverage to members throughout the country.
Doctors started Health Alliance and continue to
play a large role in our growth. Doctors know
hands-on what their patients expect from their
health insurance. That knowledge helps us deliver
world-class service to our members.
We give you what you need through quick claims
turnaround, wellness programs that actually work
and a dynamic member website,
YourHealthAlliance.org.
Of course, our Customer Service team is always just
a phone call away. We’re ready to help!
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Key Things to Know and Do
If you read only one part of this brochure,
make it this.
Having health insurance is awesome. Knowing your
benefits and starting your plan smoothly is even better.
As a New Member:
• Expect your Health Alliance ID card to arrive in the mail
within 10 business days after we receive your enrollment.
• Tell your doctor and pharmacist your health insurance
has changed. This helps avoid billing problems and
payment delay.
• Bring your new ID card when you visit your doctor and
pharmacy. (They don't all look exactly like the sample on
this page, but yours will be similar.)
• Understand that some procedures require
preauthorization and your doctor can help you with that.
Who to Ask
This guide gives you need-to-know basics. But the
employer, HR representative or benefits guru at your
company is often the best resource for certain coverage
concerns. Ask him or her about these things.
Front
Sample ID Card
• Premium and payroll deduction
• Address changes
• Adding or removing a spouse or child to/from the plan
• COBRA or continuation coverage
• Flexible Spending Account
• Health Reimbursement Account
• Health Savings Account
• Medicare status
Back
For Everything Else, Call Us.
Remember,
choosing in-network doctors and hospitals keeps your
out-of-pocket costs down. You generally pay more when you get
care outside your network (except urgent care and in
emergencies).
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Call us at 1-800-851-3379 or visit YourHealthAlliance.org
Service the Way It Should Be
There’s a difference between your average customer service and Health Alliance Customer Service.
After 5 p.m.? We’ll Call You Back.
You’ll talk to a live person.
That’s right, you’ll be quickly connected to a Health
Alliance rep during business hours.
Our automated system can steer you to an answer
during the evening and on weekends—when our
offices are closed. It’s available 24 hours on Saturday
and Sunday and until 10 p.m. CST on weeknights.
No waiting.
On average, we answer calls in the time it takes to
recite the alphabet song (20 seconds). Your time is
valuable, so we won’t let you sit on hold.
The secure system lets you:
We know what we’re talking about.
Ninety-nine percent of the time our reps resolve
member issues on the first call. That means we’ll give
you complete answers so you can get on with your day.
• Check your effective date of coverage.
• Order a new ID card.
• Leave a message. (We’ll call you back the next
business day.)
Chat online.
Maybe you are at work and don’t want to make a loud
personal call. Or maybe you were already logged in at
YourHealthAlliance.org and have a question about
something you see there. Whatever the reason, the
Customer Service online chat is there for you. You’ll
chat with an actual rep and get real-time answers to
your questions.
Translation, Please
No worries if English isn’t your primary language. We
can connect you with an interpreter through Language
Line. And we’ll stay on the call to help the interpreter
answer questions.
Accessing Language Line is easy.
• Call us during regular business hours.
• Ask for Language Line.
• Say your language of choice.
Si Usted necesita ayuda para interpretar la información
sobre sus beneficios, por favor llamar al teléfono gratis
1-800-851-3379 y pregunte por la “Language Line.”
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Your Pharmacy Benefit, Inside and Out
Feel buried by the avalanche of information
out there about medications? Here are a few
helpful pointers. And remember, you can
always call us if you need help digging out.
Let’s Talk About Tiers
Meds covered by Health Alliance are listed on our
formulary at different tiers. The list changes from time
to time, but our goal is to make safe, effective drugs
available at the best prices.
Tier 1 drugs cost the least. You pay more for Tier 2 and Tier
3 drugs, and so on.
Not One-Size-Fits-All
Not all pharmacy benefits work the same. Your neighbor
Joe's Crestor may be a Tier 3 drug with his health plan,
while your plan might consider it a Tier 2 prescription
drug.
You can look up your drug details, compare costs and
view pharmacy claims at YourHealthAlliance.org. If you
want to know how much you’ll pay for a drug, just log in
as a member and click “My Drug Benefit.”
Understanding
Utilization Management
Utilization Management is a fancy term that refers to
various drug programs that ensure members get the best
care without paying more than they need.
Step-Therapy——This tool means that before we cover
some pricey brand-name drug, you’ll need to try the
similar, lower cost alternative. If that doesn’t work, you
get to “step up” to the brand name drug.
Managed Dose Limitation——Some meds restrict how
much you get at any time and/or how often you can refill
the prescription.
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Preauthorization——There are a number of reasons a med
might need preauthorization, or preapproval. Sometimes a
drug is new to the market, other times the med might be
high risk, for example. This also makes sure your doctor
isn’t prescribing you something expensive when a lower
cost alternative is available.
Call us at 1-800-851-3379 or visit YourHealthAlliance.org
Now, About Saving Money
For your meds to be covered, you need to fill your
prescriptions at a pharmacy that partners with Health
Alliance. Most major chains, as well as a lot of local
favorites are in our network. Check with our Customer
Service Department if you’re not sure about a pharmacy
you’d like to use.
