You can learn more or view a full list of qualifying life events here. Aultcare Insurance provides ample coverage for many types of preventive care services that can help you stay on top of your health. Hospitals include Aultman Hospital, Aultman Alliance Community Hospital, Akron Childrens Hospital, and Aultman Orrville Hospital. What is covered under Aultcare insurance? For 38 years, AultCare has provided quality healthcare at an affordable cost to the community it serves. You can file a grievance in person or by mail, fax, or email. To locate a pharmacy, please click Account Login to use your personalized Pharmacy Directory associated with your plan. AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. What Is the Difference Between Life Insurance and Health Insurance? By receiving regular check-ups and taking proactive steps towards prevention, people can reduce their chances of developing more serious health issues down the road.Preventive care is an essential part of maintaining good health throughout your life. Stay Informed. Opting to select network providers over non-network providers can save you money. Out-of-network coinsurance usually costs you more than in-network coinsurance.Out-of-Network Copayment:A fixed amount (for example, $30) you pay for covered healthcare services from providers who do not contract with your health insurance or plan. Ohio has become the cradle of a drug overdose for the American Midwest, a problem driven primarily by the uptick in American opioid addiction, part of the epidemic affecting the rest of the country as well.Data from the state's Department of Health indicated that there were 4,854 overdose fatalities in 2017, while alcohol addiction continued to threaten . Are you someone who believes that prevention is better than cure? https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, http://www.hhs.gov/ocr/office/file/index.html, Experience of Care Utilization and Risk-Adjusted Utilization, Measures Collected Using Electronic Clinical Data System . The Alliance of Community Health Plans (ACHP) represents the nations top-performing nonprofit health plans to improve affordability and outcomes in the health care system. Your request will be furnished within 30 days of receipt. AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. We are extremely proud of our achievement, in terms of not only what it means to us but also what it means to you - that you can be confident in the quality of healthcare you receive from us. Where Can I Purchase Individual Health Plans? Services may be provided in a licensed hospitals emergency room or other places that provide care for emergency medical conditions.Excluded Services: Healthcare services that your plan does not pay for or cover.Formulary: A list of drugs your plan covers. Subsidies may be available through the Marketplace for those who qualify. Typically, these receipts are stapled to the outside of the prescription bag when you pick them up. View our 2021 Scholarship Recipients (PDF) at this link. (Medical Doctor)or D.O. AultCare Insurance Company will not be automatically mailing 2022 Form 1095-Bs to members. If we deny your request, we will send you a written notice that explains why we denied it. Prescription drug coverage is coverage under a plan to help pay for prescription drugs. AultSaveRx is yet another way you are empowered to make important decisions regarding your prescription medications. Your insurance plan does not pay the portion of the non-network provider fees that exceed RBP. You and/or your employer usually pay it monthly, quarterly, or yearly.Premium Tax Credits: Financial help that lowers your taxes to help you and your family pay for private health insurance. You will be able to make a payment or report a claim over the phone. Your health insurance company could require prior authorization before receiving the service or treatment. You deserve access to the best in healthcare with AultCare health insurance plans: in-network hospitals, to give you and your family local access to quality care, as well as plenty of choices for where you get that care. In many Health Maintenance Organizations (HMOs), you need to obtain a referral before you can receive healthcare services from anyone except your Primary Care Provider. Founded in 1985, AultCare operates as an insurance company that provides health, dental, wellness, workers compensation, accidental, and disability insurance services. Morning sickness and a non-emergency cesarean section generally are not complications of pregnancy. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.Screening:A type of preventive care that includes tests or exams to detect the presence of something, usually performed when you have no symptoms, signs, or prevailing medical history of a disease or condition. You can also call us at 330-363-6360 or 800-344-8858 with any questions. Your share is usually lower for in-network-covered services. This data set includes over 90 measures that evaluate six different domains, including: . Does Homeowners Insurance Cover Gas Lines? That's one of countless reasons why more than 95% of AultCare clients renew about AultCare year after year. Through the use of innovative plan designs, superior customer service, and a high-quality network, AultCare strives to satisfy enrollees and clients and remains committed to providing affordable health insurance. These may include routine check-ups with your primary care physician, screenings for various health conditions like cancer or high blood pressure, immunizations, and certain lab tests.Once you know which services are covered under your Aultcare plan, the next step is to schedule an appointment with a provider in their network who offers these services. To receive your 2022 IRS Form 1095-B, submit the request via our CONTACT US on our website or send the request to:AultCare Insurance Company2600 Sixth ST SWCanton, OH 44710. