Download MARKETPLACE/INDIVIDUAL NEW MEMBER

MARKETPLACE/INDIVIDUAL NEW MEMBER
FREQUENTLY ASKED QUESTIONS (FAQs)
YOUR DOCTORS
1. How can I choose or change my Primary Care Physician (PCP)?
2. Can I keep my current doctor?
3. Am I required to have all services approved through my PCP?
4. Where can I find the Provider Directory?
5. I also cover family members under my health plan. Does every member of my family have to use the
same PCP?
6. What if I have a specific health condition and want to see a specialist or another doctor?
YOUR PAYMENTS
7. If I received a bill from one of my providers that I do not believe I should pay, what should I do?
8. If I did not get an invoice for my monthly premium or I am late in paying my invoice, how can I pay my
bill?
9. When are my monthly premium payments due?
10. Can I pay my premiums on-line?
11. Can I pay my premiums via phone?
12. Can I mail my premium payment?
YOUR BENEFITS/HEALTH PLAN
13. How can I print a temporary FHCP Member ID card online?
14. Where can I find more information about my plan benefits?
15. What if I need lab services, x-rays or other diagnostic tests?
16. How can I find out how much I will have to pay for a particular service or procedure?
17. How can I find out how much of my annual deductible I have met, or my maximum out of pocket limit?
18. How can I obtain care outside of FHCP’s service area?
19. My plan provides unlimited gym visits. Which gyms can I use?
20. How do I change my address or other contact information with FHCP?
21. If I lose my FHCP Member ID card, how can I get another one?
YOUR PHARMACY
22. How can I find out if my medication will be covered under my health plan?
23. What if I am already on a prescribed medication? How can I refill/transfer my prescription to FHCP so
it is covered?
24. Can I get my medication filled at any pharmacy?
25. How can I find out how much I will have to pay for a particular medication?
YOUR REFERRALS
26. If I am currently undergoing treatment for a specific health condition such as chemotherapy, do I have
to go through the referral process to continue my treatment?
27. Are there any services that do not require a referral through my PCP?
28. After my doctor orders a referral, how long before I can see the specialist?
29. What is a Prior Authorization and when will this be needed?
YOUR DOCTOR
1. How can I choose or change my Primary Care Physician (PCP)?
If you would like to choose or change your PCP, you can do so one of three ways. Simply go online to
our Member Portal (memberportal.fhcp.com/). Once logged in, click “Change My PCP” (as shown below).
You also may go through FHCP Member Services, either via email ([email protected]) or on
the phone at 386-615-4022 (TRS Relay 711 for hearing impaired) to make a change as well.
2. Can I keep my current doctor?
If you are already a patient of a FHCP affiliated PCP when you enroll, that doctor may continue to see you under
your plan. However, it is important that you request to be assigned to your doctor by emailing FHCP’s Member
Services Department at [email protected], or by calling FHCP’s Member Services Department at
(877) 615-4022 as soon as possible after you enroll.
3. Am I required to have all services approved through my Primary Care Physician (PCP)?
Your PCP is the physician you should see for all of your general and preventive medical care. Your PCP will refer
you for other care as needed.
4. Where can I find the Provider Directory?
You can search FHCP’s online Provider Directory located on our website at:
fhcp.com/find-providers/physician.
If you prefer, you can download a paper copy at: fhcp.com/members/provider-directories, or you can request a
copy from our Member Services Department via email ([email protected]), or by calling
(877) 615-4022.
5. I also cover family members under my health plan. Does every member of my family have to use
the same Primary Care Physician?
No. Each member of your family may choose a different PCP.
6. What if I have a specific health condition and want to see a specialist or another doctor?
Your PCP will coordinate all of your care including any necessary referrals to a specialist.
YOUR PAYMENTS
7. If I received a bill from one of my providers that I do not believe I should pay, what should I do?
If you receive a bill and you do not believe you owe the charges, send the bill to our Claims Department at:
Florida Health Care Plans
Attention: Claims
PO Box 10348
Daytona Beach, FL 32120-0348
8. If I did not get an invoice for my monthly premium, or I am late in paying my invoice, how can I
pay my bill?
If you did not receive an invoice for your premium, please contact our Accounts Receivable Department directly
at (386) 615-5014 and select Option 2.