Keep Your Cash
These Health Alliance programs help you save a buck or
two on prescription meds.
• Rxtra——Allows you to get a long list of meds
free at many participating pharmacies. For a
complete list of pharmacies and meds, visit
YourHealthAlliance.org.
• Retail 90——Lets you purchase a discounted 90-day
supply of many maintenance meds from participating
pharmacies at a slight discount.
• Value-Based Benefit——Helps members save money on
some drugs used to treat asthma, high cholesterol, high
blood pressure and diabetes.
Because over-the-counter meds no longer qualify as a medical
expense——unless they're prescribed by your doctor--you can't
pay for these meds using a Flexible Spending Account or Health
Savings Account.
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Get more at YourHealthAlliance.org
Doctors, Hospitals and Clinics
Search for in-network doctors and hospitals in our
Provider Directory. To change your Primary Care
Physician (PCP), click “View Plan Detail” on your
Member Dashboard and then choose “Change Primary
Care Physician” about halfway down the page.
interactive, secure member website.
Treatment Cost Calculator
Find the right treatments, facilities and doctors for
your needs by comparing costs with this powerful,
personalized tool.
After logging in, you’ll have all the
Sign-up is Simple
information you need right at your
To get a member account, go to
YourHealthAlliance.org. Click “Register” to sign up for
a new account and follow the instructions. We’ll then
send you a confirmation email.
YourHealthAlliance.org is your
fingertips.
Customer Service
Bypass the hold line by going online to order ID cards
(and print temporary cards while you wait for the new
ones to arrive in the mail). You can also ask a question
through the website, and a Customer Service rep will
respond.
Important Plan Documents
View your plan’s Summary of Benefits and Coverage
(SBC), policy, amendments and all the documents that
explain how your coverage works.
If you have questions about YourHealthAlliance.org,
please call us at the number on the back of your ID
card.
For optimal viewing, please use the most recent
version of Google Chrome, Apple Safari, Mozilla
Firefox or Microsoft Internet Explorer available for
your operating system.
Claims and Explanation of Benefits (EOB)
Check on the status of a claim or view your full EOB,
which tells you who paid what and how much.
Pharmacy Coverage
Review your Drug List for covered drugs, use pricing
tools to determine your true drug costs and find
in-network pharmacies.
Medical and Pharmacy Policies
Look up policies on specific drugs, treatments or
procedures to learn about their coverage rules.
Stay Connected
facebook.com/HealthAlliance
pinterest.com/HealthAlliance
@HealthAlliance
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Call us at 1-800-851-3379 or visit YourHealthAlliance.org
Rally—Your Online Health Experience
We know getting healthier isn’t always easy, but we’re
here to help. Health Alliance now offers Rally*—an
online experience to help you improve your health in
small ways every day.
Missions. Rally gets to know you through a quick
health survey and uses your answers to suggest
specific health goals or missions, like getting eight
hours of sleep each night or cooking at home at
least once a week.
Support. Rally will support and inspire you with
helpful tips and advice customized for your life.
You can also compete in group challenges or
join online communities to discuss health
topics with other users.
Rewards. Rally tracks your progress and
rewards you for checking in and completing
your missions. You can use your accrued
Rally coins to enter raffles and enter to win
gift cards or other prizes.
With Rally, better begins here.
To sign up or learn more, go to HealthAlliance.org
*At this time, Rally is available to all Health Alliance
members, except those with Medicare Advantage plans.
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Help to Stay Healthy
Everyone tells you to eat healthy, exercise
and take care of yourself. Easier said than
done, right? Be Well makes it easier.
Be Healthy
PREVENTIVE CARE BENEFITS
Case
Management
SUPPORT FOR WELLBEING
If you’re coping with a health condition, it’s easy to
get frustrated. You have so much to try to understand
and remember.
We cover yearly visits, tests, screenings and
As part of our free Case Management program, we’ll
vaccines—even when you’re healthy. A full listing of free connect you with a Case Manager who will:
preventive care benefits is available on our website in
• Talk with doctors for you to help you understand
our Wellness Center found under Health and Wellness.
your situation.
• One wellness exam per plan year
• Teach you how to cope with your condition and
• One visit to a Women’s Principal Health Care
live healthier.
Provider per plan year
• Call to see how you’re feeling and what help you
• Well-child care (based on American Association of
might need.
Pediatricians recommendations for how often)
• Blood sugar, cholesterol, chlamydia and cervical
For more information, call our Medical Management
cancer screenings (Pap smear)
Department at 1-800-851-3379, extension 8061.
• Childhood immunizations (again, according to
AAP guidelines)
Be Your Best
TOOLS FOR MANAGING YOUR HEALTH
Members can receive newsletters and reminders about:
• Smoking cessation
• Asthma
• COPD
• Diabetes
• High blood pressure
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Be Fit
NUTRITION AND EXERCISE TOOLS
We’ve teamed up with some industry-leading
companies to offer discounts on weight-loss programs
and fitness club memberships.