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Because you matter, we believe you deserve access to the best in healthcare with AultCare health insurance plans. Describe to your pharmacy/pharmacist that you want to make sure you are attaining the best price for your medication. You can also call us at 330-363-6360 or 800-344-8858 with any questions. In this blog post, well explore everything you need to know about the type of preventive care covered by your Aultcare insurance policy. In-Network Coinsurance:Your share (for example, 20%) of the allowed amount for covered healthcare services. HSA funds generally may not be used to pay premiums.Individual Responsibility Requirement:Sometimes called the individual mandate, the duty you may have to be enrolled in health coverage that provides minimum essential coverage. If there are additional questions or you are not sure which formulary your plan has, please contact AultCare at 1-800-344-8858. *The phone number and email you have registered to your account will be used for multi-factor authentication. You can search for the most cost-effective price on any generic drug. Because you matter, we believe you deserve access to the best in healthcare with AultCare health insurance plans. A 1095-A form includes information about a Marketplace plan you had in the past year. Colorectal cancer screening for adults 45 to 75. Because you matter, are believe you deserve access to the best on healthcare with AultCare human insurance plans. The health insurance or plan pays the rest of the allowed amount.Complications of Pregnancy: Conditions due to pregnancy, labor, and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Present the savings coupon shown from the AultSaveRx platfrom by email, text, print, or showing your mobile device, to the pharmacist. A plan may also have only separate deductibles. Your request will be furnished within 30 days of receipt. Skilled NursingCare:Services performed or supervised by licensed nurses in your home or in a nursing home. AultCare Insurance Company will not be automatically mailing 2022 Form 1095-Bs to members. Should you need emergency services while traveling out of the area you should go to the nearest emergency room or urgent care. If you need help filing a grievance, our Civil Rights staff is available to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD). (Medical Doctor) or D.O. Forgot Username? This can include both emergency and nonemergency transportation. AultCare offers health plans for young adults, students, self-employed individuals, early retirees, individuals, and families. You're involved in a road accident abroad. The most extensive cover is comprehensive car insurance - which provides more protection than all . Quality, local care is a priority at AultCare. We use cookies to improve your experience of our website. Types of emergency medical transportation may include transportation by air, land, or sea. If you need to speak with a representative, please call AultCare Customer Service at 330-363-6360 or 1-800-344-8858. When we give you our decision, we will use the "standard" deadlines unless we have agreed to use the urgent or expedited deadlines. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Preventive care is a term that refers to any health service or procedure performed with the aim of preventing illness rather than treating it. Call AAHammersmith at 1.800.852.7276 to get in touch with your AultCare agent. Health plans will often pay less to non-network providers because of the inability to control costs. Each type of policy differs in terms of the level of cover it provides, as explained individually below. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law and the terms of the plan, which provides coordinates, or helps you access a range of healthcare services. The employer funds and owns the arrangement. The federal government runs the HealthCare.gov Marketplace, which serves the majority of states. What household contents insurance normally covers, how to choose a policy and how to make a claim. CAHPS is the Consumer Assessment of Healthcare Providers and Systems. Cholesterol screening for adults of certain ages or at higher risk. Preauthorization is not a promise; your health insurance or plan will cover the cost.Premium:The amount that must be paid for your health insurance or plan. Examples of preventive services are routine healthcare, including screenings, check-ups and patient counseling. For 38 years, AultCare has provided quality healthcare at an affordable cost to the community it serves. Concerns such as this allow us to review our procedures in order to improve our delivery of service to our customers. A 1095-A form will provide information needed to claim the tax credit. Your request will be furnished within 30 days of receipt. AultCare developed a pharmacy transparency tool allowing you to make the most cost-effective decisions with your prescriptions. (Medical Doctor) or D.O. AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. Preventive care refers to health services that aim to prevent illnesses or diseases from developing or progressing. What to do:You or your doctor (or another prescriber) can request a coverage determination by calling, emailing, writing, or faxing our plan at the numbers below. Through the use of innovative plan designs, superior customer service, and a high-quality network, AultCare strives to satisfy enrollees and clients and remains committed to providing affordable health insurance. AultCare offered condition schedules for young adults, students, self-employed individuals, early retirees, private, the families. UCR will apply. AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Canton, OH 44710. TheSelect & Traditional Networks havelower monthly premiums with access to local providers. I agree to the Terms & Conditions Its about well-being and being well. AultCare will process your claims and apply the network level of benefits. What is Referenced Based Pricing (RBP)? We want you to be the best you. (Doctor of Osteopathic Medicine), provides or coordinates. Some specialty medications are considered limited distribution and are only available at certain pharmacies. What is Usual, Customary, and Reasonable (UCR)? (Doctor of Osteopathic Medicine), who provides or coordinates a range of healthcare services for you.Primary Care Provider:A physician, including an M.D. You deserve access to quality health and wellness services so you can be the best version of you. Healthcare is complex and confusing, but it doesnt need to be. All the health insurance plans discussed above include a network of doctors and hospitals, but the size and scope of those networks can vary, even for plans of the same type. The dates for this period change yearly and could be dependent upon where you live. First, its important to understand what services are considered preventive care and covered by your plan. Network preventive care and services that apply a copayment are covered before you meet your deductible. AultCare 2600 6th St SW. Canton, OH 44710. ACHP