9. When are my monthly premium payments due?
Premium payments are due on the last day of the month before the month of coverage. For example, February’s premium is due by January 31st. If you are late in paying your invoice, you may lose your coverage.
10. Can I pay my premiums on-line?
Yes! Payments may be made online using a credit/debit card or via a bank account withdrawal by logging into
fhcp.softheon.com/payment. This is a free service available 24 hours a day, 7 days a week.
11. Can I pay my premiums via phone?
Yes! You can make payments over the phone by calling (386) 615-5014 (select Option 1 to use the automated
system which is available 24/7 or Option 2 to speak with a representative during business hours).
12. Can I mail my premium payment?
Yes! You can mail your check to our lockbox at:
Florida Health Care Plans
PO Box 743005
Atlanta, GA 30374-3005
YOUR BENEFITS/HEALTH PLAN
13. How can I print a temporary FHCP Member ID Card online?
If you would like to print a temporary FHCP Member ID Card, you can do so one of two ways. Simply
call Member Services at 386-615-4022, or go online to our Member Portal (memberportal.fhcp.com/).
Once logged in, click “Print My ID Card” (as shown below), and follow the instructions.
14. Where can I find more information about my plan benefits?
Benefit information specific to the plan you enrolled with is available online through the FHCP Member Portal
located at memberportal.fhcp.com/. This information includes the Summary of Benefits and Coverage (SBC),
Certificate of Coverage (COC), Schedule of Benefits, deductibles and maximum out of pocket and claims history.
15. What if I need lab services, x-rays or other diagnostic tests?
To locate network laboratories or diagnostic/imaging facilities* please access the provider directory at
fhcp.com/find-providers/physician and follow the prompts (see example below). Your PCP or participating specialist will assist in the coordination of such care and make any necessary referrals for these services.
You can also contact Member Services with any questions by calling 1-877-615-4022 or emailing
[email protected].
*Please be aware that in most cases there is a higher cost share for testing performed at outpatient hospital facilities verses non-hospital facilities.
16. How can I find out how much I will have to pay for a particular service or procedure?
For medical service cost estimates, we recommend you use a helpful online tool called the Healthcare Blue
Book, located at healthcarebluebook.com. For specific estimates, you can contact FHCP’s Cost Estimation Center via email at [email protected] or via phone at (800) 352-9824, ext. 5068.
17. How can I find out how much of my annual deductible I have met, or my maximum out of pocket
limit?
To track your progress toward reaching your annual deductible or maximum out of pocket, you can use the
FHCP Member Portal located at memberportal.fhcp.com/Account/Login.aspx
18. How can I obtain care outside of FHCP’s service area?
When traveling outside of our service area, you are covered for urgently needed and emergency care. Florida
Blue’s BlueCard® Program is available to all FHCP members. The online BlueCard® Provider Directory is located
at: bluecardworldwide.com/ or you can call BlueCard® directly at (800) 810-2583 for assistance.
Please note: If you experience a medical emergency, you should dial 911 or go directly to the nearest hospital emergency room for
care. After you have been treated and/or stabilized, you or a family member must contact your PCP immediately for coordination of
any additional care you may need.
19. My plan provides unlimited gym visits. Which gyms can I use?
You can call Member Services at (877) 615-4022 for assistance. A list of participating fitness centers is available
online at fhcp.com/health/documents/preferred-fitness-plan-gym-list.pdf
20. How do I change my address or other contact information with FHCP?
When you visit your PCP’s office, you may be asked to verify your current address, phone and email information.
In addition to notifying your PCP, if you have changed your address, phone number, name, etc., and have not yet
notified FHCP, please take the time to notify our Enrollment Department by sending request to:
Email: contact.fhcp.com/plans_benefits/contact/contact-fhcp-enrollment
Fax: (386) 676-7137
Mail: FHCP Enrollment Department
1340 Ridgewood Avenue
Holly Hill, FL 32117
Please include the following with your request: Full Name, Date of Birth, Medical Record Number,
and Contact Phone Number.
The FHCP Enrollment Department may need additional documentation from you before certain changes can be
made; we will contact you accordingly. If you have questions, you may contact us by phone at (386) 676-7176 or
(800) 352-9824 ext. 7176.
If you enrolled through the Health Insurance Marketplace (healthcare.gov), and need to update your address
or phone number, you will also need to make those changes with the Marketplace by calling 1-800-318-2596.