To learn more about our Be Well suite of
programs and to see the list of fitness center
discounts, visit the Health and Wellness section
at HealthAlliance.org.
Call us at 1-800-851-3379 or visit YourHealthAlliance.org
Help While You’re Traveling
You’re vacationing in Costa Rica. On the second day, you
get hurt. Maybe you strain your back, slip by the pool or
get stung by a jellyfish. You don’t speak the language.
What do you do?
Health Alliance members call Assist America, a global
emergency services program that Health Alliance includes
in your plan, free of charge.
How Does it Work?
Assist America is not travel or medical insurance. It allows
Health Alliance to provide global emergency services.
The coverage is in effect when traveling more than 100
miles from home for less than 90 days. Assist America
representatives are available 24 hours a day, 365 days a
year, ready to help you:
• Locate and get admitted to a hospital.
• Replace prescription meds if you forget or lose them.
• Get transportation for a loved one to join you if you’re
alone and hospitalized for more than seven days.
• Find care for children left unattended because
you had a travel-related emergency.
In the back pocket, find the Assist America
pamphlet, which includes a tear-off ID card for your
wallet.
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We Have High Standards
We’re proud the National Committee for Quality
Assurance (NCQA) considers Health Alliance a leader in
health plan quality and member satisfaction, awarding us
with its highest accreditation. We remain the top-ranked
health plan in Illinois for our Private HMO/POS
plans––#35 out of 474 private health plans nationally,
according to the NCQA Private Health Insurance
Ratings, 2013-2014.*
* Based on NCQA’s Private Health Insurance Plan Rankings,
2013-2014, Health Alliance Medical Plans HMO/POS ranks 55th
nationally.
J.D. Power ranked Health
Alliance ranked “Highest In
Member Satisfaction Among
Commercial Health Plans In
The Illinois/Indiana Region.”
Health Alliance Medical Plans received the highest numerical score among commercial health plans in the Illinois/Indiana region in the
proprietary J.D. Power 2014 U.S. Member Health Plan StudySM. Study based on 34,315 total member responses, measuring seven plans in
the Illinois/Indiana region (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of
members surveyed December 2013–January 2014. Your experiences may vary. Visit jdpower.com
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Call us at 1-800-851-3379 or visit YourHealthAlliance.org
All About Health Care Reform
Lots of people are talking about it. Does
anyone really know what it means? We do.
Consider us your guide when it comes to health care
reform. We understand the changes and how you and your
family may be affected.
Click on the Health Care Reform tab under the
Learning Center on our website to find more information.
•The top things individuals, employers and Medicare
beneficiaries should know
•Answers to frequently asked questions and links to other
helpful websites.
Beginning in 2014
Preexisting conditions——The law will not let plans refuse
to sell coverage or renew policies because of your preexisting conditions. They also can’t refuse to cover adults who
have been uninsured for six months and have been denied
coverage because of a preexisting condition.
Gender or health status——Plans won’t be able to charge
higher rates because of your gender or health status if you
have an individual or small group policy. The only factors
that affect your monthly cost are age, where you live and if
you’re a tobacco user.
Low-income earners——More people, including all those
who earn less than a certain percent of the poverty level,
will be able to get health coverage through Medicaid. To
learn about Health Alliance Medicaid plans in Illinois, visit
HealthAllianceConnect.org.
Unique coverage——Health care reform doesn’t mean the
same coverage for all. You won’t necessarily have the
same coverage as your neighbor, brother or best
friend—health plan designs can be different.
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Beyond Group Coverage
You’re covered. That’s great. Maybe you
know about someone who needs individual
coverage. Health Alliance has that, too.
Health Alliance Medicare
Depending where you live, we have several Medicare
options available to people 65 and older and those with
certain disabilities. Our options include Medicare
Advantage HMO and PPO plans with and without
prescription coverage, as well as Medicare Supplement
plans and Stand-Alone Prescription Drug Plans.
For more information or a helpful guidebook, call
Health Alliance Medicare at 1-888-382-9771 or visit
HealthAllianceMedicare.org.
Health Alliance Individual Plans
Our individual plans for people younger than age 65 range
from short-term coverage to more robust HMO, POS and
PPO plans.
For details or an information kit, call 1-888-382-9771.
Or go to HealthAlliance.org to compare plans, get
free quotes and enroll online.
Frequently Asked Questions
I’m pregnant and new to the plan. Can I still see
my current doctor?
Most likely. After your coverage begins, you have 15 days to
call us to work out the details.
Do I have emergency coverage?
Yes. If it’s not an emergency but your doctor can’t see you right away,
please use an Urgent Care Center.
What if my ID card hasn’t arrived and I need to fill a prescription or see my doctor?
Visit YourHealthAlliance.org to print a temporary ID card or call
Customer Service for help.
I got a bill, but it doesn’t look right. What should I do?
Call us first. We can explain your coverage and tell you what you need to pay.
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1-800-851-3379, Monday through Friday, 8 a.m. to 5 p.m.
TTY 711 or 1-800-526-0844 (Illinois Relay) for the hearing impaired
301 S. Vine St. • Urbana, IL 61801 • HealthAlliance.org