member companies are provider-aligned health organizations that provide high-quality coverage and care to tens of millions of Americans. Is there anything wrong with this page? Preventive Care (Preventive Service):Routine healthcare, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems. The management and staff all work together in helping others learn something new everyday. Deductible and out-of-pocket accumulators. For example, an x-ray can be a diagnostic test to see if you have a broken bone.Durable Medical Equipment (DME): Equipment and supplies ordered by a healthcare provider for everyday or extended use. They are leading the industry in practical, proven reforms around primary care delivery, value-based payment, and data-driven systems improvement. Receive alerts to stay informed on the news from your employer and AultCare. Canton, OH 44710, 330-363-7456, CivilRightsCoordinator@aultcare.com. Prescription Drugs:Drugs and medications that by law require a prescription. AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. Please note, this is a small list of qualifying life event examples. Advice for people affected by child abuse. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). Let us know, Copyright 2023 Citizens Advice. If your doctor or other prescriber tells us that your health requires an "expedited decision," we will automatically agree to give you an expedited decision. You may need to provide the details of your illness/injury to AultCare to assure your claim processes at the network level of benefits. To receive your 2022 IRS Form 1095-B, submit the request via our CONTACT US on our website or send the request to:AultCare Insurance Company2600 Sixth ST SWCanton, OH 44710. Sometimes called prior authorization, prior approval, or precertification. Other costs, including your premiums, penalties you may have to pay, or the cost of care a plan does not cover usually are not considered cost-sharing.Cost-Sharing Reductions: Discounts that reduce the amount you pay for certain services covered by an individual plan you buy through the Marketplace. AultCare prides itself on the personal service we provide to our customers. The prescription would not apply unless all requirements are met. HRA Health Reimbursement Arrangement (HRA)- HealthReimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Urgent Care:Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care. Also called preferred provider or participating provider.Orthotics andProsthetics:Leg, arm, back, and neck braces, artificial legs, arms, and eyes, and external breast prostheses after a mastectomy. AultCare helped me learn a lot of new applications and methodologies that I will be able to implement further into my career. However, its always best practice to double-check before scheduling any appointments just in case there are any out-of-pocket expenses associated with a specific service.Utilizing preventive care benefits through your Aultcare insurance is straightforward and can help keep you healthy while saving money on healthcare costs down the line. Learn how to access resourceful member information including: Summary of Benefits and Coverage/Plan Certificate. About NCQA NCQA is a private, non-profit organization dedicated to improving health care quality. Through the use of our personalized customer service, our members can rely on AultCare for guidance in navigating the healthcare system. Network Provider (Preferred Provider):A provider who has a contract with your health insurer or plan which has agreed to provide services to members of a plan. However, upon request, any applicable members can have their 2022 Form 1095-B. Home healthcare usually does not include help with non-medical tasks, such as cooking, cleaning, or driving.Hospice Services:Services to provide comfort and support for persons in the last stages of a terminal illness and their families.Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. The AultCare managed formularies are designed to provide value. To receive your 2022 IRS Form 1095-B, submit the request via our CONTACT US on our website or send the request to:AultCare Insurance Company2600 Sixth ST SWCanton, OH 44710. Making a claim if your car or its contents are stolen. You can take the pricing information to the pharmacy that you normally utilize and see if they can offer the same pricing through GoodRx or other means. AultCare Profile and History. At AultCare, we believe in keeping you healthy as much as helping you when youre not. Telephone: 330-363-6360 or toll free 1-800-344-8858, Mail: Attn: AultCare Pharmacy Department, 2600 Sixth Street S.W., Canton, Ohio 44710. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Over 38 years ago, health insurance in our region changed forever. Applies to most types of health plans and insurance. May also be called non-preferred or non-participating instead of out-of-network provider.Out-of-Pocket Limit:The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. 24-Hour Nurse Line: 866-422-9603 330-363-7620, Customer Service Hours: Monday - Friday 7:30 am - 5:00 pm EST, Mailing Address:2600 Sixth St S.W. Vehicle insurance. An expedited decision means we will give you an answer within 24 hours. You can also call us at 330-363-6360 or 800-344-8858 with any questions. You can also call us at 330-363-6360 or 800-344-8858 with any questions. AultCare is a great place to hone your skills. AultCare is 1 of only 4 commercial plans in Ohio to receive a 4 out of 5 overall star rating. critical illness - this can provide you with a lump sum payment if you can't work for medical reasons, such as a heart attack, cancer or a stroke. An urgent decision means we will give you an answer within 24 hours. Other events could be considered and you should contact your health plan to see if your event qualifies. Register for a new account If you are in need of immediate medical attention, contact your physician, poison control center, or emergency medical professional. At AultCare, you matter. However, upon request, any applicable members can have their 2022 Form 1095-B. UCR will apply. If the plans formulary uses tiers (levels), prescription drugs are grouped together; such as generic, brand, preferred, non-preferred and specialty. If your plan is tied to a managed formulary, only specific drugs in each . Your request will be furnished within 30 days of receipt. A standard decision means we will give you an answer within 72 hours.
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