21. If I lose my FHCP Member ID card, how can I get another one?
To request a replacement identification card, please fill out the online form at:
contact.fhcp.com/plans_benefits/contact/replace-fhcp-card.
A replacement card will be mailed to the address on file. You will receive your new card within 5 business days. If
you have questions, please call (386) 676-7176, or you may call our Member Services Department at
(877) 615-4022.
You can also download our free “myFHCP” mobile application on Apple and Android devices to view your card
on your phone or tablet.
YOUR PHARMACY
22. How can I find out if my medication will be covered under my health plan?
All of FHCP’s Formularies are located on our website at www.fhcp.com/members/formulary. It is important that
you select the correct formulary for the type of plan you have purchased. If you need assistance to ensure you
select the correct formulary or to request a paper copy, you may contact our Member Services Department by
calling (877) 615-4022.
23. What if I am already on a prescribed medication? How can I refill/transfer my prescription to
FHCP so it is covered?
You can bring your prescription bottle with any refills to any FHCP pharmacy to transfer your prescription to
FHCP. For medications that are not covered under our formulary, you will be provided a one-time 30 day supply
priced at a non-preferred tier to allow you time to speak with your doctor about alternatives available on our
formulary. Specialty medications will require review and authorization through the Referral Department prior to
coverage.
24. Can I get my medication filled at any pharmacy?
• We encourage you to fill your prescriptions at our FHCP Pharmacies where your copayment is lower. Find
a list of these locations at www.fhcp.com/pharmacies/fhcp-staff-pharmacies and/or you can download
our free “myFHCP” mobile application on Apple and Android devices to view available pharmacies on your
phone or tablet.
• You may fill your prescriptions at select Walgreens locations throughout our service area. If you are enrolled in a plan with “BC” in the name (i.e. IND Silver HMO BC 0941 94%), you have access to all Walgreens.
Your co-payment for prescriptions filled at any Walgreens may be higher.
• You may also utilize our mail order pharmacy by calling (386) 676-7126. A three-month supply of most of
your medications can be delivered to your home at no extra charge.
25. How can I find out how much I will have to pay for a particular medication?
For medication cost, we recommend you utilize the attached link to search for your medication.
client.formularynavigator.com/Search.aspx?siteCode=9754856648
The link above will show the Tier of the medication. Your plan documents show
what you pay for each Tier. If you have additional questions, you may
contact any FHCP preferred pharmacy.
YOUR REFERRALS
26. If I am currently undergoing treatment for a specific health condition such as chemotherapy, do I
have to go through the referral process to continue my treatment?
FHCP has a transition of care process that assists new members currently in active treatment. Please contact
(386) 615-5017 to begin the transition of care process.
27. Are there any services that do not require a referral through my PCP?
Yes. Emergency and urgent care services and certain “direct access” services do not require a referral from
your PCP. Direct access services are listed in the FHCP Provider Directory and include, but are not limited to
the following:
• Gastroenterology (colonoscopy screening)
• Dermatology
• Optometry
• Orthopedics/Sports Medicine (direct access only for follow up after an Emergency Room visit)
• Podiatry
• Chiropractic Medicine
• Gynecology
• Obstetrics
28. After my doctor orders a referral, how long before I can see the specialist?
In most cases, your PCP will refer you directly to the specialist* and they will call you within a few days to
schedule an appointment.
*If enrolled in one of our Point of Service (POS) or Triple Option (TO) plans, you do not need a referral to see a specialist unless the referral is for highly specialized, complex care such as transplants, high-risk surgeries, etc. Your physician can call our Referral Office at
(386) 238-3230 or (800) 352-9824, ext. 3230 or fax requests to (386) 238-3253 or (877) 659-3427.
29. What is a Prior Authorization and when will this be needed?
Certain needed care and/or services must be reviewed and authorized by FHCP before you can have the services
performed. Examples of services that require a prior authorization include, but are not limited to:
• Breast MRIs
• PET scans
• Referrals to non-contracted, out-of-network physicians, hospitals and/or facilities
• Surgeries in an in-patient or out-patient setting
• Organ and bone marrow transplants
Your physician can call our Referral Office at (386) 238-3230 or (800) 352-9824, ext. 3230 or fax requests to
(386) 238-3253 or (877) 659-3427.