For more information please call: 501.228.7111 or 800.235.7111.
QualChoice Standard Option Plan HMO Plan FAQs:
What is the QualChoice Standard Option HMO Plan?
Members in the QualChoice Standard Option HMO Plan have the freedom to visit any in-network provider for covered services without a referral.
What are the advantages of the QualChoice Standard Option HMO Plan?
The QualChoice Standard Option HMO Plan provides a full range of medical benefits, access to Arkansas’ largest network of highly qualified doctors, hospitals and pharmacies and the freedom to see QualChoice network specialists without a referral.
Can I go to any physician?
You may visit any PCP or specialist in the QualChoice network. To find a list of QualChoice network providers use our online Provider Directory.
Out-of-network services and supplies are not covered under this Standard Option HMO Plan. However, eligible expenses for emergency care and urgent care services are covered. See Section 5(d) Emergency Services/Accidents in the Federal Employees brochure.
Can I go to any emergency room?
We ask that you go to the nearest in-network emergency room when you are in need of emergency care.
We define emergency as those health care services provided on a 24-hour/365-days-a-year basis to evaluate and treat medical conditions of a recent onset and severity, leading a prudent lay person, possessing an average knowledge of medicine and health, to believe his or her condition, sickness, or injury is of such a nature where failure to seek immediate medical care could result in: placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.
If you have to go to an out-of-network facility and need inpatient care you must notify QualChoice as soon as possible or within 48 hours of your stay so that we may attempt to transfer you to an in-network facility.
Do I have to notify QualChoice when I am admitted to the hospital?
QualChoice does require notification of your admission if you are admitted to a network facility. The network facility will notify us on your behalf.
Do I have to select a primary care physician (PCP) under this Plan?
You do not have to select a PCP. We encourage you however, to establish a relationship with one as it can help you better manage your health. Your PCP can provide routine care, treat you for illnesses and injuries, or recommend that you see participating providers or specialists, if required. NOTE: The higher specialist co-payment will apply if you do not seek care with your PCP for services.
What is a co-payment?
A co-payment is the fixed dollar amount or percentage you must pay to a health care professional, facility or pharmacy when you receive covered services.
How does the co-payment work?
You pay a co-payment at the time of service. The co-payment will vary, depending on where the services are delivered and by whom (e.g. PCP, specialist, inpatient hospital stay, emergency room, outpatient hospital and pharmacy). Please see the current plan brochure for co-payment amounts.
What online resources are available to help me use my benefits?
When you enroll in the QualChoice Standard Option HMO Plan, you have access to valuable online resources.
My Account Member Portal
Your secure, mobile friendly self-service website for health and benefits information. Order an ID card or print a temporary one, check eligibility or claim status, and much more.
How do I enroll in QualChoice Standard Option HMO Plan?
Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available on the "How Do I Enroll?" page. The federal enrollment codes for the QualChoice Standard Option HMO Plan are:
- Self Only – DH4
- Self and Family Enrollment – DH5
- Self Plus One – DH6
When will I get my ID card and what do I use in the meantime?
If you do not receive your ID card by your effective date, you may use a copy of your Health Benefits Election (SF2809) Form or electronic enrollment (e.g. Employee Express, PostalEase, etc.) confirmation.