Managing Your Drug Coverage with OptumRx
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Managing Your Drug Coverage with OptumRx

To manage your OptumRx drug coverage, sign in to My Account at QualChoice.com to access the Optum member website. Because the Optum site has been updated, previous users will need to re-register.

High-deductible Health Plans – Lower Premiums
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High-deductible Health Plans – Lower Premiums

Employers are finding High-deductible Health Plans (HDHPs) an attractive way to reduce their employees’ health insurance premiums.

Coverage for Routine and Complex Procedures
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Coverage for Routine and Complex Procedures

In the past, you may have had to go to a hospital for certain healthcare services. Today, many of those same things are done in your doctor’s office. How much you pay for those services depends on if they are routine or complex.

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Health Tips for a Quality Life: Heart Health

Learn about your risks for heart disease and stroke and stay “heart healthy” for yourself and loved ones.

Care Management Helps Employees and Employers
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Care Management Helps Employees and Employers

Employees with serious medical conditions may find managing their health to be stressful. But if Care Management is included in their health plan, there are experts who can help.

How We Make Coverage Decisions
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How We Make Coverage Decisions

We work to make sure our members get the right healthcare in every care setting. We support proper care decisions based on medical necessity and the member’s specific health plan. When a service needs pre-authorization, our Medical Director and clinical staff follow QualChoice Medical Coverage Policies. They also follow the peer-reviewed and nationally noted guidelines of MCG Health, LLC.

Employer Group Email:  Demographic Verification
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Employer Group Email: Demographic Verification

QualChoice sends member lists each year to the Internal Revenue Service (IRS) as proof of members’ health coverage. If member records do not match IRS records, QualChoice has 30 days to submit the correct data to the IRS.

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Transition Policy Extended for Non-ACA Compliant Plans

The Centers for Medicare and Medicaid Services (CMS) recently extended an existing transition policy for non-ACA compliant plans through the end of 2018.

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Amended Medical Coverage Policy

Preventive health benefit BI062 has been updated to allow virtual colonoscopy with pre-authorization. Added that Cologuard and Epi proColon tests will not be covered.

Health Coverage and Your Taxes
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Health Coverage and Your Taxes

The Affordable Care Act (ACA) requires everyone to have health insurance. You must report it on your 2016 federal tax return.

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